Investigation of the frequency and significance of gastric metaplasia in duodenal biopsy materials of untreated pediatric celiac patients

Year 2023, Volume: 45 Issue: 2, 180 - 187, 15.03.2023

Funda Canaz Damla Oflas Evrim Yılmaz Deniz Arık Yusuf Aydemir Zeren Barış Hülya Özen

https://doi.org/10.20515/otd.1161843

Abstract

Gastric (foveolar) metaplasia (GM) in the duodenum occurs in many cases where duodenitis develops histologically. However, few studies have investigated the presence of GM in celiac patients. This study aimed to determine the prevalence of GM and its relationship with clinicopathological parameters in untreated pediatric celiac patients. Duodenal biopsy specimens of 153 pediatric cases were analyzed. MUC5AC immunohistochemical staining was applied to all cases to detect GM. The patient group was evaluated in terms of the disease activity score (DAS), neutrophilic activity score (NAS), eosinophilic infiltration, and presence of intramucosal Brunner glands. The rate of GM was 53.4% in the control group and 98.8% in the patient group. GM was observed as diffuse morphology at a rate of 4.1% (n:3) in the control group and 55% (n:44) in the patient group (p<0.001). Diffuse type of GM was more frequent in girls in the patient group (p=0.03). When GM (focal/diffuse) age, DAS, NAS, and all histopathological parameters were compared, a statistically significant difference was found between diffuse GM and DAS, and NAS. (p=0.023 and p=0.039, respectively). The present study considered that duodenal neutrophilia and increased disease activity might play a role in the development of GM in celiac patients. We think that it would be appropriate to include a diffuse type of GM, which can be easily detected by immunohistochemical or histochemical methods, in pathology reports as a finding of histologically active celiac disease.

Keywords

gastric metaplasia, celiac disease, duodenum, pathology

Tedavi Edilmemiş Pediatrik Çölyak Hastalarının Duodenal Biyopsi Materyallerinde Gastrik Metaplazi Sıklığının ve Öneminin Araştırılması

Abstract

Duodenumda gastrik (foveolar) metaplazi (GM), histolojik olarak duodenitin geliştiği birçok durumda ortaya çıkar. Bununla birlikte, çölyak hastalarında GM'nin varlığını araştıran az sayıda çalışma vardır. Bu çalışma, tedavi edilmemiş pediatrik çölyak hastalarında GM prevelansını ve klinikopatolojik parametrelerle ilişkisini belirlemeyi amaçlamaktadır. 153 pediatrik olgunun duodenal biyopsi örneği incelendi. GM'yi saptamak için tüm olgulara MUC5AC immünohistokimyasal boyası uygulandı. Hasta grubu hastalık aktivite skoru (DAS), nötrofilik aktivite skoru (NAS), eozinofilik infiltrasyon ve intramukozal Brunner bezlerinin varlığı açısından değerlendirildi. GM, kontrol grubunda %53.4, hasta grubunda ise %98.8 idi. GM, kontrol grubunda %4,1 (n:3) ve hasta grubunda %55 (n:44) oranında yaygın morfolojide gözlendi (p<0,001). Hasta grubundaki kızlarda yaygın GM daha sıktı (p=0.03). GM (fokal/yaygın) yaş, DAS, NAS ve tüm histopatolojik parametreler karşılaştırıldığında, yaygın GM ile DAS ve NAS arasında istatistiksel olarak anlamlı fark bulundu. (sırasıyla p=0.023 ve p=0.039). Bu çalışmada, çölyak hastalarında GM gelişiminde duodenal nötrofili ve artmış hastalık aktivitesinin rol oynayabileceği düşünülmüştür. İmmünhistokimyasal veya histokimyasal yöntemlerle kolaylıkla saptanabilen diffüz tip GM'nin patoloji raporlarında histolojik olarak aktif çölyak hastalığı bulgusu olarak yer almasının uygun olacağı kanaatindeyiz.

