Investigation of the frequency and significance of gastric metaplasia in duodenal biopsy materials of untreated pediatric celiac patients

Gastric (foveolar) metaplasia (GM) in the duodenum occurs in many cases where duodenitis develops histologically. However, few studies have investigated the presence of GM in celiac patients. This study aimed to determine the prevalence of GM and its relationship with clinicopathological parameters in untreated pediatric celiac patients. Duodenal biopsy specimens of 153 pediatric cases were analyzed. MUC5AC immunohistochemical staining was applied to all cases to detect GM. The patient group was evaluated in terms of the disease activity score (DAS), neutrophilic activity score (NAS), eosinophilic infiltration, and presence of intramucosal Brunner glands. The rate of GM was 53.4% in the control group and 98.8% in the patient group. GM was observed as diffuse morphology at a rate of 4.1% (n:3) in the control group and 55% (n:44) in the patient group (p<0.001). Diffuse type of GM was more frequent in girls in the patient group (p=0.03). When GM (focal/diffuse) age, DAS, NAS, and all histopathological parameters were compared, a statistically significant difference was found between diffuse GM and DAS, and NAS. (p=0.023 and p=0.039, respectively). The present study considered that duodenal neutrophilia and increased disease activity might play a role in the development of GM in celiac patients. We think that it would be appropriate to include a diffuse type of GM, which can be easily detected by immunohistochemical or histochemical methods, in pathology reports as a finding of histologically active celiac disease.