Two Diseases and One Biopsy: Navigating the Diagnostic Overlap between Helicobacter Pylori Gastritis and Celiac Disease

Purpose: The duodenal biopsy has dual responsibilities: detecting celiac disease and sampling adjacent gastric mucosa for Helicobacter pylori. When both conditions coexist, pathologists and clinicians face interpretive challenges that affect patient management. This study describe the clinicopathological features of concurrent H. pylori infection and celiac disease, highlighting
diagnostic pitfalls and implications for clinical practice. 
Materials and Methods: We identified three patients with histological evidence of both conditions from 2023–2024 pathology records at private laboratories in Zawia city, Libya. Clinical presentations, endoscopic findings, serological data, and histopathological features 
were analyzed. 
Results: All three patients presented with abdominal pain and anemia; two had positive celiac serology prompting biopsy. Histology revealed villous atrophy (Marsh 3a-3c) alongside H. pylori-associated gastritis of varying severity. The diagnostic sequence determining which condition dominated clinical symptoms proved complex, with H. pylori potentially confounding celiac assessment and vice versa. 
Conclusion: Concurrent H. pylori and celiac disease create diagnostic ambiguity that requires careful histopathological evaluation and clinical correlation. Recognition of this overlap prevents under diagnosis and guides appropriate dual therapy. (Open J Biomed Res 2024;3:21-25)