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Upper Gastrointestinal Involvement in Celiac Disease: Histopathologic and Endoscopic Findings-A Retrospective

Yeşim Tural1,2, Erdal Sarı2, Egemen Tural3

  • 1Department of Pediatrics, Kosuyolu Istanbul Medipol Hospital, Istanbul, Türkiye.

Clinical Pediatrics
|July 21, 2026
PubMed

Insights

Pediatric celiac disease (CD) shows distinct upper gastrointestinal features, including increased chronic lymphocytic gastritis and peptic ulcers, with lower Helicobacter pylori infection rates. Esophagitis inversely correlated with celiac disease severity.

Area of Science:

  • Pediatric Gastroenterology
  • Gastrointestinal Pathology
  • Celiac Disease Research

Background:

  • Upper gastrointestinal (GI) involvement beyond the duodenum in pediatric celiac disease (CD) is not well-defined.
  • Understanding these patterns is crucial for comprehensive diagnosis and management.

Purpose of the Study:

  • To characterize upper GI endoscopic and histological findings in children with celiac disease compared to non-celiac controls.
  • To investigate associations between celiac disease severity (Marsh stage) and upper GI pathologies.

Main Methods:

  • Single-center retrospective analysis of pediatric esophagogastroduodenoscopies.
  • Comparison of 260 celiac disease cases with non-celiac controls (996 total procedures).
  • Histological grading using modified Marsh-Oberhuber and Sydney systems; Helicobacter pylori assessed by histology and rapid urease testing.

Main Results:

  • Gastritis was common in both groups; chronic active gastritis was most frequent.
  • Chronic lymphocytic gastritis was significantly more prevalent in pediatric CD patients (P < .05).
  • Helicobacter pylori infection was lower in CD (39.6% vs 50.3%, P < .05), while peptic ulcers were more frequent, especially in the duodenal bulb (P < .001). Esophagitis showed an inverse relationship with Marsh stage (P < .05).

Conclusions:

  • Pediatric celiac disease presents unique upper GI features, including specific gastritis subtypes and increased peptic ulcer risk.
  • The findings suggest a need for thorough upper GI evaluation during endoscopy for pediatric celiac disease diagnosis and management.

Keywords:
Helicobacter pyloriceliac diseaseesophagitisesophagogastroduodenoscopygastritis

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