Keywords

gastrik metaplazi, çölyak hastalığı, duodenum, patoloji

References

• 1- Oberhuber G, Granditsch G, Vogelsang H. The histopathology of coeliac disease: time for a standardized report scheme for pathologist. European Journal of Gastroenterology & Hepatology. 1999;11:1185-1194.
• 1- Oberhuber G, Granditsch G, Vogelsang H. The histopathology of coeliac disease: time for a standardized report scheme for pathologist. European Journal of Gastroenterology & Hepatology. 1999;11:1185-1194.
• 2- Moran CJ, Kolman OK, Russell GJ, et al. Neutrophilic Infiltration gluten-sensitive enteropathy is neither uncommon nor ınsignificant assessment of duodenal biopsies from 267 pediatric and adult patients. Am J Surg Pathol. 2012;36:1339–1345.
• 2- Moran CJ, Kolman OK, Russell GJ, et al. Neutrophilic Infiltration gluten-sensitive enteropathy is neither uncommon nor ınsignificant assessment of duodenal biopsies from 267 pediatric and adult patients. Am J Surg Pathol. 2012;36:1339–1345.
• 3- Bingham SM, Bates MD. Pediatric celiac disease: A review for non-gastroenterologists. Curr Probl Pediatr Adolesc Health Care.20;50:100786.
• 3- Bingham SM, Bates MD. Pediatric celiac disease: A review for non-gastroenterologists. Curr Probl Pediatr Adolesc Health Care.20;50:100786.
• 4- Almallouhi E, King KS, Patel B, et al. Increasing incidence and altered presentation in a population-based study of pediatric celiac disease in North America. J Pediatr Gastroenterol Nutr. 2017;65(4):432–437.
• 4- Almallouhi E, King KS, Patel B, et al. Increasing incidence and altered presentation in a population-based study of pediatric celiac disease in North America. J Pediatr Gastroenterol Nutr. 2017;65(4):432–437.
• 5- Villanacci V, Ciacci C, Salviato T, et al. Histopathology of celiac disease. Position statements of the Italian group of gastrointestinal pathologists. Translational Medicine @ UniSa.2020;6: 28-36.
• 5- Villanacci V, Ciacci C, Salviato T, et al. Histopathology of celiac disease. Position statements of the Italian group of gastrointestinal pathologists. Translational Medicine @ UniSa.2020;6: 28-36.
• 6- Kamboj AK, Oxentenko AS. Clinical and histologic mimickers of celiac disease. Clinical and Translational Gastroenterology. 2017; doi:10.1038/ctg.2017.41.
• 6- Kamboj AK, Oxentenko AS. Clinical and histologic mimickers of celiac disease. Clinical and Translational Gastroenterology. 2017; doi:10.1038/ctg.2017.41.
• 7- Ronald S, Margaret MA, Yoshio O, et al. Gastric metaplasia: A frequently overlooked feature of duodenal biopsy specimens in untreated celiac disease. Journal of Pediatric Gastroenterology and Nutrition. 2000;30(4):397-403.
• 7- Ronald S, Margaret MA, Yoshio O, et al. Gastric metaplasia: A frequently overlooked feature of duodenal biopsy specimens in untreated celiac disease. Journal of Pediatric Gastroenterology and Nutrition. 2000;30(4):397-403.
• 8- Harris WA, Gummett PA, Walker MM, et al. Relation between gastric acid output, Helicobacter pylori, and gastric metaplasia in the duodenal bulb. Gut. 1996;39:513-520.
• 8- Harris WA, Gummett PA, Walker MM, et al. Relation between gastric acid output, Helicobacter pylori, and gastric metaplasia in the duodenal bulb. Gut. 1996;39:513-520.
• 9- James AH. Gastric epithelium in the duodenum. Gut. 1964;5:285.
• 9- James AH. Gastric epithelium in the duodenum. Gut. 1964;5:285.
