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H. pylori Infection and Marsh Classification in Celiac Disease: Insights from a Mixed-Methods Approach

Cilt: 36 Sayı: 2026 26 Haziran 2026
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H. pylori Infection and Marsh Classification in Celiac Disease: Insights from a Mixed-Methods Approach

Öz

Aim: Previous studies have reported conflicting associations between Helicobacter pylori infection and celiac disease (CD). Some suggest a protective effect, whereas others propose a pathogenic role. These inconsistencies may be due to overlapping histological features such as intraepithelial lymphocytosis and duodenitis. This study aimed to evaluate the clinical and histopathological consequences of H. pylori infection in biopsy-proven CD cases.
Materials and Methods: Between 2017 and 2025, a dual-center, convergent parallel mixed-methods study was conducted with 377 participants (226 CD patients, 151 controls). Quantitative analyses assessed clinical symptoms, histopathological features, and Marsh classification, with H. pylori status evaluated using chi-square tests, logistic regression, and odds ratios. In addition, purposively selected CD patients underwent semi-structured interviews exploring abdominal pain, weakness, dietary experiences, and perceptions of H. pylori diagnosis.
Results: The prevalence and semi-quantitative severity of H. pylori colonization were similar between CD and control groups (44.6% vs. 44.2%, p = 0.947), with no significant correlation to Marsh grades. Histopathology revealed antral gastritis, pangastritis, duodenitis, and duodenal ulcers more frequently in controls, while villous atrophy with crypt hyperplasia was higher in CD patients (43.2% vs. 1.3%, p < 0.001). Clinically, weakness was more common in CD patients (24.8% vs. 10.6%, p < 0.001), whereas abdominal pain was more frequent in controls (77.5% vs. 44.7%, p < 0.001). Qualitative findings highlighted fatigue as an “invisible disability” and reflected uncertainty about symptom improvement following H. pylori eradication.
Conclusion: H. pylori colonization was not associated with histopathological severity in CD, supporting evidence that it has neither a protective nor pathogenic role. While H. pylori–related lesions were more frequent in dyspeptic controls, CD-specific mucosal injury remained distinct. Fatigue emerged as a key symptom in qualitative accounts, underscoring the need for patient-centered management. Future prospective, strain-level, and multi-center studies are warranted to clarify potential context-dependent interactions.

Anahtar Kelimeler

Helicobacter pylori, Marsh classification, Histopathology, Mixed-methods study

Destekleyen Kurum

none

Etik Beyan

The study protocol was approved by the Medical Research Ethics Committee of Karamanoğlu Mehmetbey University (Approval No: 17-2025/19, dated 05 March 2025). Retrospective quantitative data were anonymized prior to analysis. Written informed consent was obtained from all participants involved in the qualitative interviews. The study was conducted in accordance with the principles of the Declaration of Helsinki

Teşekkür

none

Kaynakça

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  3. 3. Kıyak M, Düzenli T. Helicobacter pylori colonization density may have an important role in the development of celiac disease. Akad Gastroenterol Derg 2023; 22(1):6–12.
  4. 4. Lebwohl B, Blaser MJ, Ludvigsson JF, Green PH, Rundle A, Sonnenberg A, et al. Decreased risk of celiac disease in patients with Helicobacter pylori colonization. Am J Epidemiol 2013; 178(12):1721–1730.
  5. 5. Aydogdu S, Cakir M, Yuksekkaya HA, Tumgor G, Baran M, Arikan C, et al. Helicobacter pylori infection in children with celiac disease. Scand J Gastroenterol 2008; 43(9):1088–1093.
  6. 6. Basyigit S, Unsal O, Uzman M, Sapmaz F, Dogan OC, Kefeli A, et al. Relationship between Helicobacter pylori infection and celiac disease: a cross-sectional study and a brief review of the literature. Gastroenterol Rev 2017; 12(1):49–54.
  7. 7. Simondi D, Ribaldone DG, Bonagura GA, Foi S, Sapone N, Garavagno M, et al. Helicobacter pylori in celiac disease and in duodenal intraepithelial lymphocytosis: active protagonist or innocent bystander? Clin Res Hepatol Gastroenterol 2015; 39(6):740–745.
  8. 8. Civelek Z, Urgancı N, Usta M, Özgüven MB. Prevalence of Helicobacter pylori infection in pediatric patients with celiac disease. Cyprus J Med Sci 2022; 7(3):349–353.
  9. 9. Crabtree JE, O’Mahony S, Wyatt JI, Heatley RV, Vestey JP, Howdle PD, et al. Helicobacter pylori serology in patients with coeliac disease and dermatitis herpetiformis. J Clin Pathol 1992; 45(7):597–600.
  10. 10. Jozefczuk J, Bancerz B, Walkowiak M, Glapa A, Nowak J, Piescikowska J, et al. Prevalence of Helicobacter pylori infection in pediatric celiac disease. Adv Med Sci 2015; 60(1):3–10.

