Upper Gastrointestinal Involvement in Celiac Disease: Histopathologic and Endoscopic Findings-A Retrospective Cross-sectional Study.

Abstract

Upper gastrointestinal involvement beyond the duodenum in pediatric celiac disease (CD) remains undercharacterized. We conducted a single-center retrospective analysis of children who underwent esophagogastroduodenoscopy, comparing CD cases with non-CD controls. Biopsies were graded using the modified Marsh-Oberhuber and Sydney systems; Helicobacter pylori was assessed by histology and rapid urease testing. Outcomes were esophagitis, gastritis subtypes, H pylori infection, peptic ulcers, and, in CD, associations with Marsh stage. Among 996 procedures, 260 (26.1%) had CD. Gastritis was common in both groups, with chronic active gastritis most frequent. Chronic lymphocytic gastritis was more prevalent in CD (P < .05), while H pylori infection was lower (39.6% vs 50.3%; P < .05). Peptic ulcers were more frequent in CD, predominantly in the duodenal bulb (P < .001). Esophagitis showed an inverse relationship with Marsh stage (P < .05). These findings delineate distinct upper gastrointestinal features in pediatric CD and may support a more comprehensive evaluation of the upper gastrointestinal tract during diagnostic endoscopy.