JPED Journal

Abstract

Introduction: Increased duodenal intraepithelial lymphocytes (IELs) with normal villous architecture is a nonspecific finding associated with a variety of etiologies, including but not limited to celiac disease (CD) and Helicobacter pylori infection. Prior studies evaluating this finding in children have been primarily done in populations known to have high rates of CD. We aim to investigate this feature in a pediatric population with low rates of CD and high rates of H. pylori. Methods: We performed a single-center matched cohort study with prospective follow up of patients aged 0-21 years who underwent esophagogastroduodenoscopy (EGD) with duodenal biopsy between 2015-2019 in the Bronx, New York, USA. These patients were matched to control subjects with normal duodenal biopsies. Patients with increased IELs were followed for a minimum of two years to determine if any further diagnoses were made. Surgical pathology slides were reviewed by two independent pathologists. Results: This study evaluated 2115 pediatric patients finding 39 patients (1.8%) with increased duodenal lymphocytes with normal villi. When compared to 78 age matched controls, the frequency of etiologies including CD, inflammatory bowel disease (IBD), the use of acid suppressing medications, or lactase deficiency was not significantly different. The adjusted odds ratio for the diagnosis of H. pylori was 8.7 for patients with elevated IEL counts on duodenal biopsy (95% CI=1.56, 48.99; p=0.014). Conclusions: The adjusted odds ratio for the diagnosis of H. pylori was elevated in those with elevated IELs. Statistical associations were not found for other potential etiologies or patient characteristics.

Keywords: Pathology; Helicobacter Pylori; Celiac Disease; Endoscopy