Letter: lymphocytic gastritis and coeliac disease.

Abstract

We read with great interest the paper by Lebwohl et al.1 on the relationship between lymphocytic gastritis and coeliac disease. In 1994, we suggested the existence of a strong association between gastric lymphocytic infiltration of the surface and pit gastric epithelium with gluten enteropathy.2 In our study, we evaluated the histological features of both gastric and duodenal biopsy specimens from 245 consecutive children and adolescents, and found chronic gastritis in 60 children and coeliac disease in 25. Chronic gastritis was associated with Helicobacter pylori infection in 36 children and with coeliac disease in 15. Lymphocytic gastritis was found in nine children with coeliac disease, but in none with H. pylori infection. Children with lymphocytic gastritis had a mean of 40.64 lymphocytes per 100 epithelial cells, compared with a mean of 3.92 lymphocytes per 100 epithelial cells in children with H. pylori-associated gastritis and 5.15 lymphocytes in normal control subjects. Immunohistochemical studies showed that the intraepithelial lymphocytes in lymphocytic gastritis were T cells. No child with lymphocytic gastritis had serological evidence of past H. pylori infection. At that time, we suggested a relationship between lymphocytic gastritis and coeliac disease in children, who are models of unifactorial aetiology – compared with adults, where ageing, alcohol and drugs may also be present. We concluded that lymphocytic gastritis in children is associated with coeliac disease and we think that, 20 years later, the paper of Lebwohl et al.1 strongly supports our conclusions. Declaration of personal and funding interests: None.