Chronic atrophic gastritis and Helicobacter pylori infection in primary biliary cirrhosis: a cross-sectional study with matching.
OBJECTIVE
Primary biliary cirrhosis (PBC) is a chronic liver disease characterized by exocrine gland impairment. Up to now there have been no reports dealing with gastric mucosa involvement in this autoimmune condition, which is frequently associated with Sjögren's syndrome. The aim of this study was to investigate the morphologic, biochemical and immunological features of the gastric mucosa in PBC.


METHODS
A cross-sectional study with matching was performed. Thirty-three PBC patients (30 F, 3 M, mean age 58 years; 17 with stage II-III, and 16 with stage IV disease) and 33 sex- and age-matched dyspeptic controls were included. Six biopsy specimens from the fundus (2), body (2) and antrum (2) were taken from all patients and controls. A serological assessment was performed for each subject, i.e. pepsinogen A (PGA), pepsinogen C (PGC), gastrin (G), and antibodies against Helicobacter pylori (anti-Hp IgG).


RESULTS
Endoscopic gastritis was found in 22 PBC patients (66.6%). There was no difference between PBC patients and controls regarding the percentage of subjects with mild, moderate, severe or atrophic gastritis (AG). There was no difference in gastric mucosal involvement between PBC subjects with or without secondary Sjögren's syndrome. A discrepancy was observed in the data obtained with respect to Helicobacter pylori (H. pylori) infection. H. pylori colonization was significantly more frequent in controls than in PBC patients (79% vs 49%, p < 0.002), but anti-Hp IgG were detected in the same percentage in the two groups (90% vs 83% respectively). There was no difference between the two groups in the PGA, PGC, PGA/PGC ratio, or gastrin. Eight PBC patients had esophageal varices.


CONCLUSIONS
PBC patients are not characterized by chronic atrophic gastritis. Even though they present chronic gastritis with the same prevalence as dyspeptic controls, and show signs of previous H. pylori infection as frequently as dyspeptic patients, they are actually much less frequently infected. The reasons for this observation are unclear.
Floreani
A
A
Division of Gastroenterology, University of Padova, Italy.
Biagini
M R
MR
Zappalà
F
F
Farinati
F
F
Plebani
M
M
Rugge
M
M
Surrenti
C
C
Naccarato
R
R
D000328:Adult; D000368:Aged; D000907:Antibodies, Bacterial / Q000032:analysis; D016022:Case-Control Studies; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D004415:Dyspepsia / Q000382:microbiology; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology; D005755:Gastrins / Q000032:analysis; D005756:Gastritis / Q000150:complications / Q000378:metabolism / Q000473:pathology; D005757:Gastritis, Atrophic / Q000150:complications* / Q000382:microbiology / Q000473:pathology; D005773:Gastroscopy; D016481:Helicobacter Infections / Q000150:complications*; D016480:Helicobacter pylori / Q000276:immunology; D006801:Humans; D008105:Liver Cirrhosis, Biliary / Q000150:complications* / Q000378:metabolism / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D010435:Pepsinogens / Q000032:analysis; D012859:Sjogren's Syndrome / Q000097:blood / Q000150:complications
D000907:Antibodies, Bacterial; D005755:Gastrins; D010435:Pepsinogens