Spectrum of gastritis in celiac disease in childhood

Celiac disease (CD) may cause changes throughout the gastrointestinal tract . The pathology is best described in the distal duodenum and jejunum. It is also associated with lymphocytic gastritis (LG) and varioliform gastritis in adults and children, but the histologic spectrum in the gastric biopsy a nd the clinical implications are undefined. In this report we relate our ex perience with the clinical, endoscopic, and histologic changes in gastric b iopsies in CD in childhood. Slides (hematoxylin and eosin stained) were reviewed from 33 celiac childre n, 5 having had more than 1 gastric biopsy during a 7-year period. Gastric intraepithelial lymphocyte (IEL) counts were compared with those of 10 hist ologically normal controls (normal range, 1-7 IEL/100 antral or body epithe lial cells) and 10 nonceliac chronic gastritis (CG) biopsies without H. pyl ori (normal range, 1-19 IEL/100 antral cells), noting changes in the epithe lium and lamina propria (LP). LG was present in 29/33 initial biopsy sets. Fifteen of 29 showed LG/CG. The IEL number was greater in LG/CG than in LG only (27.2 +/- 9.3, n = 14 vs. 18.6 +/- 13.4, n = 15 in the antrum; 23.5 +/ - 2.8, n = 4 vs. 13.0 +/- 8.4 in the body). In CD the difference between th ese mean values and those of normal and nonceliac CG controls was statistic ally significant. In CG/LG the inflammatory infiltrate was predominantly di ffuse/superficial in the LP; mucin depletion was noted in 11/15. The IELs w ere in the LG/CG range in two CG controls. The IELs were normal at follow-u p in five cases. There were no statistically significant differences betwee n the groups with respect to clinical parameters or gastric endoscopic find ings. No child had varioliform gastritis. We conclude that in CD children, the stomach is endoscopically unremarkable but may show LG, or LG/CG with or without mucin depletion, or occasionally appear normal. Gastric histology returned to normal with gluten withdrawal . Normal gastric histology is not typical, but does not exclude CD.