Pediatr Gastroenterol Hepatol Nutr.  2014 Sep;17(3):186-190. 10.5223/pghn.2014.17.3.186.

Helicobacter pylori Associated Lymphocytic Gastritis in a Child

• Kim MJ
• Eom DW
• Park K

• KMID: 1803119
• DOI: http://doi.org/10.5223/pghn.2014.17.3.186

Abstract

Lymphocytic gastritis (LG) is a rare subtype of chronic gastritis. It is defined as dense proliferation of intraepithelial lymphocytes (IELs) more than 25 lymphocytes per 100 epithelial cells. The known major causes of LG are celiac disease and Helicobacter pylori infection. H. pylori associated LG (HpLG) has more enhanced cytotoxic and apoptotic tendencies than chronic H. pylori gastritis. A 12-year-old girl with postprandial epigastric pain was diagnosed HpLG on endoscopic biopsy. After the 1st eradication therapy, H. pylori bacilli were still found, and urea breathing test was positive. Although the endoscopic finding was partially improved, clinical symptoms and histologic finding were persisted. We could achieve the improvement of clinical symptoms and disappearance of IELs after the 2nd eradication. The discordant of histopathologic and endoscopic improvement occurred after the 1st eradication therapy of HpLG. Therefore the clinical and histopathologic evaluation should be considered as well as endoscopic findings.

Keyword

Helicobacter pylori; Child; Intraepithelial lymphocyte; Chronic gastritis; Lymphocytic gastritis; Eradication

MeSH Terms

Biopsy
Celiac Disease
Child*
Epithelial Cells
Female
Gastritis*
Helicobacter pylori*
Humans
Lymphocytes
Respiration
Urea
Urea

Figure

• 

  Fig. 1 Endoscopic findings. (A) and (B) varioliform gastritis was shown before beginning of the 1st eradication treatment. It was more severe on gastric body and angle than antrum. (C) After the 1st eradication, varioliform gastritis had improved considerably but mild nodularity was remained on angle. (D) After the 2nd eradication, gastric mucosa became normalized.

• 

  Fig. 2 Histologic and immunohistochemistry findings. (A) More than 50 intraepithelial lymphocytes (IELs) per 100 epithelial cells were present in the intraepithelial layer (H&E, ×400). On immunohistochemical staining, (B) IELs were mostly positive for CD3 (×400) and (C) CD8 (×400). (D) After the 1st eradication, the number of IELs was decreased but still counted as 25-50 IELs per 100 epithelial cells (H&E, ×400). (E) Majority of IELs were positive for CD8 immunohistochemical staining (×200). (F) After the 2nd eradication, gastric mucosa was normalized (H&E, ×200).

Reference

1. 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. J Pediatr Gastroenterol Nutr. 2008; 47:568–572.

2. Haot J, Hamichi L, Wallez L, Mainguet P. Lymphocytic gastritis: a newly described entity: a retrospective endoscopic and histological study. Gut. 1988; 29:1258–1264.

3. Hayat M, Arora DS, Dixon MF, Clark B, O'Mahony S. Effects of Helicobacter pylori eradication on the natural history of lymphocytic gastritis. Gut. 1999; 45:495–498.

4. Wu TT, Hamilton SR. Lymphocytic gastritis: association with etiology and topology. Am J Surg Pathol. 1999; 23:153–158.

5. Broide E, Sandbank J, Scapa E, Kimchi NA, Shapiro M, Lerner A. The immunohistochemistry profile of lymphocytic gastritis in celiac disease and Helicobacter pylori infection: interplay between infection and inflammation. Mediators Inflamm. 2007; 2007:81838.

6. Bhatti TR, Jatla M, Verma R, Bierly P, Russo PA, Ruchelli ED. Lymphocytic gastritis in pediatric celiac disease. Pediatr Dev Pathol. 2011; 14:280–283.

7. De Giacomo C, Gianatti A, Negrini R, Perotti P, Bawa P, Maggiore G, et al. Lymphocytic gastritis: a positive relationship with celiac disease. J Pediatr. 1994; 124:57–62.

8. Luzza F, Mancuso M, Imeneo M, Mesuraca L, Contaldo A, Giancotti L, et al. Helicobacter pylori infection in children with celiac disease: prevalence and clinicopathologic features. J Pediatr Gastroenterol Nutr. 1999; 28:143–146.

9. Han SH, Joo M, Kim KM. High proportion of granzyme B+ intraepithelial lymphocytes contributes to epithelial apoptosis in Helicobacter pylori-associated lymphocytic gastritis. Helicobacter. 2013; 18:290–298.

10. Oberhuber G, Bodingbauer M, Mosberger I, Stolte M, Vogelsang H. High proportion of granzyme B-positive (activated) intraepithelial and lamina propria lymphocytes in lymphocytic gastritis. Am J Surg Pathol. 1998; 22:450–458.

11. Quiding-Järbrink M, Lundin BS, Lönroth H, Svennerholm AM. CD4+ and CD8+ T cell responses in Helicobacter pylori-infected individuals. Clin Exp Immunol. 2001; 123:81–87.

12. Lu AP, Zhang SS, Zha QL, Ju DH, Wu H, Jia HW, et al. Correlation between CD4, CD8 cell infiltration in gastric mucosa, Helicobacter pylori infection and symptoms in patients with chronic gastritis. World J Gastroenterol. 2005; 11:2486–2490.

13. Wu YY, Chen JH, Kao JT, Liu KC, Lai CH, Wang YM, et al. Expression of CD25(high) regulatory T cells and PD-1 in gastric infiltrating CD4(+) T lymphocytes in patients with Helicobacter pylori infection. Clin Vaccine Immunol. 2011; 18:1198–1201.

14. Miettinen A, Karttunen TJ, Alavaikko M. Lymphocytic gastritis and Helicobacter pylori infection in gastric lymphoma. Gut. 1995; 37:471–476.

15. Nga ME, Tan SH, Teh M, Koay ES, Chong SM, Putti TC, et al. Lymphocytic gastritis-like T cell lymphoma: molecular evidence of an unusual recurrence. J Clin Pathol. 2004; 57:1222–1224.

16. Song DE, Kim JS, Huh JR, Choi J, Jang SJ, Yu E. Lymphocytic gastritis in Helicobacter pylori-positive gastric MALT lymphoma--report of two cases. Korean J Gastroenterol. 2005; 45:354–360.

17. Madisch A, Miehlke S, Neuber F, Morgner A, Kuhlisch E, Rappel S, et al. Healing of lymphocytic gastritis after Helicobacter pylori eradication therapy--a randomized, double-blind, placebo-controlled multicentre trial. Aliment Pharmacol Ther. 2006; 23:473–479.

18. Müller H, Volkholz H, Stolte M. Healing of lymphocytic gastritis by eradication of Helicobacter pylori. Digestion. 2001; 63:14–19.

19. Haot J, Jouret A, Willette M, Gossuin A, Mainguet P. Lymphocytic gastritis--prospective study of its relationship with varioliform gastritis. Gut. 1990; 31:282–285.