Search

Chronic pancreatitis is a common disorder caused by various etiological factors. It usually manifests with abdominal pain and exocrine (steatorrhea, malnutrition) or endocrine insufficiency (diabetes mellitus). Abdominal pain is the dominant symptom in these patients. Medical, endoscopic and surgical modalities are available for therapy. This review focuses on the pharmacological approaches to manage pancreatic pain. Before embarking on medical management of pain it is prudent to exclude complications like pancreatic cancer, pseudocysts, inflammatory mass, biliary or duodenal obstruction which may contribute to abdominal pain. Pharmacological measures for pain relief include central analgesics, enzyme supplements and antioxidants. Other measures include endoscopic and surgical therapy which are not discussed here. Appropriate management of exocrine and endocrine insufficiency and successful control of diabetes are also important in the management of chronic pancreatitis.

Background There is paucity of data on the effect of interventions on risk of gastrointestinal bleeding (GIB) in acute pancreatitis (AP). Methods Retrospective study of records of patients with AP and GIB. Results 16 (3.7%) patients (14 males; mean age 39.3 ± 12.8 years) had gastrointestinal bleeding. Two patients had peptic ulcer disease related GIB. The cause of GIB in remaining patients was: pseudoaneurysms in 5, gastrointestinal fistulization in 4, and no identifiable lesion in 5. Two patients with pseudoaneurysms were treated with angioembolisation whereas 3 needed surgery. The patients with gastrointestinal fistula had complicated course and 3 of these 4 patients died due to sepsis and multi organ failure. Rest 5 patients with no identifiable lesion were managed conservatively and there was no recurrence of GIB. Of the 14 patients with AP related GIB, a previous intervention had been done in 11(79%) patients. Fifty-three patients (12.7%) without GIB died whereas 5 (31.2%) patients with GIB succumbed to the illness (p = 0.04). Conclusions The majority of our patients of AP with GIB had antecedent history of interventions. The mortality was higher in patients with GIB, which was not due to hemorrhage but to sepsis and related complications.

Radiologic evaluation of small bowel is usually done by barium examination, which involves considerable radiation exposure. A new sonographic method, sonoenteroclysis, is a promising technique for diagnosing small intestinal disorders. In this study the applicability, performance, and diagnostic yield of sonoenteroclysis were assessed and the results of this novel method were compared with those of barium enteroclysis.Forty-five consecutive patients with suspected small bowel disorder were studied. All patients underwent abdominal ultrasound before and after infusion of an isotonic nonabsorbable electrolyte solution containing polyethylene glycol through a nasojejunal tube (modified Billbao Dotter tube), and images at various levels were obtained. Small bowel wall thickness, luminal narrowing, intestinal dilatation, peristalsis, and extraintestinal complications were noted. It was followed by barium enteroclysis and findings were recorded. Findings of sonoenteroclysis were compared with those of barium enteroclysis.Satisfactory distention of the intestinal lumen was obtained with sequential visualization of jejunoileal loops in 34.4 +/- 18.4 min. Of 45 patients, 10 showed normal small bowel on sonoenteroclysis and barium enteroclysis. These 10 patients served as controls. Sonoenteroclysis displayed normal diameters smaller than 3.0 and 2.0 cm for the jejunum and ileum, respectively. Bowel wall thickness was 1.7 to 3.0 mm and all five layers of bowel wall could be well appreciated. Valvulae conniventes were clearly visualized with a fold thickness between 1.4 and 2.0 mm. The remaining 35 patients showed abnormalities in the form of strictures, matted bowel loops, dilated loops, thickened folds, deformed ileocecal junction, mass lesions, etc., on sonoenteroclysis and barium enteroclysis. In addition, sonoenteroclysis showed thickened bowel wall with loss of stratification. Extraintestinal findings such as enlarged lymph nodes and ascites were also disclosed at the time of sonography. These were diagnosed subsequently as cases of tuberculosis (n = 23), celiac disease (n = 6), adenocarcinoma (n = 2), leiomyoma (n = 2), Immunoproliferative small intestinal disease (n = 1), and segmental enteritis (n = 1).The diagnostic accuracy of sonoenteroclysis for detecting small bowel lesions is comparable to that of barium enteroclysis. This new, widely available, inexpensive, and undemanding technique can be used as an initial investigation in the evaluation of patients with small bowel disorders.

