Gluten Free Works: TREATMENT GUIDE Get well and stay healthy living gluten free
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What Is Lymphocytic Gastritis?
Lymphocytic gastritis is an inflammatory stomach disorder that is characterized by superficial inflammation of the stomach lining (mucosa) that mainly involves the gastric antrum in children.
Lymphocytic gastritis is defined by the recognition of more than 25 intraepithelial lymphocytes (IEL) per 100 surface epithelial cells lining the stomach wall.
Q: What are intraepithelial lymphocytes?
A: Intraepithelial lymphocytes in lymphocytic gastritis are a unique T-cell population of white blood cells that are interspersed between epithelial cells in the mucosa.
What Is Lymphocytic Gastritis In Celiac Disease and/or Gluten Sensitivity?
- Relationship between lymphocytic gastritis and celiac disease. Lymphocytic gastritis is strongly associated with celiac disease, with increasing prevalence correlating with more advanced villous atrophy. Chronic active gastritis and chronic inactive gastritis are also significantly associated with coeliac disease. Inflammation increases risk of infection by H. pylori bacteria.1
- Relationship between lymphocytic gastritis in celiac disease and without. Compared to patients with normal duodenal histology (cell appearance), lymphocytic gastritis was more common in patients with partial villous atrophy, and subtotal/total villous atrophy. Celiac disease was also more common in chronic active gastritis not caused by H. pylori infection.1
- Relationship between lymphocytic gastritis in children vs adults. Lymphocytic gastritis associated with celiac disease in children contains a peculiar celiac disease 8+ intraepithelial T-lymphocyte population which immunohistochemically lacks perforin and granzyme B, undergoes apoptosis, and is not associated with substantial damage to the epithelial cells.2
- Relationship between lymphocytic gastritis in children with celiac disease and those without. In a study by De Giacomo et al., children with lymphocytic gastritis had a mean of 40.64 lymphocytes per 100 epithelial cells, compared with a mean of 3.92 lymphocytes per 100 epithelial cells in children with H. pylori-associated gastritis and 5.15 lymphocytes in normal control subjects.3
How Prevalent Is Lymphocytic Gastritis In Celiac Disease and/or Gluten Sensitivity?
- Lymphocytic gastritis occurred in 10% of 70 patients with celiac disease. Cases without lymphocytic gastritis nevertheless showed increased gastric intraepithelial lymphocytes.4
- A pediatric study of 226 children diagnosed with celiac disease found a prevalence for lymphocytic gastritis of 7%.5
- In patients with collagenous gastritis, 33% also had lymphocytic gastritis.6
What Are The Symptoms Of Lymphocytic Gastritis In Celiac Disease and/or Gluten Sensitivity?
- Lymphocytic gastritis is marked by minimal stomach discomfort.
How Does Lymphocytic Gastritis In Celiac Disease and/or Gluten Sensitivity Develop?
- Lymphocytic gastritis results from gluten exposure in celiac disease that mildly inflames the mucosal lining of the stomach.
Does Lymphocytic Gastritis Respond To Gluten-Free Diet?
Yes. Celiac disease-related lymphocytic inflammation disappears after a gluten free diet.7
6 Steps To Improve Lymphocytic Gastritis In Celiac Disease and/or Gluten Sensitivity:
- 1Remove the Trigger. Maintain a Strict, Nutritious Gluten Free Diet:
- Gut health is the foundation to restore ALL health. Restored health will enable you to maintain a strict gluten free diet, just as other life tasks will be easier.
- A strict gluten free diet means removing 100% of wheat, barley, rye and oats from the diet.
- Cutting out bread and other obvious sources of gluten is not good enough for recovery. Even 1/8th teaspoon of flour or bread crumb is enough to sustain the inflammation that is damaging your small intestine, causing increased permeability (leaky gut) and allowing undigested gluten to enter your body where it can damage structures and function, and instigate immune inflammatory responses.
Correct Your Individual Nutritional Needs.
- Eat foods that can replenish missing nutrients. Find them under NUTRIENT DEFICIENCIES.
- Take nutritional supplements as needed. Find them under NUTRIENT DEFICIENCIES.
