Characteristics of gastric and duodenal mucosa in the patients  with primary biliary cholangitis

Dragana Popović; Sanja Zgradić; Sanja Dragašević; Simon Zec; Marijan Micev; Tamara Naumović; Tomica Milosavljević; Tamara Milovanović

doi:10.2298/VSP161123141P

Dragana Popović Clinical Center of Serbia, Clinic for Gastroenterology and Hepatology, Belgrade, Serbia
Sanja Zgradić Clinical Center of Serbia, Clinic for Gastroenterology and Hepatology, Belgrade, Serbia
Sanja Dragašević Clinical Center of Serbia, Clinic for Gastroenterology and Hepatology, Belgrade, Serbia
Simon Zec University of Belgrade, Faculty of Medicine, Belgrade, Serbia
Marijan Micev University of Belgrade, Faculty of Medicine, Belgrade, Serbia
Tamara Naumović University of Belgrade, Faculty of Medicine, Belgrade, Serbia
Tomica Milosavljević Clinical Center of Serbia, Clinic for Gastroenterology and Hepatology, Belgrade, Serbia
Tamara Milovanović Clinical Center of Serbia, Clinic for Gastroenterology and Hepatology, Belgrade, Serbia

DOI: https://doi.org/10.2298/VSP161123141P

Keywords: liver cirrhosis, biliary;, gastritis, atrophic;, glutens;, celiac disease;, comorbidity;, histology;, helicobacter pylori.

Abstract

Background/Aim. Primary biliary cholangitis (PBC) is an immune-mediated chronic cholestatic disease of liver, with a slow progression. The aim of our study was to determine the correlation of PBC, atrophic gastritis (AG) and gluten-sensitive enteropathy (GSE), to identify the macroscopic and histopathological modifications of gastric and duodenal mucosa which occur in PBC and to analyze the frequency of these changes compared to a control group. Methods. This study included 50 patients with PBC and 46 control subjects with the dyspeptic symptoms, without liver disease. All of the examined subjects underwent esophagogastroduodenoscopy. Macroscopic and histopathological findings of the gastric and duodenal mucosal samples were recorded and analyzed. Results. There was no statistically significant association between the PBC and AG, or between the PBC and Helicobacter pylori infection. There was a highly significant difference in the frequency of Helicobacter pylori infection and the presence of GSE in the patients in the control group compared to those with PBC. Conclusions. The patients with PBC are at a lower risk for Helicobacter pylori infectionand atrophic gastritis. Testing for GSE in the PBC patients may be beneficial, considering the higher incidence of GSE amongst these patients. GSE represents a risk factor for the presence of PBC and the patients with GSE are nearly four times more likely to have PBC.

References

Hohenester S, Oude-Elferink RP, Beuers U. Primary biliary cir-rhosis. Semin Immunopathol 2009; 31(3): 283–307.

Watt FE, James OF, Jones DE. Patterns of autoimmunity in primary biliary cirrhosis patients and their families: A popula-tion-based cohort study. QJM 2004; 97(7): 397–406.

Jones DE, Donaldson PT. Genetic factors in the pathogenesis of primary biliary cirrhosis. Clin Liver Dis 2003; 7(4): 841–64.

Drastich P, Honsová E, Lodererová A, Jarešová M, Pekáriková A, Hoffmanová I, et al. Celiac disease markers in patients with liver diseases: A single center large scale screening study. World J Gastroenterol 2012; 18(43): 6255–62.

Marsh MN. Gluten, major histocompatibility complex, and the small intestine. A molecular and immunobiologic approach to the spectrum of gluten sensitivity (‘celiac sprue’). Gastroen-terology 1992; 102(1): 330–54.

Mirzaagha F, Azali SH, Islami F, Zamani F, Khalilipour E, Khatibian M, et al. Coeliac disease in autoimmune liver disease: A cross-sectional study and a systematic review. Dig Liver Dis 2010; 42(9): 620–3.

