Gastrointestinal findings in 26 adults with common variable immunodeficiency: The fickle nature of the disease manifests in gastrointestinal biopsies

Özet

Background/Aims: The aim of the present study was to demonstrate the histopathological findings in gastrointestinal (GI) biopsies inadults with common variable immunodeficiency (CVID).Materials and Methods: A total of 172 GI biopsies of 26 patients with CVID obtained over a 16-year period were reevaluated. Findingswere analyzed using descriptive analyzes and χ2 test.Results: Female-to-male ratio was 1.36. The median age at diagnosis was 36±13.94 (16-72) years. Chronic esophagitis was noted in 3patients. The absence of plasma cells in the stomach, duodenum, and colon was observed in 16, 14, and 9 patients, respectively. Divergent results for the presence of plasma cells in concurrent stomach and duodenum samples were found in 11 (44%) patients. Nodularlymphoid hyperplasia (NLH) was notable in the duodenum (56%). The mean number of eosinophils in one high-power field was significantly higher in duodenal biopsies with NLH (27.21 vs. 14.37, p=0.002). Active inflammation was more prominent in the colon (91%) thanin the stomach (65%) and duodenum (60%). Helicobacter pylori infection was found in 57.6%, including a case with persistent infectionby the coccoid form. Celiac-like villous blunting and increased intraepithelial lymphocytes were seen in 40% and 24%, respectively. Inaddition, 23% had giardiasis associated with acute duodenitis and duodenal NLH (p<0.05).Conclusion: CVID gastroenteropathy is a challenging entity, and due to the heterogeneity in the presence and distribution of plasmacells throughout the GI tract and diverse disease course, multiple concurrent biopsies may be needed for tissue diagnosis. Duodenal CVIDmay present with villous alterations and giardiasis, and NLH appears to be an important clue in the duodenum. The association betweenduodenal NLH and eosinophil infiltration deserves further investigation.