Çocuklarda Helicobacter pylori Enfeksiyonu ile Çölyak Hastalığı Arasındaki İlişki

Öz

Amaç Çölyak hastalığı, prevalansı giderek artan kronik bir otoimmün bozukluktur. Helicobacter pylori, mide ve duodenumda inflamasyona yol açan bir enfeksiyon olup, gelişmekte olan ülkelerde prevalansı giderek azalmaktadır. Helicobacter pylori’nin çölyak hastalığının artan prevalansındaki rolünü inceleyen çalışmaların çoğu erişkin popülasyonlara odaklanmıştır. Bu çalışmada, söz konusu ilişkiyi çocuklarda inceleyerek literatüre katkıda bulunmayı amaçladık. Gereç ve Yöntem Çalışma, tek merkezli ve retrospektif bir tasarımla yürütülmüştür. Ocak 2010 ile Aralık 2024 tarihleri arasında çeşitli endikasyonlarla üst gastrointestinal endoskopi ve biyopsi uygulanan, 1–18 yaş aralığındaki hastalar değerlendirilmiştir. Olgular, yaş gruplarına ve çalışma yıllarına göre kategorize edilerek analiz edilmiştir. Bulgular Çalışma süresince toplam 2.659 tanısal endoskopi gerçekleştirilmiştir. Dahil edilme kriterlerini karşılayan toplam 1.910 pediatrik hasta çalışmaya dahil edilmiştir (ortalama yaş: 11,99 ± 4,62 yıl; %62,3’ü kız). Nihai tanılara göre 151 hasta (%7,9) çölyak hastalığı grubuna, 1.759 hasta (%92,1) kontrol grubuna dahil edilmiştir. Helicobacter pylori prevalansı çölyak grubunda daha düşük saptanmış; ancak bu fark istatistiksel olarak anlamlı bulunmamıştır. Çölyak hastalarında Helicobacter pylori enfeksiyon oranları, Marsh evresi arttıkça hafif bir artış göstermiş; ancak bu bulgu da istatistiksel olarak anlamlı değildir (p > 0,05). Sonuç Çalışmamız, çölyak hastalığı olan çocuklarda Helicobacter pylori enfeksiyonunun daha düşük sıklıkta görüldüğünü, ancak bu farkın istatistiksel olarak anlamlı olmadığını göstermiştir.

Anahtar Kelimeler

• Çölyak hastalığı
• Çocuklar
• Helicobakter pylori
• Endoskopi
• Marsh sınıflaması

The Relationship Between Helicobacter pylori Infection And Celiac Disease In Children

Öz

Background/Aims Celiac disease is a chronic autoimmune disorder with an increasing prevalence. Helicobacter pylori is an infection that causes inflammation in the stomach and duodenum, and its prevalence has been gradually declining in developing countries. Most studies examining the role of Helicobacter pylori in the increasing prevalence of celiac disease have focused on adult populations. In this study, we aimed to contribute to the literature by examining this relationship in children. Materials and Methods The study was designed as a single-center, retrospective study. Patients aged 1 to 18 years who underwent upper gastrointestinal endoscopy with biopsy for various indications between January 2010 and December 2024 were evaluated. Cases were analyzed by categorizing them based on age groups and study years. Results During the study period, a total of 2,659 diagnostic endoscopies were performed. A total of 1,910 pediatric patients who met the inclusion criteria were included in the study (mean age: 11.99 ± 4.62 years, 62.3% female). Based on final diagnoses, 151 patients (7.9%) were classified in the celiac disease group, while 1,759 patients (92.1%) comprised the control group. The prevalence of Helicobacter pylori was lower in the celiac group; however, this difference was not statistically significant. Among celiac patients, Helicobacter pylori infection rates showed a slight increase with higher Marsh stages, but this finding was not statistically significant (p>.05). Conclusion Our study demonstrated that Helicobacter pylori infection was less frequent in children with celiac disease; however, the difference was not statistically significant.

