Chronic Gastritis in Dermatitis Herpetiformis: A Controlled Study

Anna Alakoski,Timo Reunala,Katri Kaukinen,Kaisa Hervonen,Maarit Salo,Hannu Kautiainen,Pekka Collin,Teea T Salmi

doi:10.1155/2012/640630

Anna Alakoski, Timo Reunala + Show 6 more

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https://doi.org/10.1155/2012/640630

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Abstract

Background and Objective. Previous small studies suggest that chronic atrophic gastritis is common in dermatitis herpetiformis (DH). We here examined the frequency and topography of chronic gastritis in 93 untreated DH subjects and in 186 controls with dyspepsia. Methods. Specimens were drawn from the gastric corpus and antrum and examined for atrophy, intestinal metaplasia, and Helicobacter pylori. Duodenal biopsies were taken. Results. Atrophic corpus gastritis was more frequent in DH than in controls (16.0% and 2.7%, resp., P < 0.001); atrophy in the antrum was rare in both groups (3.2% and 1.1%, P = 0.34). Intestinal metaplasia was present in 13 (14.0%) DH and 12 (6.5%) control patients (P = 0.038) and H. pylori in 17 (18.3%) and 17 (9.3%) (P = 0.028), respectively. Small-bowel villous atrophy was seen in 76% of the DH patients, equally in patients with and without chronic gastritis. One DH patient with atrophic gastritis developed gastric cancer. Conclusion. In DH, chronic atrophic gastritis was common in the corpus, but not in the antrum. H. pylori will partly explain this, but corpus atrophy is suggestive of an autoimmune etiology. Atrophic gastritis may increase the risk of gastric cancer. We advocate performing upper endoscopy with sufficient histologic samples in DH.

Highlights

The majority of patients with dermatitis herpetiformis (DH) evince small-bowel mucosal damage or inflammation similar to that in classic or early-stage celiac disease [1, 2]
Earlier studies indicate that chronic atrophic gastritis (CAG) is common in DH and may be of autoimmune origin, but the data are based on a limited number of patients only [10,11,12]
In the present study we examined the occurrence of CAG and H. pylori, as classified by the Sydney System, in a large series of DH patients sampled over the past 20 years

Summary

Introduction

The majority of patients with dermatitis herpetiformis (DH) evince small-bowel mucosal damage or inflammation similar to that in classic or early-stage celiac disease [1, 2]. Earlier studies indicate that chronic atrophic gastritis (CAG) is common in DH and may be of autoimmune origin, but the data are based on a limited number of patients only [10,11,12]. Helicobacter pylori infection is the main agent causing chronic gastritis [13, 14], but autoimmune gastritis may occur. Previous small studies suggest that chronic atrophic gastritis is common in dermatitis herpetiformis (DH). Specimens were drawn from the gastric corpus and antrum and examined for atrophy, intestinal metaplasia, and Helicobacter pylori. Atrophic corpus gastritis was more frequent in DH than in controls (16.0% and 2.7%, resp., P < 0.001); atrophy in the antrum was rare in both groups (3.2% and 1.1%, P = 0.34). In DH, chronic atrophic gastritis was common in the corpus, but not in the antrum. We advocate performing upper endoscopy with sufficient histologic samples in DH

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Results

Discussion

Conclusion