Recovery. You should begin to feel better within a week and notice more energy as inflammation subsides and the absorbing cells that make up the surface lining of your small intestine are better able to function.
- Intestinal lining cells are replaced every 5 days. The healing process is like sunburn where the damaged surface layer of skin sloughs off and is replaced with new normal cells.
- Leaky gut normally resolves in two month after starting a gluten free diet and brings about a big improvement in health. Improvement in intestinal permeability precedes morphometric recovery (cell appearance and structure) of the small intestine in celiac disease.8
- The intestinal lining may take up to a year to heal.
- 2 Reduce Inflammation. Foods to Eat and Foods Not to Eat:
Because gluten is inflammatory, eliminate OTHER inflammatory foods from your diet to reduce an additive effect to gluten. At the same time, try to eat foods that reduce inflammation (anti-inflammatory).
- Damaging Foods. In susceptible persons, includes corn, dairy (cow), and soy. Lactose, the sugar in any animal milk disrupts intestinal permeability causing leaky gut.9
- Allergenic Foods. Includes foods that trigger the immune sytem to produce IgE antibodies. Allergy testing is the usual way to discover these offending foods.
- Shelf Stable Processed Foods. Includes any that contain additives and preservatives. Look for them on the nutrition label of the box or package. Additives and preservatives also disrupt intestinal permeability causing leaky gut.9
- Fats. Limit deep fried foods, trans-fats, saturated fats (animal fat/butter), and EXCESSIVE omega-6 fatty acid oils like corn oil. Rancid fats, sodium caprate (a medium chain fat), and sucrose monester fatty acid (a food grade surfactant) induce significant disruption of the intestinal barrier that causes leaky gut.9.
- Excessive Refined White Flours (bran layer removed). Includes products made from them such as cookies, bread, cakes, pies. Bran contains the vitamins and minerals that metabolize grains and slows the otherwise rapid entry of sugar from their digestion into the bloodstream. Also disrupt intestinal permeability causing leaky gut.9
- Refined Sugars. Includes white sugar, corn fructose and high fructose corn syrup.
- Certain Spices. Includes paprika and cayenne pepper which disrupt intestinal permeability causing leaky gut.9
- Alcohol and Caffeine. Disrupt intestinal permeability causing leaky gut.9
- Cocoa and Black Tea increase blood sugar.
- Rosemary. Increases blood sugar levels and should not be used by persons with insulin resistance or diabetes.
- Fruits. Contain ample amounts of vitamins, minerals and phytochemicals which are naturally occuring components in plants that detoxify toxins, carcinogens (reducing the risk by 50%) and mutagens.
- Non-Starchy Vegetables. Support intestinal integrity and provide ample amounts of vitamins, minerals and phytochemicals. Includes green leafy vegetables such as lettuce and kale, also onion, broccoli, garlic, and others.
- High Quality Complex Carbohydrates. Provide vitamins, minerals, and fiber while boosting serotonin levels to help you relax and feel calm. Includes whole grains, legumes, and root vegetables such as carrots, parsnips, sweet potatoes, turnips, red beets, and others.
- Antioxidants. Protect the body from inflammatory oxidant molecules that continually occur and help us handle stress and reduce irritability. Includes vitamin C-containing foods such as lemon, grapefruit, apricot, Brussels sprouts and strawberries, and others. Also, includes vitamin E-containing foods such as nuts, seeds, avocado, olive oil, and others. Cocoa is good, too.
- Omega-3 Fatty Acids. Balance opposing omega-6 fatty acids and bad fats. Fish sources includes tuna, salmon, cod, and others. Plants sources include flax, chia seeds, canola oil, and others.
- Probiotics. Supply normal microbes needed for colon health and health of the body such as these fermented foods: yogurt, kefir, and unpasteurized apple cider vinegar.
- Prebiotics/ High Fiber Foods. Food with fiber keeps our population of colonic microbes healthy.
- Protective Herbs and Spices. See below #6 below for examples.
- 3 Information Sheet You Can Take to Your Doctor or Other Health Professional:
- 4 Manage Your Medications Safely:
Certain medications can aggravate lymphocytic gastritis and deplete nutrients. Ask your doctor or pharmacist about this possible adverse effect if you are taking any of the drugs listed below. Do not stop prescribed medications without supervision.