Anahtar Kelimeler

• Celiac Disease
• Children
• Helicobacter pylori
• endoscopy
• Marsh classification

Kaynakça

1. 1. Ludvigsson JF, Leffler DA, Bai JC, Biagi F, Fasano A, Green PH, et al. The Oslo definitions for coeliac disease and related terms. Gut. 2013;62(1):43-52.
2. 2. 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. Przeglad gastroenterologiczny. 2017;12(1):49-54.
3. 3. Galipeau HJ, McCarville JL, Huebener S, Litwin O, Meisel M, Jabri B, et al. Intestinal microbiota modulates gluten-induced immunopathology in humanized mice. The American journal of pathology. 2015;185(11):2969-82.
4. 4. Lu C, Zhou W, He X, Zhou X, Yu C. Vitamin D status and vitamin D receptor genotypes in celiac disease: a meta-analysis. Critical reviews in food science and nutrition. 2021;61(12):2098-106.
5. 5. Elmas A, Akçam M. Trend of Helicobacter pylori Infection in Childhood: A Single-Center Experience. Turkish archives of pediatrics. 2024;59(3):264-9.
6. 6. Blaser MJ, Chyou PH, Nomura A. Age at establishment of Helicobacter pylori infection and gastric carcinoma, gastric ulcer, and duodenal ulcer risk. Cancer research. 1995;55(3):562-5.
7. 7. 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. American journal of epidemiology. 2013;178(12):1721-30.
8. 8. Narang M, Puri AS, Sachdeva S, Singh J, Kumar A, Saran RK. Celiac disease and Helicobacter pylori infection in children: Is there any Association? Journal of gastroenterology and hepatology. 2017;32(6):1178-82.

