Duodenal intraepithelial lymphocytosis during Helicobacter pylori infection is reduced by antibiotic treatment

Aim: To evaluate clinical, biological and immunological features of patients with increased duodenal intraepithelial lymphocytes (IELs), and its relation to Helicobacter pylori (HP) and coeliac disease (CD). Methods: We have studied all patients accrued over a 4-year period with increased duodenal IELs. Those patients were recalled for biological and immunological evaluation and a second endoscopy. Results: Twenty-three from a total of 639 patients were identified and 17 of them were included in the study. The median duodenal IEL count was 59 per 100 epithelial cells. Twelve (71%) patients were HP+; eight of them received HP eradication. At the second endoscopy the duodenal IEL count was significantly lower 2 months after HP eradication (73 versus 28), while the IEL count was unchanged in those patients seronegative for HP (n = 5) or those in whom it was not eradicated (n = 4) (55 versus 55). No patient had coeliac antibodies, four expressed HLA-DQ2, lower than in the general population, and the prevalence of CD was 2% (12/639 patients). Conclusion: In some cases an increased duodenal IEL count may be due to an inappropriate host response to HP. HP screening and eradication should be considered before recommending a gluten-free diet.