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

Öz

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.

Anahtar Kelimeler

• gastric metaplasia
• celiac disease
• duodenum
• pathology

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

Öz

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.

Anahtar Kelimeler

• gastrik metaplazi
• çölyak hastalığı
• duodenum
• patoloji

Kaynakça

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