9. 9. Hmida NB, Ben Ahmed M, Moussa A, Rejeb MB, Said Y, Kourda N, et al. Impaired control of effector T cells by regulatory T cells: a clue to loss of oral tolerance and autoimmunity in celiac disease? The American journal of gastroenterology. 2012;107(4):604-11.
10. 10. Oertli M, Sundquist M, Hitzler I, Engler DB, Arnold IC, Reuter S, et al. DC-derived IL-18 drives Treg differentiation, murine Helicobacter pylori-specific immune tolerance, and asthma protection. The Journal of clinical investigation. 2012;122(3):1082-96.
11. 11. Yue M, Chen Q, Zhou X, Li L, Lu C. Is Helicobacter pylori Infection Associated with Celiac Disease? A Meta-analysis. The Turkish journal of gastroenterology : the official journal of Turkish Society of Gastroenterology. 2022;33(3):205-12.
12. 12. Jones NL, Koletzko S, Goodman K, Bontems P, Cadranel S, Casswall T, et al. Joint ESPGHAN/NASPGHAN Guidelines for the Management of Helicobacter pylori in Children and Adolescents (Update 2016). Journal of pediatric gastroenterology and nutrition. 2017;64(6):991-1003.
13. 13. Husby S, Koletzko S, Korponay-Szabó IR, Mearin ML, Phillips A, Shamir R, et al. European Society for Pediatric Gastroenterology, Hepatology, and Nutrition guidelines for the diagnosis of coeliac disease. Journal of pediatric gastroenterology and nutrition. 2012;54(1):136-60.
14. 14. Oberhuber G, Caspary WF, Kirchner T, Borchard F, Stolte M. [Diagnosis of celiac disease and sprue. Recommendations of the German Society for Pathology Task Force on Gastroenterologic Pathology]. Der Pathologe. 2001;22(1):72-81.
15. 15. Ciacci C, Squillante A, Rendina D, Limauro S, Bencivenga C, Labanca F, et al. Helicobacter pylori infection and peptic disease in coeliac disease. European journal of gastroenterology & hepatology. 2000;12(12):1283-7.
16. 16. Lasa J, Zubiaurre I, Dima G, Peralta D, Soifer L. HELICOBACTER PYLORI PREVALENCE IN PATIENTS WITH CELIAC DISEASE: results from a cross-sectional study. Arquivos de gastroenterologia. 2015;52(2):139-42.
17. 17. Bayrak NA, Tutar E, Volkan B, Sahin Akkelle B, Polat E, Kutluk G, et al. Helicobacter pylori infection in children with celiac disease: Multi-center, cross-sectional study. Helicobacter. 2020;25(3):e12691.
18. 18. 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. Journal of clinical pathology. 1992;45(7):597-600.
19. 19. Diamanti A, Maino C, Niveloni S, Pedreira S, Vazquez H, Smecuol E, et al. Characterization of gastric mucosal lesions in patients with celiac disease: a prospective controlled study. The American journal of gastroenterology. 1999;94(5):1313-9.
20. 20. Rostami-Nejad M, Villanacci V, Mashayakhi R, Molaei M, Bassotti G, Zojaji H, et al. Celiac disease and Hp infection association in Iran. Revista espanola de enfermedades digestivas. 2009;101(12):850-4.
21. 21. Nenna R, Magliocca FM, Tiberti C, Mastrogiorgio G, Petrarca L, Mennini M, et al. Endoscopic and histological gastric lesions in children with celiac disease: mucosal involvement is not only confined to the duodenum. Journal of pediatric gastroenterology and nutrition. 2012;55(6):728-32.
22. 22. Prasad KK, Thapa BR, Lal S, Sharma AK, Nain CK, Singh K. Lymphocytic gastritis and celiac disease in indian children: evidence of a positive relation. Journal of pediatric gastroenterology and nutrition. 2008;47(5):568-72.
23. 23. Jozefczuk J, Bancerz B, Walkowiak M, Glapa A, Nowak J, Piescikowska J, et al. Prevalence of Helicobacter pylori infection in pediatric celiac disease. European review for medical and pharmacological sciences. 2015;19(11):2031-5.
24. 24. Aydogdu S, Cakir M, Yuksekkaya HA, Tumgor G, Baran M, Arikan C, et al. Helicobacter pylori infection in children with celiac disease. Scandinavian journal of gastroenterology. 2008;43(9):1088-93.
25. 25. Biernat MM, Iwańczak B, Bińkowska A, Grabińska J, Gościniak G. The Prevalence of Helicobacter pylori Infection in Symptomatic Children: A 13-Year Observational Study in the Lower Silesian Region. Advances in clinical and experimental medicine : official organ Wroclaw Medical University. 2016;25(2):303-8.
26. 26. Caron TJ, Scott KE, Fox JG, Hagen SJ. Tight junction disruption: Helicobacter pylori and dysregulation of the gastric mucosal barrier. World journal of gastroenterology. 2015;21(40):11411-27.
27. 27. Lionetti E, Catassi C. New clues in celiac disease epidemiology, pathogenesis, clinical manifestations, and treatment. International reviews of immunology. 2011;30(4):219-31.
28. 28. Caminero A, Galipeau HJ, McCarville JL, Johnston CW, Bernier SP, Russell AK, et al. Duodenal Bacteria From Patients With Celiac Disease and Healthy Subjects Distinctly Affect Gluten Breakdown and Immunogenicity. Gastroenterology. 2016;151(4):670-83.
29. 29. Maxim R, Pleşa A, Stanciu C, Girleanu I, Moraru E, Trifan A. Helicobacter pylori prevalence and risk factors among children with celiac disease. The Turkish journal of gastroenterology : the official journal of Turkish Society of Gastroenterology. 2019;30(3):284-9.
30. 30. Villanacci V, Bassotti G, Liserre B, Lanzini A, Lanzarotto F, Genta RM. Helicobacter pylori infection in patients with celiac disease. The American journal of gastroenterology. 2006;101(8):1880-5.