Presentation: Gastric Erosions Cause Spontaneous Urticaria Independent of Helicobacter Pylori ( World Allergy Congress)

Friday, 16 October 2015

Hall D1 Foyer (Floor 3) (Coex Convention Center)

Semen Zheleznov, allergist, physician, applicant for candidate of medicine degree , Laboratory of Clinical Immunology, Scientific Research Institute of Physical-Chemical Medicine, Moscow, Russia

Galina Urzhumtseva, endoscopist, gastroenterologist, specialist of highest degree , Endoscopy, City Clinical Hospital N7, Moscow, Russia

Natalia Petrova, endoscopist , Endoscopy, City Clinical Hospital N7, Moscow, Russia

Zhanna Sarsaniia, Dr. Sci. Biol. , Laboratory of Clinical Immunology, Scientific Research Institute of Physical-Chemical Medicine, Moscow, Russia

Nikolai Didkovskii, prof., MD, physician, immunologist, honored doctor of Russia, Head of the Laboratory of Clinical Immunology , Laboratory of Clinical Immunology, Scientific Research Institute of Physical-Chemical Medicine, Moscow, Russia

Torsten Zuberbier, Prof. Dr. med. Dr. h.c. , Allergy-Centre-Charité, Charité-Universitaetsmedizin Berlin, Berlin, Germany

Background. Investigation of the role of Helicobacter Pylori (HP) and erosions or ulcers (EU) of upper gastrointestinal tract (esophagus, stomach or duodenum) independently from each other in the development of spontaneous urticaria.

Methods. 36 adult patients, 5 with acute and 29 with chronic spontaneous urticaria were examined with upper gastrointestinal endoscopy (UGIE) and HP-testing in gastric biopsies, before and after treatment of the observed abnormalities.

Results. HP was found in 26 patients, or 72,2% (54,8; 85,8), what was less than across able-bodied population of Moscow - 87,9% (85,6; 90,0)¹, difference insignificant. Wherein EU were found in 50,0% (32,9; 67,1) of patients, and gastric erosions in 41,7% (25,5; 59,2), what was 6,1 times more than in 1311 asymptomatic volunteers - 6,8% (5,5; 8,3)². Two patients with most severe urticaria had duodenal ulcer. Despite these facts, only 23 patients (15,3%) reported mild gastrointestinal complaints after thorough questioning.

All 26 HP-positive patients received eradication therapy, and 4 HP-negative patients with EU received only antacid and antisecretory therapy. Second HP-determination by PCR after the therapy was carried out only in 13 patients with chronic spontaneous urticaria (11 HP-positive and 2 HP-negative at first UGIE, 10 patients with EU), as only 13 agreed for a new examination. Where in 7 from 11 HP-positive patients eradication was successful, and in 4 failed. From 7 patients with successful eradication remission was achieved in 2 cases, and in 5 cases there was no remission. In 4 patients with failed eradication remission was achieved also in 2 cases, and in 2 cases there was no remission. Fisher exact test with 1-tailed p=0,47, 2-tailed p=0,58 showed highly insignificant result of eradication therapy in the treatment of urticaria in followed patients.

At second UGIE, 3 patients from 10 with EU appeared with healed erosions. All of them showed complete remission of symptoms. Whereas 7 patients with unhealed EU, had no improvement at all. Fisher exact test showed significant difference with 1-tailed and 2-tailed p=0,008. Patients with acute spontaneous urticaria were not included in the statistical tests due to high possibility of spontaneous remission.

Conclusions. Erosions of upper gastrointestinal mucosa seem to have a very important role in the development of spontaneous urticaria, independently from HP.

References:

1. German SV, Zykova IE, Modestova AV, Ermakov NV. Epidemiological characteristics of Helicobacter pylori infection in Moscow. Gig Sanit2011;(1):44-8

2. Toljamo K. Gastric Erosions - Clinical Significance and Pathology. A long-term Follow-up Study. Acta Universitatis Ouluensis. D, Medica (1152). University of Oulu, 2012. p. 27.

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