Purpose: To evaluate the various radiological abnormalities in patients with proven esophageal tuberculosis. Material and Methods: The case records of 23 patients with proven esophageal tuberculosis were evaluated retrospectively for various radiological abnormalities. Twenty-two patients had secondary involvement of esophagus in the form of direct extension of mediastinal and pulmonary tuberculosis or spinal tuberculosis. Only 1 patient had primary involvement of the esophagus with no evidence of disease elsewhere. The diagnosis was confirmed by endoscopic and CT-guided biopsy/aspiration cytology in 7 and 6 cases, respectively. Diagnosis was made on the basis of surgical biopsy of lymph node and autopsy in 1 patient each. In the remaining 8 patients the diagnosis was based on radiological and endoscopic findings and the response to antituberculous treatment. Results: Chest radiography (CXR) was abnormal in 65% patients. While the findings were non-conclusive for esophageal tuberculosis, characteristic lesions of tuberculosis in lungs or spine were suggestive of tuberculous etiology. In 15 patients, CT of the chest confirmed the corresponding CXR findings and also showed additional findings of mediastinal lymphadenopathy when CXR was normal. Fourteen patients showed mediastinal lymphadenopathy on CT of the chest. In all these patients, more than one group of lymph nodes was involved. The characteristic hypodense center of lymph nodes suggestive of tuberculosis was seen in 12 patients. Radiological abnormalities seen in barium swallow examination were extrinsic compression, traction diverticula, strictures, sinus/fistulous tracts, kinking and pseudotumor mass of esophagus in decreasing order of frequency. The middle third of the esophagus was found to be the most frequent site of involvement.

Background: Perforation and fistulae, though uncommon, are serious complications of gastrointestinal tuberculosis. Patients with acute tuberculous perforation are subjected to surgery, whereas localized perforation and fistulae with subtle clinical signs are detected by barium contrast examination. There has been no report on radiological series regarding the incidence of perforation and fistulae, detected by barium contrast studies. Material and Methods: A retrospective analysis of barium contrast studies of 684 proven cases of gastrointestinal tuberculosis seen over a period of 15 years was done to detect the incidence of perforation and fistulae. Results: Fifty-two patients (7.6%) with localized perforation and fistulae were seen. Twenty-eight patients had evidence of perforation, and 24 patients showed fistulae formation. The most common site of perforation and fistulae was the small bowel followed by the colon. Associated abnormalities noted were ulcerations, strictures, nodular filling defects and extrinsic compression. Conclusion: Perforation and fistulae along with other associated abnormalities of the gastrointestinal tract are suggestive of tuberculosis, particularly in a population predisposed to tuberculous infection.

Background: Primary small bowel tumors are rare and their preoperative diagnosis is unsatisfactory. The cornerstone of diagnosis remains contrast radiography. The present study was done to evaluate the radiologic findings of primary small bowel tumors as shown on enteroclysis and to correlate these observations with surgical and histopathologic findings. Methods: Seventy two patients with primary small bowel tumors identified by enteroclysis were evaluated. All the patients were subjected to jejunal biopsy or surgery. The diagnosis was established by histopathologic examination in all cases. Results: Radiologic findings were suggestive of benign tumors in 19 patients and malignant tumors in 31 patients. Nonspecific findings in the form of diffuse involvement of the small bowel were noted in 22 patients. There was 100% radiologic–surgical correlation. Leiomyomas and lymphomas were the most common benign and malignant tumors, respectively. Tumor specificities were 89.5% for benign tumors and 41.5% for malignant tumors. Conclusion: Distinctive morphologic patterns as shown on enteroclysis are highly suggestive of specific tumor types in the majority of cases.

Purpose: To evaluate cholangiographic abnormalities resulting from extrahepatic portal venous obstruction (EHPVO) by sonography and endoscopic retrograde cholangiopancreaticography (ERCP). Material and Methods: Forty-three patients with an established diagnosis of EHPVO were subjected to duplex Doppler sonography and ERCP. Of these, 8 patients had obstructive jaundice. Results: Dilated common bile duct with pericholedochal varices showing a continuous type of flow pattern was seen in 5 EHPVO patients with obstructive jaundice. ERCP revealed cholangiographic abnormalities in 40 patients (93%). Extrahepatic bile ducts were involved in 100% of cases compared to intrahepatic bile ducts (57%). Abnormalities noted were contour irregularity with indentations, displacement and angulation, strictures and filling defects in the extrahepatic ductal system. Intrahepatic bile ducts showed dilatation with areas of narrowing and filling defects. Conclusion: Cholangiographic abnormalities are very common in patients with EHPVO, even without clinical manifestations of biliary disease. Extrahepatic bile ducts are far more often involved compared to intrahepatic bile ducts. Extrinsic compression with contour irregularity is the most common cholangiographic finding. Sonographic findings are not diagnostic. Dilated common bile duct with pericholedochal varices was seen in only 5 patients.

