Duodenal intraepithelial lymphocytosis in Helicobacter pylori gastritis: comparison before and after treatment
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BRIEF REPORT
Duodenal intraepithelial lymphocytosis in Helicobacter pylori gastritis: comparison before and after treatment Dustin E. Bosch 1 & Yong-Jun Liu 1,2 & Camtu D. Truong 1,3 & Kelly A. Lloyd 1,4 & Paul E. Swanson 1 & Melissa P. Upton 1 & Matthew M. Yeh 1,5 Received: 14 July 2020 / Revised: 9 September 2020 / Accepted: 27 September 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Our aims were to assess performance of duodenal intraepithelial lymphocyte counting for diagnosis of Helicobacter pylori (H. pylori) gastritis, and effects of eradication therapy on intraepithelial lymphocytosis. Paired duodenal and gastric biopsies from subjects with a pathologic diagnosis of H. pylori gastritis were reviewed. Higher duodenal intraepithelial lymphocyte counts were observed in 40 subjects with H. pylori gastritis (26 ± 5 per villus) than 52 subjects negative for H. pylori (12 ± 2 per villus). After successful eradication therapy, duodenal lymphocytes were indistinguishable from H. pylori–negative subjects, whereas they remained elevated after failed eradication therapy. This study confirms previous reports of increased duodenal intraepithelial lymphocytes in patients with concurrent Helicobacter pylori gastritis. Intraepithelial lymphocyte counts of > 15 per villus or > 10 per 100 enterocytes were predictive of infection. Duodenal lymphocytosis decreases significantly after successful eradication therapy but remains elevated when treatment fails. Keywords H. pylori . Gastritis . Duodenal lymphocytosis . Gastrointestinal
Introduction Duodenal intraepithelial lymphocytosis has been identified in inflammatory and autoimmune conditions, including celiac disease, small intestine bacterial overgrowth, inflammatory bowel disease, autoimmune diseases, and enteric infection [4, 9, 11]. Medications, including non-steroidal anti-inflammatory drugs and olmesartan, are also associated with increased duodenal intraepithelial lymphocytes (IELs) [14, * Matthew M. Yeh [email protected] 1
Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, 1959 NE Pacific Street, NE140D, Box 356100, Seattle, WA 98195-6100, USA
2
Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
3
Department of Pathology, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
4
Northwest Pathology, Bellingham, WA, USA
5
Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
16]. While duodenal intraepithelial lymphocytosis with villous blunting has been classified as “type 3 lesion” in the modified Marsh grading system for celiac disease, intraepithelial lymphocytosis with normal villous architecture (“type 1 or Marsh I lesion”) remains a clinical enigma in patients who are serologically negative for celiac disease [13]. The observed rate of isolated increased IELs in duodenal biopsies without villous blunting, neutrophilic inflammation, or chronic architectural distortion wa
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