title: Celiac disease and Helicobacter pylori infection in children: Is there any Association?
abstract: OBJECTIVE
  Helicobacter pylori (HP) infection can influence the inflammatory and immune responses in the gut and may therefore play a role in the development of gluten-related enteropathy in genetically susceptible individuals. Our objective was to assess the relationship between celiac disease and HP infection in children.
  
  
  METHODS
  Children (1-18 years) diagnosed as celiac disease (CD) (n = 324) with submission of gastric and duodenal biopsies and duodenal histology having Marsh grade III features were eligible for the study. Non-celiac patients referred for endoscopy were selected as controls. We studied proportion of HP prevalence in children with confirmed CD as compared with HP prevalence in reference group comprising non-celiac children referred for endoscopy. We also evaluated predictors of HP infection in children with celiac disease.
  
  
  RESULTS
  Of the 324 participants with CD, gastric HP was seen in 37 (11.4%) patients. The prevalence of HP in patients without CD (50%, P < 0.001) was significantly higher. Among patients with CD, HP infection was most frequent in patients with Marsh IIIa. In the stepwise regression analysis for risk factors of HP infection in CD patients: presence of gastritis, hemoglobin, and absence of scalloping were found to be independent predictors in a multivariate setup.
  
  
  CONCLUSIONS
  Celiac disease and gastric HP infection have inverse relationship that raises the question whether development of HP infection confers protection against CD.
authors.affiliation: Department of Gastroenterology, GB Pant Institute of Post Graduate Medical Education and Research, Delhi, India.
authors.forename: Manish
authors.initials: M
authors.lastname: Narang
authors.affiliation: Department of Gastroenterology, GB Pant Institute of Post Graduate Medical Education and Research, Delhi, India.
authors.forename: Amarender Singh
authors.initials: AS
authors.lastname: Puri
authors.affiliation: Department of Gastroenterology, GB Pant Institute of Post Graduate Medical Education and Research, Delhi, India.
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Sachdeva
authors.affiliation: Department of Gastroenterology, GB Pant Institute of Post Graduate Medical Education and Research, Delhi, India.
authors.forename: Jatinderpal
authors.initials: J
authors.lastname: Singh
authors.affiliation: Department of Gastroenterology, GB Pant Institute of Post Graduate Medical Education and Research, Delhi, India.
authors.forename: Ajay
authors.initials: A
authors.lastname: Kumar
authors.affiliation: Department of Pathology, GB Pant Institute of Post Graduate Medical Education and Research, Delhi, India.
authors.forename: Ravindra K
authors.initials: RK
authors.lastname: Saran
mesh_terms: D000293:Adolescent; D002446:Celiac Disease / Q000453:epidemiology* / Q000209:etiology*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D005756:Gastritis / Q000453:epidemiology* / Q000382:microbiology*; D016481:Helicobacter Infections; D016480:Helicobacter pylori; D006801:Humans; D007223:Infant; D008297:Male; D015995:Prevalence; D011446:Prospective Studies; D012720:Severity of Illness Index
keywords: Helicobacter pylori; celiac disease; endoscopy; gastritis; glutens