Background: This study characterized the phenotypic subsets of isolated gastric lymphocytes and the cellular immune response in cultured gastric biopsy specimens. Methods: Endoscopy specimens from 40 Helicobacter pylori-positive and 40 H. pylori-negative patients were studied. a) Isolated gastric lymphocytes were analysed for CD4+, CD8+ T-lymphocyte subsets, activated T cells, and natural killer cells on a fluorescence-activated cell sorter, using monoclonal antibodies. b) The supernatant of cultured gastric biopsy specimens were assayed for interleukin (IL)-2, IL-4, and IL-6 levels. Results: In H. pylori-positive patients there was (a) a decrease in CD4+/CD8+ T cells, no change in activated T cells, and an increase in natural killer cells, and (b) no change in IL-2 levels and a significant increase in IL-4 and IL-6 levels. Conclusions: There is an increase in CD8+ lymphocytes and natural killer cells, and the observed increase in IL-4 and IL-6 might be important in H. pylori-associated gastritis.

Background and objective: The Atlanta classification of acute pancreatitis enabled standardised reporting of research and aided communication between clinicians. Deficiencies identified and improved understanding of the disease make a revision necessary. Methods: A web-based consultation was undertaken in 2007 to ensure wide participation of pancreatologists. After an initial meeting, the Working Group sent a draft document to 11 national and international pancreatic associations. This working draft was forwarded to all members. Revisions were made in response to comments, and the web-based consultation was repeated three times. The final consensus was reviewed, and only statements based on published evidence were retained. Results: The revised classification of acute pancreatitis identified two phases of the disease: early and late. Severity is classified as mild, moderate or severe. Mild acute pancreatitis, the most common form, has no organ failure, local or systemic complications and usually resolves in the first week. Moderately severe acute pancreatitis is defined by the presence of transient organ failure, local complications or exacerbation of co-morbid disease. Severe acute pancreatitis is defined by persistent organ failure, that is, organ failure >48 h. Local complications are peripancreatic fluid collections, pancreatic and peripancreatic necrosis (sterile or infected), pseudocyst and walled-off necrosis (sterile or infected). We present a standardised template for reporting CT images. Conclusions: This international, web-based consensus provides clear definitions to classify acute pancreatitis using easily identified clinical and radiologic criteria. The wide consultation among pancreatologists to reach this consensus should encourage widespread adoption. Fil: Banks, Peter A.. Harvard Medical School; Estados Unidos Fil: Bollen, Thomas L.. St Antonius Hospital; Países Bajos Fil: Dervenis, Christos. Agia Olga Hospital; Grecia Fil: Gooszen, Hein G.. Radboud Universiteit Nijmegen; Países Bajos Fil: Johnson, Colin D.. University Hospital Southampton; Reino Unido Fil: Sarr, Michael G.. Mayo Clinic; Estados Unidos Fil: Tsiotos, Gregory G.. Metropolitan Hospital; Grecia Fil: Vege, Santhi Swaroop. Metropolitan Hospital; Grecia Fil: Vaccaro, Maria Ines. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina Fil: Acute Pancreatitis Classification Working Group. No especifica

Ascites can pose a difficult diagnostic problem and in some patients, despite extensive work-up, diagnostic laparoscopy or laparotomy is required. We evaluated the usefulness of endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) of peritoneal nodules in 12 patients with undiagnosed ascites (9 men, 3 women; mean [SD] age 47.5 [11.8] years). On EUS, peritoneal deposits, noted as hyperechoic rounded lesions compared with surrounding anechoic ascitic fluid, were observed in 10 /12 patients (83.3 %). Cytological examination of EUS-FNA samples from these deposits revealed metastatic adenocarcinoma in four patients, poorly differentiated carcinoma in one patient and pseudomyxoma peritonei in one patient. It also revealed inflammatory cells without granulomas in four patients, and polymerase chain reaction (PCR) for Mycobacterium tuberculosis was positive in 2 /4 patients (50 %). Deposits were larger and clearly defined in malignant ascites in comparison with tubercular ascites. No complications of EUS-FNA were observed.

