Disappearance of gastric mucosa-associated lymphoid tissue in coeliac patients after gluten withdrawal.
BACKGROUND
Mucosa-associated lymphoid tissue (MALT) develops in gastric mucosa in response to chronic antigenic stimulation, such as Helicobacter pylori infection. However, reactive lymphoid follicles have been found also in the stomach of H. pylori-negative coeliac patients, suggesting that other environmental factors may be involved in MALT genesis. The aim of our study was to evaluate the effects of gluten withdrawal in H. pylori-negative coeliac patients with gastric MALT.


METHODS
We studied 23 H. pylori-negative untreated coeliac patients with gastric MALT. All patients underwent determination of antigliadin (AGA) and antiendomysium antibodies (EMA) and upper endoscopy with multiple biopsies in duodenum, gastric corpus, and antrum. Lymphoid follicles and H. pylori status were assessed by histopathologic and enzymatic analysis. All patients were started on a gluten-free diet and were reevaluated after 12 months. To consider their adherence to the gluten-free diet we relied on direct patient questioning. Thirteen patients who had strictly adhered to the gluten-free diet constituted our study group. Ten patients who had not strictly adhered to gluten withdrawal from their diet constituted the control group.


RESULTS
Regression of MALT was obtained in 9 of 13 (69%) patients who strictly followed the gluten-free diet; in the control group MALT disappeared in 2 of 10 (20%) patients (P=0.0361).


CONCLUSIONS
Disappearance of reactive lymphoid follicles in the gastric mucosa of H. pylori-negative coeliac patients after gluten withdrawal suggests that antigens related to alimentary gluten may constitute persistent stimuli for development of gastric MALT in coeliac patients.
Cuoco
L
L
Institute of Internal Medicine, Dept. of Gastroenterology, Catholic University, Rome, Italy.
Cammarota
G
G
Tursi
A
A
Papa
A
A
Certo
M
M
Cianci
R
R
Fedeli
G
G
Gasbarrini
G
G
D000328:Adult; D001706:Biopsy; D016022:Case-Control Studies; D002446:Celiac Disease / Q000175:diagnosis / Q000178:diet therapy* / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D005753:Gastric Mucosa / Q000473:pathology*; D005983:Glutens / Q000008:administration & dosage*; D016480:Helicobacter pylori / Q000302:isolation & purification; D006801:Humans; D008221:Lymphoid Tissue / Q000473:pathology*; D008297:Male; D010349:Patient Compliance; D013997:Time Factors
D005983:Glutens