Abstract

BACKGROUND:
Celiac disease is one of the commonest autoimmune, systemic diseases, occurs at any age in genetically predisposed individuals. It occurs in female more than male. H .pylori chronic gastritis occurs in association with celiac disease, the relations are poorly understood, many studies showed that H.pylori chronic gastritis trigger autoimmune response in celiac disease, other suggest that H.pylori reduces immune response.  
OBJECTIVE:
To evaluate  the association  of  Helicobacter pylori chronic gastritis with celiac disease in terms of clinical presentation, histological features (including Marsh grading of celiac disease and Sydney system classification of chronic gastritis), celiac serology and endoscopic findings.
MATERIAL AND METHOD:
A cross-sectional retrospective study conducted in the Department of Pathology/ Collage of Medicine /Al-Nahrain University for a period from January 2020 to March 2021. A study included analysis of 164 cases of celiac disease as control group and 164 cases had  celiac with H.Pylori associated gastritis as a case group collected sample of Iraqi patients from January 2017 to December 2019.
RESULTS:
In this study, 374 cases were included; out of this numbers, 210 cases (56.1%) had associated H. Pylori chronic gastritis, whereas 164 cases (43%) were endoscopically negative for changes of H.pylori chronic gastritis (as mentioned by gastrointestinal specialist), this relation was statistically significant (P value < 0.05). In case group (Celiac disease and H. Pylori gastritis), the mean age             was 34.6±15.3 years; the age range was 9 -85 years. In control group (Celiac disease only), the mean age was 30.8±13.9 years; the range was 3.5 - 83 years. The commonest symptom was epigastric                pain which was significantly higher in 66 patients (40.7%) in cases versus 38 patients (23.3%) in control group (p value < 0.05). The endoscopic findings were significantly different between case and control groups (p value < 0.05), normal finding was found in 5 patients (3.1%) of the cases in comparison to 81patients (49.4%) of the control .Pangastropathy was significantly higher in case group (112 patients, 69.1%) than control group (6 patients, 3.7%). Classification of duodenal histopathological changes of cases groups according to Marsh Oberhuber classification (1999) showed that Marsh 3b was more in both case and control groups. In (marsh 3a), 11patients (42.3%) had                 mild atrophy, 3patients (20.00%) had moderate atrophy. In (marsh 3b), 12 patients (46.20%) had mild atrophy, 12 patients (80%) had moderate atrophy, 1patient (100.00%) had severe atrophy. In (marsh 3c) 3 patients (11.50%) had mild atrophy; this relation was statistically significant (P value=0.02).               In (marsh 3a), 14 patients (20.9%) had gastric atrophy. In (marsh3b), 25 patients (26%) had gastric atrophy. In (marsh 3c), 3patients had gastric atrophy, this relation was statistically significant                      (P value <0.05).
CONCLUSION:
There is statistically significant association between H.pylori chronic gastritis and celiac disease                  (p value=0.017). No significant difference in classification of celiac disease according to March Oberhuber (1999) between case and control groups; however, Marsh3b was in 79(48.2%) of control group and in 93(56.7%) of case group. There was a significant association between presence and grade of atrophy of gastric mucosa in chronic gastritis in and Marsh grading of celiac disease in case group.