Background Transhiatal oesophagectomy is an accepted approach for the treatment of carcinoma of the oesophagus. However, experience of this technique in benign diseases is limited. Methods Transhiatal oesophagectomy was done in 29 patients for benign oesophageal conditions including corrosive stricture (21), achalasia of the cardia (four), tuberculosis (one), mediastinal fibrosis (one), Crohn's disease (one) and peptic stricture (one). Dysphagia was the predominant symptom in all patients; strictures had all previously been dilated repeatedly. The stomach was used as an oesophageal substitute in 24 patients; in five with a scarred stomach due to damage by a corrosive agent, oesophagocoloplasty was performed. Resection and reconstruction were done in one stage in 25 patients; four with poor nutritional status had a two-stage procedure. Results There was no perioperative death. Complications encountered were recurrent laryngeal nerve palsy (six patients) which was mostly transient, anastomotic leak (seven) and stenosis (eight). Postoperative function of the intrathoracic stomach was satisfactory. Conclusion Transhiatal oesophagectomy is a safc and satisfactory procedure for benign obstructive conditions of the oesophagus.

We describe the radiologic appearances of small bowel tuberculosis as shown by enteroclysis. A total of 265 patients with proven small bowel tuberculosis seen over a period of more than one decade was evaluated. All patients had positive radiologic findings as shown on enteroclysis examination. Of the 265 patients with small bowel tuberculosis, 174 had isolated small bowel involvement with a normal ileocecal region, whereas 91 had associated noncontiguous involvement of the ileocecal region. The most common radiologic finding was the presence of strictures, noted in 62.7% of cases. Most strictures were short, concentric, and smooth in outline. These strictures were solitary or multiple and located mainly in the jejunum. Other radiologic findings were adhesions (21.8%), ulcerations (9.1%), and diffuse thickening of folds (6.4%). Complications noted were in the form of enteroliths, perforations, and fistulae. The radiographic findings of small bowel tuberculosis, although non-specific, may indicate tuberculosis in a high-risk population.

New clinical, endoscopic, and imaging modalities for diagnosing varices and predicting bleeding are being investigated. Transnasal endoscopy and ultrathin battery-powered esophagoscopes are being used to improve patient comfort and compliance. Patients who respond to portal pressure-reducing drugs not only have a reduced risk of bleeding, but also a reduced risk of developing other complications, with improved survival. Nitrates have been shown to have no definite role in primary prophylaxis against variceal bleeding. The hemodynamic response to treatment has an independent prognostic value for the risk of variceal bleeding. Newer drugs have been investigated for reducing the hepatic venous pressure gradient, but with little success. Survival after bleeding has increased due to improved patient care and technological advances. Combined radiographic and endoscopic management of gastric varices is evolving and appears to be promising. Nonvariceal bleeding from portal hypertensive gastropathy is increasingly being recognized as a potential cause of bleeding in patients with portal hypertension, and pharmacotherapy with octreotide appears to be promising for the treatment of this condition. Variceal band ligation in children has been found to be as safe and effective as in adults.

Background: Anomalous junction of the pancreaticobiliary duct (AJPB) is a rare finding in endoscopic retrograde cholangiopancreatography (ERCP). We present our data on the incidence of AJPB and associated diseases. Methods: A retrospective analysis of 2885 ERCPs performed over 15 years was done to study the incidence of AJPB and the diseases associated with this anomaly. Results: Of the 2885 patients who underwent ERCP, AJPB was seen in 46 (1.6%). AJPB was taken as a common channel exceeding 15 mm in length with or without dilatation of the common channel. Anomalous junction was of type I in 50%, type II in 39.1%, and type III in 2.2% cases. Y-type anomalous junction was seen in 8.7% of cases. Choledochal cyst was found in 87% of patients. Other disorders associated with AJPB were gallstones, gallbladder polyps, gallbladder carcinoma, protein plugs. and pancreatic ductal calculi. Four patients with AJPB did not show any associated abnormality. Conclusion: AJPB is a rare finding, and the diagnosis is based on a common channel longer than 15 mm on ERCP. Choledochal cyst is the most common association with AJPB. We believe that the clinical spectrum of AJPB may unfold further with the widespread use of cholangiographic techniques.

