Clinical characteristics and associated factors of celiac disease complicated by Helicobacter pylori-negative chronic gastritis: A retrospective study

Celiac disease (CD) is a chronic immune-mediated enteropathy characterized by gluten-induced small intestinal mucosal injury and a broad spectrum of clinical manifestations. Emerging evidence suggests that CD may also be associated with gastric mucosal abnormalities, including Helicobacter pylori-negative chronic gastritis (HPNCG). This study aimed to investigate the clinical, laboratory, and histopathological features of patients with CD complicated by HPNCG and to identify factors associated with this condition. A total of 60 patients with CD were retrospectively enrolled and divided into 2 groups: CD alone (n = 26) and CD with HPNCG (n = 34). Demographic characteristics, gastrointestinal symptoms, comorbidities, laboratory parameters, and histopathological findings were compared between groups. Univariate and multivariate logistic regression analyses were performed to identify factors independently associated with CD complicated by HPNCG. Receiver operating characteristic curve analysis was used to evaluate discriminatory performance. Among the 60 patients, 45.0% were male and 55.0% were female, with a mean age of 41.8 ± 15.2 years. Compared with the CD-alone group, patients with CD and HPNCG had significantly higher prevalence of abdominal bloating (61.8% vs 30.8%, P = .018), anemia (58.8% vs 26.9%, P = .013), osteopenia/osteoporosis (38.2% vs 15.4%, P = .048), and liver function abnormalities (23.5% vs 3.8%, P = .036). Histopathologically, Marsh grade IIIb-IIIc (88.2% vs 61.5%, P = .019) and moderate-to-severe chronic gastric inflammatory infiltration (64.7% vs 34.6%, P = .022) were more frequent in the CD with HPNCG group. Multivariate logistic regression identified Marsh grade IIIb-IIIc as the only factor independently associated with CD complicated by HPNCG (odds ratio = 3.96, 95% confidence interval: 1.05-14.91, P = .042). Receiver operating characteristic analysis showed that Marsh grade IIIb-IIIc alone yielded an area under the curve of 0.73, while the combined model achieved an area under the curve of 0.81. Patients with CD complicated by HPNCG present with a heavier burden of gastrointestinal symptoms, nutritional impairments, and mucosal injury compared to those with CD alone. Severe duodenal villous atrophy, reflected by Marsh grade IIIb-IIIc, is independently associated with HPNCG in CD and may serve as a clinically useful indicator for identifying this high-risk subgroup.