Gastric pathology in patients with common variable immunodeficiency

Background/Aims-Common variable immunodeficiency (CVID) is an immunological disorder characterised by defective antibody production. Patients with CVI D have a high risk of gastric cancer. It has been suggested that gastric ca ncer results from an interaction between environmental factors and a geneti c predisposition. The role of Helicobacter pylori as an environmental facto r in gastric carcinogenesis is of current interest. Moreover, p53 gene muta tions have been reported in gastric cancer. This study focuses on the gastr ic pathology of patients with CVID and correlation with H pylori infection. Methods-Thirty four consecutive dyspeptic patients with CVID (mean age 49.6 years, range 14-72; 17 men) were included in the study. An upper gastroint estinal endoscopy was performed and biopsy specimens were taken from the an trum, incisura angularis, and gastric body. Biopsies were used for histolog ical assessment, to identify the presence of H pylori, and to evaluate p53 overexpression. Results-H pylori infection was detected in 14/34 (41%) patients. Chronic ac tive gastritis involving both antrum and body was observed more frequently in H pylori positive (79%) than H pylori negative (20%) patients (p = 0.001 ). Similarly, a histological feature of multifocal atrophic gastritis was f ound more frequently in infected (50%) than uninfected patients (10%) (p = 0.012). In addition, one case of gastric adenocarcinoma and another of nota ble dysplasia were observed in the H pylori positive group. Overexpression of p53 was found in six (18%) patients, including one with normal gastric m ucosa. Conclusions-It can be hypothesised that bath H pylori and p53 alterations p lay a role in the gastric carcinogenesis of patients with CVID.