This is not a complete listing.
ANTI-INFLAMMATORIES inflame the stomach lining and disrupt intestinal permeability which complicates celiac disease.
- NSAIDS (Motrin®, Aleve®, Advil®, Anaprox®, Dolobid®, Feldene®, Naprosyn® and others) deplete Folic acid.
- 5Nutritional Supplements To Help Correct Deficiencies:
The type and quantity of nutritional supplements that may be needed depend on which nutrients are deficient.
- Multivitamin/mineral combination that provides 100% once a day is useful to improve overall nutrient levels. This is a safe dose, but always check with your doctor to avoid interactions with medications.
- Folic acid as needed.
Storage Note: Store container tightly sealed, away from heat, moisture and direct light to avoid loss of potency. That is, in a safe kitchen cabinet – not in the bathroom or on the kitchen table.
- 6Manage Natural Remedies:
- Eight glasses of water are recommended per day unless there is a contraindication such as kidney or heart disease. The Institute of Medicine recommends approximately 2.7 liters (91 ounces) of total water, from all beverages and foods, each day for women and 3.7 liters (125 ounces) daily of total water for men.
- If you are thirsty, drink water. Add fresh, squeezed lemon to water. Lemon is anti-inflammatory, alkalizing and provides vitamin C.
- Hydration Test: Urine should be pale yellow. Fingertips should be plump, without pruning but this may not be reliable when fingers are swollen with edema. Lips should be plump, without puckering. The feeling of thirst can be unreliable.
- What is wrong with soda, coffee, tea, and alcohol? These drinks are dehydrating, increase acid, and deplete nutrients.
Carminative Food Remedies:
- Raspberry.
- Carrot is also a cleansing digestive tonic.
- Grape is also bile stimulating and a cleansing remedy for sluggish digestion and laxative.
- Redbeets also stimulate and improve digestion and are easily digested.
- Cabbage also stimulates and improves digestion and is also a liver decongestant.
- Lettuce also stimulates and improves digestion and is also an alterative, meaning it improves the function of organs involved with the digestion and excretion of waste products to bring about a gradual change.
- Potatoes are antispasmodic (due to atropine like properties) and a liver remedy.
Carminative Herb Remedies:
- Sage is also a digestive, astringent, bile stimulant and energy tonic that heals the mucosa. Drink as tea or use in cooking.
- Chamomile, lemon balm, and fennel, (as a tea) also help relieve nervous tension.
- Parsley also relieves indigestion.
- Rosemary as a tea and in cooking also is a nervous system tonic for stress and fatigue, bile stimulant, and can relieve headaches and indigestion. However, because it increases blood sugar levels, it should not be used by persons with insulin resistance or diabete.
- Thyme is also soothing remedy useful for stimulating digestion of rich, fatty foods.
Carminative Spice Remedies:
- Cloves are also antispasmodic.
- Nutmeg is also useful for indigestion.
- Ginger.
Exercise improves circulation and rids the body of toxins.
- Walking is aerobic exercise that reconditions the whole body to improve stamina. Read more about Exercise and Fitness.
- Weight training builds muscle. Read more about Exercise and Fitness.
- Stretching improves flexibilty. Read more about Exercise and Fitness.
Note: Exercise is important, but the amount and type of exercise undertaken depends on your health. Your first priority is to heal.
What Do Medical Research Studies Tell About Lymphocytic Gastritis In Celiac Disease and/or Gluten Sensitivity?
RESEARCH STUDY SUMMARIES
“The celiac stomach: gastritis in patients with coeliac disease.” This study investigating the prevalence of lymphocytic gastritis (LG), chronic active gastritis (CAG) that is H. pylori-negative gastritis and chronic inactive gastritis (CIG) that is H. pylori-negative gastritis among those with normal duodenal histology (or nonspecific duodenitis) and those with celiac disease, as defined by villous atrophy (Marsh 3) found that lymphocytic gastritis is strongly associated with coeliac disease, with increasing prevalence correlating with more advanced villous atrophy. Chronic active gastritis and chronic inactive gastritis are also significantly associated with celiac disease.
