ABSTRACT
Background Some previously published studies have suggested an inverse relationship between celiac disease and Helicobacter pylori, raising the possibility of the protective role Helicobacter pylori could have against celiac disease development. Nevertheless, this association is inconclusive. Objectives To determine the prevalence of Helicobacter pylori infection in celiac subjects. Methods Between January 2013 and June 2014, patients over 18 years old undergoing upper endoscopy who required both gastric and duodenal biopsies were included for analysis. Enrolled subjects were divided in two groups: those with a diagnosis of celiac disease and those without a celiac disease diagnosis. Helicobacter pylori infection prevalence was compared between groups. Among celiac patients, endoscopic markers of villous atrophy as well as histological damage severity were compared between those with and without Helicobacter pylori infection. Results Overall, 312 patients were enrolled. Seventy two of them had a diagnosis of celiac disease. Helicobacter pylori infection prevalence among celiac disease patients was 12.5%, compared to 30% in non-celiac patients [OR=0.33 (0.15-0.71)]. There was not a significant difference in terms of the severity of villous atrophy in patients with Helicobacter pylori infection compared to those without it. There was a slight increase in the prevalence of endoscopic markers in those Helicobacter pylori-negative celiac subjects. Conclusion Helicobacter pylori infection seems to be less frequent in celiac patients; among those celiac subjects with concomitant Helicobacter pylori infection, histological damage degree and presence of endoscopic markers suggesting villous atrophy seem to be similar to those without Helicobacter pylori infection. .
Contexto Alguns estudos publicados anteriormente sugerem uma relação inversa entre a doença celíaca e Helicobacter pylori, levantando a possibilidade do papel protetor que o Helicobacter pylori poderia ter contra o desenvolvimento de doença celíaca. No entanto, esta associação é inconclusiva. Objetivos Determinar a prevalência da infecção por Helicobacter pylori em indivíduos celíacos. Métodos Entre janeiro de 2013 e de 2014 junho, foram incluídos para análise pacientes com mais de 18 anos de idade submetidos a endoscopia para necessárias biópsias gástricas e duodenais. Os pacientes foram divididos em dois grupos: aqueles com diagnóstico de doença celíaca e aqueles sem um diagnóstico de doença celíaca. A prevalência da infecção por Helicobacter pylori foi comparada entre os grupos. Entre os pacientes celíacos, os marcadores endoscópicos de atrofia das vilosidades, bem como a gravidade do dano histológico foram comparados entre aqueles com e sem infecção pelo Helicobacter pylori. Resultados De um total de 312 pacientes, 72 deles tiveram diagnóstico da doença celíaca. A prevalência de infecção pelo Helicobacter pylori entre pacientes com doença celíaca foi de 12,5%, em comparação com 30% em pacientes não-celíacos [OR=0,33 (0,15-0,71)]. Não houve diferença significativa em termos da gravidade da atrofia das vilosidades em pacientes com infecção pelo Helicobacter pylori em comparação com aqueles sem ele. Houve um ligeiro aumento na prevalência de marcadores endoscópicos nos indivíduos celíacos com Helicobacter pylori-negativo. Conclusão A infecção pelo Helicobacter pylori parece ser menos frequente em pacientes celíacos; entre esses indivíduos celíacos com concomitante infecção por Helicobacter pylori, o grau de dano histológico e a presença de marcadores endoscópicos sugerindo atrofia vilosa, parecem ser semelhantes com os sem infecção. .
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Celiac Disease/complications , Helicobacter pylori , Helicobacter Infections/complications , Biopsy , Cross-Sectional Studies , Celiac Disease/pathology , Gastroscopy , Helicobacter Infections/epidemiology , Helicobacter Infections/pathology , Prevalence , Retrospective StudiesABSTRACT
En los estudios ambulatorios de pH esofágico, al considerer solo las caídas de pH por debajo de 4, no se detectan los episodios de reflujo débilmente ácidos que coinciden, a veces, con la ocurrencia de síntomas. Objetivo: Establecer la incidencia de las variantes clínico-phmétricas que permiten confirmar o descartar la presencia de reflujo astroesofágico ácido y su correlación sintomática. Pacientes y método: Durante 12 meses, 100 pacientes (58 hombres y 42 mujeres) fueron incluidos en forma consecutiva para estudio prolongado del pH esofágico. Las variables consideradas fueron: número de episodios sintomáticos durante elestudio, número de episodios con correlación sintomática positiva para caídas de pH mayor de 4, número de episodios con correlación sintomática positiva para episodios con caída de pH menor de 4 y puntaje de Demeester. Los pacientes se clasificaron operativamente en seis grupos: Sin evidencias de reflujo ácido (SRGE), reflujo ácido patológico hipoalgésico (RPHO), reflujo ácido patológico normoalgésico (RPNO), reflujo acido patológico hiperalgésico (RPHP), reflujo acido fisiológico hiperalgésico (RFHP) y reflujo acido fisiológico alodínico (RFAL). Resultados: 18% presentaron SRGE, 7% RPHO, 36% RPNO, 14% RPHP, 18% RFHP y 7% RFAL. Los pacientes con reflujo ácido patológico presentaron mayor número de episodios con correlación sintomática positiva que los pacientes con ausencia de reflujo patológico(P=0,0008). En base a la intensidad del reflujo ácido y a la presencia o ausencia de correlación sintomática, se diferenciaron seis grupos de pacientes con enfermedad por reflujo que posiblemente deban ser tratados y seguidos de modo diferente.
Background: Ambulatory pH monitoring, that defines acid reflux episodes as a fall in pH below 4, fail to diagnose weakly acidic reflux, which sometimes is related to the occurrence of symptoms. Aim: To establish the incidence of clinical-phmetric variables that allow to confirm or discard the presence of gastroesophageal reflux and its symptomatic correlation. Patents and methods: During a period of 12 months, 100 patients (58 males and 42 females) were consecutively included for 24 hour esophageal ambulatory phmetry. The variables considered were: number of symptomatic episodes during the study, number of episodes with positive symptomatic correlation for pH drop greater than 4, number of episodes with positive symptomatic correlation for pH drop lower than 4 and Demeester score. For operative reasons we divided the patients in six groups: without evidence of acidic reflux (WAR), hypoalgesic pathologic acid reflux (HPAR), normoalgesic pathologic acid reflux (NPAR), hyperalgesic pathologicacid reflux (HyPAR), allodinic pathologic reflux (APR), hyperalgesic physiologic acid reflux (HyPhAR) and allodynic physiologic acid reflux (APhAR). Results: 18% presented WAR, 7% HPAR, 36% NPAR, 14% HyPAR, 18% HyPhAR and 7% APhAR. The patients with pathologic acid reflux presented more episodes with positive symptomatic correlation than patients without pathologic reflux (P=0,0008). Based on acid reflux intensity and presence or absence of symptomatic correlation, six groups of patients with gastroesophageal reflux disease were differentiated, and pbably they should be evaluated and treated in a different way.