Objectives: Increased numbers of duodenal intra-epithelial lymphocytes (IELs) characterize celiac disease (CD), but have also been described in non-celiacs. Controversy exists regarding an association between increased IELs and infection with Helicobacter pylori, which is commonly found in children. The study aim was to assess the relationship between H. pylori infection and duodenal IELs in a large cohort of children, with and without CD.
Methods: We reviewed gastric and duodenal biopsies of children who underwent esophagogastroduodenoscopy between January 2006 and February 2013 because of either recurrent abdominal pain (RAP) or suspected CD at Schneider Children's Medical Center of Israel, a referral center for Israel's largest Health Maintenance Organization. The duodenal IEL count and HP presence in antral biopsies were determined for each specimen.
Results: Children with RAP (n=693) or CD (n=306) were included. Among children with RAP, H. pylori was present in 33.8%. The mean IEL count in the H. pylori positive RAP group was 17.8(±8.8) /100 enterocytes, versus 15.8(±8.3) in the H. pylori negative patients (p=0.004). Increased IEL counts (≥25 IELs/100 enterocytes) were found in 15.7% of healthy, H. pylori negative, non-celiac children. Among children with CD, there was no significant difference in IEL counts according to H. pylori status: 73.1(±26.1) versus 72.6 (±26.5) in H. pylori positive and negative patients, respectively.
Conclusions: Our study suggests that slightly elevated duodenal IEL counts are common in the healthy pediatric population. H. pylori infection has no major influence on the IEL counts in children with RAP or children with CD.