All concurrent gastric and duodenal biopsy specimens submitted to a national pathology laboratory during a 6-year period were analyzed.
Among 287,503 patients who underwent concurrent gastric and duodenal biopsy, the mean age was 52 and the majority (67%) were female. Compared to patients with normal duodenal histology, LG was more common in partial villous atrophy, and subtotal/total villous atrophy. Celiac disease was also more common in CAG.1
“Endoscopic and histological gastric lesions in children with celiac disease: mucosal involvement is not only confined to the duodenum.” This retrospective study investigating gastric mucosa involvement in celiac children and control subjects found that gastritis is a common finding in children with celiac disease and adolescents in whom 7% had lymphocytic gastritis.
In 226 patients with celiac disease (median age: 5.7 years) at diagnosis and 154 controls (median age: 7.4 years), the evaluation of gastric and duodenal mucosa was performed. Celiac disease was diagnosed according to the North America Society for Pediatric Gastroenterology, Hepatology, and Nutrition criteria. Gastric lesions were classified according to Updated Sydney System. Anti-gastric parietal cell antibodies were assayed by enzyme-linked immunosorbent assay.
A total of 21.2% and 7% of patients with celiac disease showed chronic superficial gastritis and lymphocytic gastritis, respectively. Helicobacter pylori infection was found in 6 (2.7%) children with celiac disease. Chronic superficial gastritis was present in 21.4% of controls. No control subject showed lymphocytic gastritis. Among patients with chronic superficial gastritis, helicobacter pylori infection was more frequent in controls than in celiac children. Ten of 90 patients with celiac disease and 1 of 29 controls were positive for anti-gastric parietal cell antibodies.
“Our data suggest the hypothesis that lymphocytic gastritis may be related to a longer exposure to gluten. The presence of anti-gastric parietal cell antibodies may suggest the presence of an underlying autoimmune process.5
“Lymphocytic gastritis in pediatric celiac disease – immunohistochemical study of the intraepithelial lymphocytic comptonen.” This study investigating the intraepithelial population of lymphocytes in children demonstrated that lymphocytic gastritis associated with celiac disease in children contains a peculiar celiac disease 8+ intraepithelial T-lymphocyte population which immunohistochemically lacks perforin and granzyme B, undergoes apoptosis (death), and is not associated with substantial damage to the epithelial cells. No patient presented with helicobacter pylori-like organisms at the luminal surface (mucosal lining). Findings fit with those reported in adults except for the negative results for granzyme B.7
“Lymphocytic gastritis and coeliac disease: evidence of a positive association.” This study investigating the prevalence of lymphocytic gastritis in patients with celiac disease found that lymphocytic gastritis occurred in 10% of patients with celiac disease. Cases without lymphocytic gastritis nevertheless showed increased gastric intraepithelial lymphocytes. Celiac disease may on occasion be a diffuse lymphocytic enteropathy occurring in response to gluten.
Gastric biopsies from 70 patients with coeliac disease were examined by light microscopy for the presence of lymphocytic gastritis, defined as 25 or more intraepithelial lymphocytes/100 gastric columnar epithelial cells.
RESULTS: Lymphocytic gastritis was found in seven cases. Positive cases had a mean of 32.1 intraepithelial lymphocytes/100 columnar cells, compared with a mean of 13.9 in negative cases, and 5.15 in non-celiac controls. No differences were found for age, sex, gastric corpus or antrum, or degree of inflammation in the gastric lamina propria. All intraepithelial lymphocytes were of T cell lineage. Cases not showing lymphocytic gastritis did however show significantly increased gastric intraepithelial lymphocytes compared with non-coeliac controls. Eighteen of 70 cases were positive for Helicobacter pylori, and four of seven cases of lymphocytic gastritis were H pylori positive; no significant difference was observed between H pylori positive and negative patients. Three cases had concomitant ulcerative enteritis, of which none showed lymphocytic gastritis, while five cases had concomitant enteropathy associated T cell lymphoma, of which one showed lymphocytic gastritis.