Antico A, Tampoia M, Villalta D, Tonutti E, Tozzoli R, Bizzaro N. Clinical usefulness of the serological gastric biopsy for the diagnosis of chronic autoimmune gastritis. Clin Dev Immunol 2012; 2012: 520970.

Dixon MF, Genta RM, Yardley JH, Correa P. Classification and grading of gastritis. The updated Sydney System. International Workshop on the Histopathology of Gastritis, Houston 1994. Am J SurgPathol 1996; 20(10): 1161–81.

Scheuer PJ. Primary biliary cirrhosis: diagnosis, pathology and pathogenesis. Postgrad Med J 1983; 59 Suppl 4: 106–15.

Price AB. The Sydney system: Histological division. J Gastro-enterol Hepatol 1991; 6(3): 209–22.

Sakauchi F, Mori M, Zeniya M, Toda G. A cross-sectional study of primary biliary cirrhosis in Japan: Utilization of clinical data when patients applied to receive public financial aid. J Epi-demiol 2005; 15(1): 24–8.

Joshita S, Umemura T, Nakamura M, Katsuyama Y, Shibata S, Kimura T, et al. STAT4 gene polymorphisms are associated with susceptibility and ANA status in primary biliary cirrhosis. Dis Markers 2014; 2014: 727393.

Bardella MT, Quatrini M, Zuin M, Podda M, Cesarini L, Velio P, et al. Screening patients with celiac disease for primary biliary cirrhosis and vice versa. Am J Gastroenterol 1997; 92(9): 1524–6.

Chatzicostas C, Roussomoustakaki M, Drygiannakis D, Niniraki M, Tzardi M, Koulentaki M, et al. Primary biliary cirrhosis and autoimmune cholangitis are not associated with coeliac disease in Crete. BMC Gastroenterol 2002; 2: 5.

Lawson A, West J, Aithal GP, Logan RF. Autoimmune choles-tatic liver disease in people with coeliac disease: a population-based study of their association. Aliment Pharmacol Ther 2005; 21(4): 401–5.

Sorensen HT, Thulstrup AM, Blomqvist P, Nørgaard B, Fonager K, Ekbom A. Risk of primary biliary liver cirrhosis in patients with coeliac disease: Danish and Swedish cohort data. Gut 1999; 44(5): 736–8.

Huang J, Cui J. Evaluation of Helicobacter pylori Infection in Patients with Chronic Hepatic Disease. Chin Med J 2017; 130(2): 149–54.

Dohmen K, Shigematsu H, Miyamoto Y, Yamasaki F, Irie K, Ishi-bashi H. Digestive diseases and sciences 2002; 47(1): 162–9.

Brown ML. Helicobacter pylori: Epidemiology and Routes of Transmission. Epidemiol Rev 2000; 22(2): 283–97.

Floreani A, Biagini MR, Zappalà F, Farinati F, Plebani M, Rugge M, et al. Chronic atrophic gastritis and Helicobacter pylori in-fection in primary biliary cirrhosis: a cross-sectional study with matching. Ital J Gastroenterol Hepatol 1997; 29(1): 13–7.

Renoux M, Beaugrand M, Lévy VG, Bernard JF, Boivin P. Prima-ry biliary cirrhosis andperniciousanemia. A fortuitous associa-tion. Gastroenterol Clin Biol 1980; 4(2): 109–13.

Chung CS, Hsu YC, Huang SY, Jeng YM, Chen CH. Primary bil-iary cirrhosis associated with pernicious anemia. Can Fam Physician 2010; 56(9): 889–91.

Abenavoli L, Arena V, Giancotti F, Vecchio FM, Abenavoli S. Ce-liac disease, primary biliary cirrhosis and helicobacter pylori in-fection: one link for three diseases. Int J Immunopathol Pharmacol 2010; 23(4): 1261–5.

Ibrişim D, Cevikbaş U, Akyüz F, Poturoğlu S, Ahishali E, Güllüoğlu M, et al. Intestinal metaplasia in portal hypertensive gastropathy: a frequent pathology. Eur J Gastroenterol Hepa-tol 2008; 20(9): 874–80.