Kaynak Göster

APA
Sanal Yılmaz, B., Uğuz, A., Celik, M., & Varansev, S. G. (2026). H. pylori Infection and Marsh Classification in Celiac Disease: Insights from a Mixed-Methods Approach. Genel Tıp Dergisi, 36(2026), 1-8. https://doi.org/10.54005/geneltip.1788514
AMA
1.Sanal Yılmaz B, Uğuz A, Celik M, Varansev SG. H. pylori Infection and Marsh Classification in Celiac Disease: Insights from a Mixed-Methods Approach. Genel Tıp Derg. 2026;36(2026):1-8. doi:10.54005/geneltip.1788514
Chicago
Sanal Yılmaz, Burcu, Afife Uğuz, Murat Celik, ve Sabriye Gamze Varansev. 2026. “H. pylori Infection and Marsh Classification in Celiac Disease: Insights from a Mixed-Methods Approach”. Genel Tıp Dergisi 36 (2026): 1-8. https://doi.org/10.54005/geneltip.1788514.
EndNote
Sanal Yılmaz B, Uğuz A, Celik M, Varansev SG (01 Haziran 2026) H. pylori Infection and Marsh Classification in Celiac Disease: Insights from a Mixed-Methods Approach. Genel Tıp Dergisi 36 2026 1–8.
IEEE
[1]B. Sanal Yılmaz, A. Uğuz, M. Celik, ve S. G. Varansev, “H. pylori Infection and Marsh Classification in Celiac Disease: Insights from a Mixed-Methods Approach”, Genel Tıp Derg, c. 36, sy 2026, ss. 1–8, Haz. 2026, doi: 10.54005/geneltip.1788514.
ISNAD
Sanal Yılmaz, Burcu - Uğuz, Afife - Celik, Murat - Varansev, Sabriye Gamze. “H. pylori Infection and Marsh Classification in Celiac Disease: Insights from a Mixed-Methods Approach”. Genel Tıp Dergisi 36/2026 (01 Haziran 2026): 1-8. https://doi.org/10.54005/geneltip.1788514.
JAMA
1.Sanal Yılmaz B, Uğuz A, Celik M, Varansev SG. H. pylori Infection and Marsh Classification in Celiac Disease: Insights from a Mixed-Methods Approach. Genel Tıp Derg. 2026;36:1–8.
MLA
Sanal Yılmaz, Burcu, vd. “H. pylori Infection and Marsh Classification in Celiac Disease: Insights from a Mixed-Methods Approach”. Genel Tıp Dergisi, c. 36, sy 2026, Haziran 2026, ss. 1-8, doi:10.54005/geneltip.1788514.
Vancouver
1.Burcu Sanal Yılmaz, Afife Uğuz, Murat Celik, Sabriye Gamze Varansev. H. pylori Infection and Marsh Classification in Celiac Disease: Insights from a Mixed-Methods Approach. Genel Tıp Derg. 01 Haziran 2026;36(2026):1-8. doi:10.54005/geneltip.1788514