Lymphocytic gastritis outside celiac disease may involve an immune response to luminal antigens, such as H pylori, not unlike the response to gluten in patients with celiac disease.10
“Lymphocytic gastritis: a positive relationship with celiac disease.” This study investigating whether celiac disease is a cause of lymphocytic gastritis found that lymphocytic gastritis in children is associated with celiac disease. Immunohistochemical studies showed that the intraepithelial lymphocytes in lymphocytic gastritis were T cells. No child with lymphocytic gastritis had serologic evidence of past H. pylori infection.
Researchers evaluated the histologic features of both gastric and duodenal biopsy specimens from 245 consecutive children and adolescents, and found chronic gastritis in 60 children and celiac disease in 25. Chronic gastritis was associated with H. pylori infection in 36 children and with celiac disease in 15. Lymphocytic gastritis was found in nine children with celiac disease. Children with lymphocytic gastritis had a mean of 40.64 lymphocytes per 100 epithelial cells, compared with a mean of 3.92 lymphocytes per 100 epithelial cells in children with H. pylori-associated gastritis and 5.15 lymphocytes in normal control subjects. Dyspeptic symptoms are frequent and the endoscopic appearance is not characteristic.11
- Lebwohl B, Green PH, Genta RM. The celiac stomach: gastritis in patients with coeliac disease. Aliment Pharmacol Ther. 2015 Jul;42(2):180-7. doi: 10.1111/apt.13249. Epub 2015 May 14. [↩] [↩] [↩]
- Drut R, Drut RM. Lymphocytic gastritis in pediatric celiac disease – immunohistochemical study of the intraepithelial lymphocytic component. Medical Science Monitor: International Medical Journal of Experimental and Clinical Research. Jan 2004;10(1):CR38-42. [↩]
- De Giacomo C, Gianatti A, Negrini R, Perotti P, Bawa P, Maggiore G, Fiocca R. Lymphocytic gastritis: a positive relationship with celiac disease. J Pediatr 1994 Jan;124(1):57-62. [↩]
- Feeley KM, Heneghan MA, Stevens FM, McCarthy CF. Lymphocytic gastritis and coeliac disease: evidence of a positive association. J Clin Pathol 1998 Mar;51(3):207-10. [↩]
- Nenna R, Magliocca FM, Tiberti C, Mastrogiorgio G, Petrarca L, Mennini M, Lucantoni F, Luparia RP, Bonamico M. Endoscopic and histological gastric lesions in children with celiac disease: mucosal involvement is not only confined to the duodenum. J Pediatr Gastroenterol Nutr. 2012 Dec;55(6):728-32. doi: 10.1097/MPG.0b013e318266aa9e. [↩] [↩]
- Leung ST, Chandan VS, Murray JA, Wu TT. Collagenous gastritis: histopathologic features and association with other gastrointestinal diseases. Am J Surg Pathol. 2009 May;33(5):788-98. doi: 10.1097/PAS.0b013e318196a67f. [↩]
- Drut R, Drut RM. Lymphocytic gastritis in pediatric celiac disease – immunohistochemical study of the intraepithelial lymphocytic component. Medical Science Monitor: International Medical Journal of Experimental and Clinical Research. Jan 2004;10(1):CR38-42. [↩] [↩]
- Cummins AG, Thompson FM, Butler RN, et al. Improvement in intestinal permeability precedes morphometric recovery of the small intestine in coeliac disease. Clinical Science. Apr 2001;100(4):379-86. [↩]
- Farhadi A, Banan A, Fields J, Keshavarzian A. Intestinal barrier: an interface between health and disease. Journal of Gastroenterology and Hepatology. 2003;18:479-91. [↩] [↩] [↩] [↩] [↩] [↩]
- Feeley KM, Heneghan MA, Stevens FM, McCarthy CF. Lymphocytic gastritis and coeliac disease: evidence of a positive association. J Clin Pathol 1998 Mar;51(3):207-10, [↩]
- De Giacomo C, Gianatti A, Negrini R, Perotti P, Bawa P, Maggiore G, Fiocca R. Lymphocytic gastritis: a positive relationship with celiac disease. J Pediatr 1994 Jan;124(1):57-62. [↩]
