Prevalence and prognostic value of hepatic histological alterations in patients with Crohn's disease.

UNLABELLED: Variable degrees of liver histological changes in patients with Crohn's disease (CD) have been reported. OBJECTIVE: To evaluate the liver histological alterations and their prognostic significance in patients affected by CD without abnormalities of liver biochemical parameters and ultrasound features. MATERIAL AND METHODS: A prospective, single-blind study, including 35 consecutive patients with CD that underwent bowel resection with a contemporary performance of liver biopsy from 1992 to 2003. EXCLUSION CRITERIA: the presence of standard causes of liver disease, such as alcohol consumption exceeding 20 g/day, primary sclerosing cholangitis, viral infections, celiac disease, metabolic syndrome and alterations of the metabolism. Patients were followed up with regular evaluation of hepatic cytolysis, cholestasis, synthesis and ultrasound performance. After a mean interval of 14 years (from May to December 2013), liver fibrosis was assessed by Fibroscan®. RESULTS: Histological alterations were shown in 60% of patients, without serious liver injuries (no case of inflammation or significant fibrosis). Fibroscan® was performed in 33 subjects and no significant changes were observed (mean value of liver stiffness: 5.2 ± 1.2 kPa). The minimal microscopic damage did not evolve either in patients with a normal histology or in those with an altered histology at baseline (p = 0.9). Only patients who took azathioprine had a statistically significant increase of liver stiffness values (5.7 ± 1.5 kPa vs 4.7 ± 1.3 kPa, p = 0.017). CONCLUSIONS: Patients with CD do not need additional examinations compared to the general population, unless clinical or biochemical abnormalities are found.

Helicobacter pylori in celiac disease and in duodenal intraepithelial lymphocytosis: Active protagonist or innocent bystander?

BACKGROUND AND OBJECTIVE: Helicobacter pylori (H. pylori) infection influences duodenal inflammation. Consequently, in celiac disease and in duodenal intraepithelial lymphocytosis, the bacterium could affect the clinical-histological manifestations. The aim of this work was to evaluate the prevalence and the potential role of H. pylori infection in celiac disease and duodenal intraepithelial lymphocytosis. METHODS: H. pylori status was reviewed in 154 patients with celiac disease or duodenal intraepithelial lymphocytosis and in a control population. This retrospective study was performed at Molinette hospital, university of Torino, Italy. RESULTS: H. pylori prevalence was 36% in celiac disease patients, 19% in case of duodenal intraepithelial lymphocytosis and 41% in controls (P<0.05 vs. duodenal intraepithelial lymphocytosis). H. pylori prevalence was not significantly different between celiac disease patients with or without iron deficiency anemia (22% vs. 39%) and it was higher in patients with milder duodenal lesions: 50% in Marsh-Oberhuber classification type 1-2 vs. 33% in type 3. Celiac disease patients had a mean intraepithelial lymphocytes count greater than that of duodenal intraepithelial lymphocytosis patients (52 vs. 44 intraepithelial lymphocytes per 100 epithelial cells). Both in celiac disease and in duodenal intraepithelial lymphocytosis patients, H. pylori infection was associated with an increase in intraepithelial lymphocytes count, but this difference was not significant. CONCLUSION: H. pylori prevalence was similar in celiac disease patients and in controls and higher in patients with milder duodenal lesions. There was no association between H. pylori infection and duodenal intraepithelial lymphocytosis.