The newer diagnostic and therapeutic options continue to evolve and important developments have been made in the field of variceal bleeding and portal hypertension. A meeting was held at Baveno to update consensus on different terminologies in relation to portal hypertension. beta-blockers continue to be the mainstay for primary prophylaxis of variceal bleeding, and endoscopic variceal ligation (EVL) is fast emerging as a strong contender. The role of vasoactive drugs in the management of variceal bleeding was assessed. Octreotide and terlipressin were shown to be as effective as sclerotherapy in achieving initial hemostasis, and octreotide was shown to be safe and efficacious in the prevention of rebleeding. EVL was superior to endoscopic sclerotherapy (EST) for obliteration of esophageal varices. Sequential and simultaneous ligation and sclerotherapy were more effective than ligation alone, in reducing the recurrence rate after variceal obliteration. For gastric varices, cyanoacrylate glue continues to be the first line of treatment, and band ligation is being assessed further. Bleeding ectopic varices were dealt by appropriate endoscopic means. Endosonography has developed strongly in the assessment of variceal eradication and prediction of variceal recurrence. Transjugular intrahepatic portosystemic shunting (TIPS) significantly reduces rebleeding rates compared to EVL.

Background: Autoimmune pancreatitis (AIP) can present as pancreatic mass mimicking malignancy. However, it has specific histomorphology and immunohistology which in clinical context can be diagnostic. Aim: To retrospectively analyze pancreatic resections done for pancreatic head masses to identify cases of autoimmune pancreatitis. Methods: Hematoxylin and eosin stained slides of pancreatic resections (n-142) done for pancreatic masses (2004-2012) were reviewed. Immunohistochemistry for IgG4 was done in cases suggestive of AIP. As controls, 30 pancreatic carcinomas (n-30) and plasma cells rich chronic pancreatitis (n25) were stained with IgG4. Clinical records were retrieved. Results: There were 5/142 cases (3.5%) of autoimmune pancreatitis among pancreatic resections done for presumed pancreatic tumors. There were 3 females and 2 males and age range was 35-65 (mean 51). Presenting symptoms were painless jaundice (n-4), with adult onset diabetes (n-1) and feature of gastric outlet obstruction (n-1). Histomorphology of all the five masses was of Type I autoimmune pancreatitis showing lobulocentric plasma cell rich inflammation and storiform fibrosis. IgG4 positive plasma cells (>10 per high power field) in all the cases diagnosed as autoimmune pancreatitis; though few IgG4 positive plasma cells were positive in controls. Venulitis and veno-oblitrative changes, neural hyperplasia, neuritis were present in all. Serum IgG4 levels done immediately after surgeries in three patients were elevated. Conclusion: Incidence of autoimmune pancreatitis in pancreatic resections done for pancreatic masses is 3.5%. All the five cases were of Type 1 autoimmune pancreatitis with significant number of IgG4 positive plasma cells using >10 positive cells per high power field as cut off.

Our aim was to present a report about the usefulness of ileoscopy as an adjunct to colonoscopy, as studied in India, in the face of a dearth of such reports from the developing countries and to study the role of ileoscopy in increasing the yield of diagnosis reached and modified. In a prospective study in 66 consecutive patients undergoing colonoscopy for various indications, colonoscopy/ileoscopy was performed with a forward viewing fiberoptic colonoscope. Details of ileal mucosa, time taken to reach ileum, and length of ileum intubated were noted. Of the 66 patients undergoing colonoscopy, cecum could be reached in 62, whereas ileum was successfully intubated in 57 (86.4%). In 13 (22.5%) cases, additional information was obtained. In eight (14.4%) cases, diagnosis was established on ileoscopy. Of these, two were of lower gastrointestinal (GI) bleed (typhoid ulcer and nonsteroidal antiinflammatory drug ulcer), one had lymphoma, two had tuberculosis, and three were cases of reactive arthritis with ulcers in terminal ileum. After ileoscopy, the diagnosis was altered in five (8.7%) cases. Time taken to reach ileum from cecum was 3.3 +/- 2.5 minutes and the length of examined ileum was 17.3 +/- 7.5 cm. Ileoscopy is a useful adjunct to colonoscopy that not only helps to modify the diagnosis but also established them.