• 10- Wyatt JI, Rathbone BJ, Sobala GM, et al. Gastric epithelium in the duodenum: Its association with Helicobacter pylori and inflammation. J Clin Pathol. 1990;43:981-986.
• 10- Wyatt JI, Rathbone BJ, Sobala GM, et al. Gastric epithelium in the duodenum: Its association with Helicobacter pylori and inflammation. J Clin Pathol. 1990;43:981-986.
• 11- Heikkinen M, Pikkarainen R, Vornanen et al. Prevalence of gastric metaplasia in the duodenal bulb is low in Helicobacter pylori positive non-ulcer dyspepsia patients. Digest Liver Dis.2001;33:459-463.
• 11- Heikkinen M, Pikkarainen R, Vornanen et al. Prevalence of gastric metaplasia in the duodenal bulb is low in Helicobacter pylori positive non-ulcer dyspepsia patients. Digest Liver Dis.2001;33:459-463.
• 12- Taylor AL. The epithelial heterotopias of the alimentary tract. J Path Bact. 1927;30:415-449.
• 12- Taylor AL. The epithelial heterotopias of the alimentary tract. J Path Bact. 1927;30:415-449.
• 13- Liu KC, Wright NA. The migration pathway of epithelial cells on human duodenal villi: the origin and fate of 'gastric metaplastic' cells in duodenal mucosa. Epithelial Cell Biol. 1992; 1:53–58.
• 13- Liu KC, Wright NA. The migration pathway of epithelial cells on human duodenal villi: the origin and fate of 'gastric metaplastic' cells in duodenal mucosa. Epithelial Cell Biol. 1992; 1:53–58.
• 14- Kreuning J, Bosman FT, Kuiper G, et al. Gastric and duodenal mucosa in 'healthy' individuals an endoscopic and histopathological study of 50 volunteers. Journal of Clinical Pathology. 1978;31:69-77.
• 14- Kreuning J, Bosman FT, Kuiper G, et al. Gastric and duodenal mucosa in 'healthy' individuals an endoscopic and histopathological study of 50 volunteers. Journal of Clinical Pathology. 1978;31:69-77.
• 15- Giacosa A. Morphometry of normal duodenal mucosa. Scand J Gastroenterol Suppl. 1989; 24:10–2.
• 15- Giacosa A. Morphometry of normal duodenal mucosa. Scand J Gastroenterol Suppl. 1989; 24:10–2.
• 16- Cotton PB, Price AB, Tıghe JR, et al. Preliminary evaluation of "duodenitis" by endoscopy and biopsy. British Medical Journal. 1973;3: 430-433.
• 16- Cotton PB, Price AB, Tıghe JR, et al. Preliminary evaluation of "duodenitis" by endoscopy and biopsy. British Medical Journal. 1973;3: 430-433.
• 17- Gormally SM, Kierce BM, Daly LE, et al. Gastric metaplasia and duodenal ulcer disease in children infected by Helicobacter pylori. Gut. 1996;38: 513-517.
• 17- Gormally SM, Kierce BM, Daly LE, et al. Gastric metaplasia and duodenal ulcer disease in children infected by Helicobacter pylori. Gut. 1996;38: 513-517.
• 18- Sahin Y. Celiac disease in children: A review of the literatüre. World J Clin Pediatr. 2021;10(4): 53-71.
• 18- Sahin Y. Celiac disease in children: A review of the literatüre. World J Clin Pediatr. 2021;10(4): 53-71.
• 19- Serra S, Jani PA. An approach to duodenal biopsies. J Clin Pathol. 2006;59:1133–1150.
• 19- Serra S, Jani PA. An approach to duodenal biopsies. J Clin Pathol. 2006;59:1133–1150.
• 20- Mubarak A, Nikkels P, Houwen R, et al. Reproducibility of the histological diagnosis of celiac disease. Scandinavian Journal of Gastroenterology. 2011;46:1065-1073.
• 20- Mubarak A, Nikkels P, Houwen R, et al. Reproducibility of the histological diagnosis of celiac disease. Scandinavian Journal of Gastroenterology. 2011;46:1065-1073.