Background and Study Aims: Anastomotic leak is a known complication after transhiatal esophagectomy (THE) and cervical esophagogastric anastomosis. Conservative management takes a long time to heal such leaks. We assessed the role of endoscopic dilation in patients with anastomotic leak following THE. Patients and Methods: Eight consecutive patients (seven men, one woman; mean age 51) with anastomotic leak following THE were subjected to endoscopic dilation using Savary Gilliard dilators of 7-15 mm diameter. The mean interval between surgery and detection of leak was 9 days (range 5-22 days) and dilation was performed at a mean interval of 11.4 days (range 1-20 days) after detection of the leak. Results: Drainage from fistulas stopped completely after 1-8 days (mean 3 days). X-ray with water soluble contrast showed closure of the fistula in all cases. Duration of follow-up ranged from 2 to 12 months. Anastomotic strictures developed in three patients. These patients required three sessions each of repeat dilation, and were alive at follow-up periods of 2, 4, and 12 months, respectively. One patient developed recurrence of growth at an anastomotic site. Four patients died because of distant metastasis. Conclusions: Bougie dilation of anastomotic sites is a safe and effective technique for the healing of anastomotic leaks following THE. However there is a need for a prospective randomized trial comparing endoscopic dilation with no dilation in patients with anastomotic leaks following THE.

Background and Study Aims: In cases of hookworm and roundworm infestation, chronic occult bleeding is well known, but acute gastrointestinal bleeding is rarely described. We report five patients with worm infestation who presented with acute massive gastrointestinal bleeding. Patients and Methods: Over I year, we have encountered 15 patients with obscure gastrointestinal bleeding. All the patients had normal findings on upper gastrointestinal endoscopy. Push enteroscopy was performed in each patient and evaluation of the proximal 40-50 cm of the jejunum was done. Results: Five patients (four men, one woman; average age 50 yr, range 40-60) had worm infestation (two hookworm, three roundworm). All the patients had gastrointestinal bleeding (five had melena, one hematemesis, and two hematochezia) for a duration of 7-14 days. Hemoglobin ranged from 2.8 to 9 g/dl. Push enteroscopy revealed fresh blood in the jejunum, multiple erosions, and hookworms in two patients and roundworms in three patients. Hookworms were retrieved endoscopically in two patients whereas roundworms could be retrieved in only one patient. All the patients were treated with mebendazole (100 mg twice a day for 3 days), iron, and folic acid. Gastrointestinal bleeding subsided in all the patients. Conclusions: In developing countries, worm infestation should be considered an important cause of obscure acute gastrointestinal bleeding. Evaluation of the jejunum using an enteroscope will result in more frequent diagnosis of worms as a cause of acute gastrointestinal bleeding which might have been classified as obscure gastrointestinal bleeding.

Vascular anomalies involving the small bowel are an uncommon cause of gastrointestinal bleeding in childhood. We present here an 11-year-old boy who presented with severe anemia and malena. The routine investigations did not reveal any pathology. A capsule endoscopy study was performed, which clinched the diagnosis and identified two intestinal hemangiomas. The hemangiomas were resected and the child recovered.

Aim Lymphocytic gastritis (LG) is a histological entity characterised by intense lymphocytic infiltration (≥25 lymphocytes/100 epithelial cells) in the gastric surface and pit epithelium. Its cause has not been established, but an association with Helicobacter pylori infection or celiac disease (CD) has been suggested. The aim of this study was to verify the association of LG in adults with CD, with and without H. pylori infection. Methods This prospective study included 63 adults with CD in whom gastric and duodenal biopsy was taken simultaneously. The adults were diagnosed as cases of CD based on the modified ESPGHAN criteria and positive serology. The control consisted of 63 non-celiac adults matched for gender and age (within 2 years) without any gastric or duodenal ulcer in whom upper digestive endoscopy was performed. Helicobacter pylori were recognised in gastric biopsy on HE a modified Giemsa stain was performed in biopsy suspicious for H. pylori . The results were expressed as number and percentage or mean+SEM. Comparisons of quantitative measurements between groups were performed with Student’s t test. Results The mean age of CD cases (M:F 27:36) at presentation was 34.7±2.2 years. LG was found in 22 (34.9%) CD cases. CD cases positive for LG had a mean gastric IEL/100 surface epithelial cells of 43.2±3.5, compared with a mean of 10.5±0.7 in negative cases. CD cases not showing LG, however, did show significantly increased gastric IEL compared with non-celiac controls (10.5±0.7 vs 4.9±0.3; p H. pylori , and none of 22 cases of LG were H. pylori positive. Conclusions This study shows support for a pathogenetic relationship between celiac disease and lymphocytic gastritis. Celiac disease without lymphocytic gastritis also showed increased gastric intraepithelial lymphocytes. Histopathologists should be alerted to the distinct appearance of lymphocytic gastritis, and duodenal biopsy may be considered to pick up the celiac disease cases.