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1
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Panozzo MP, Antico A, Bizzaro N. Monitoring the follow-up of autoimmune chronic atrophic gastritis using parietal cell antibodies and markers of gastric function. J Transl Autoimmun 2025; 10:100273. [PMID: 39917315 PMCID: PMC11800024 DOI: 10.1016/j.jtauto.2025.100273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2024] [Revised: 01/14/2025] [Accepted: 01/20/2025] [Indexed: 02/09/2025] Open
Abstract
Increased interest in the pathogenesis and the evolution of autoimmune chronic atrophic gastritis (A-CAG) has led to the search for serological markers that can be used to detect changes in the gastric mucosa at an early stage and to monitor the course of the disease. Parietal cell autoantibodies have been proposed as suitable immunological markers of atrophic damage, as they can be detected in the serum when symptoms of gastritis are not yet present. However, the utility of measuring only the level of parietal cell autoantibodies in the follow-up of A-CAG does not appear to suffice. Recent evidence has suggested that, in monitoring A-CAG, parietal cell antibodies should be associated with an evaluation of gastric function through biochemical and hormonal tests, such as pepsinogens and gastrin 17. This integrated approach will allow for the more effective real-time monitoring of the state of the gastric mucosa. As A-CAG is a progressive disorder associated with an increased risk of gastric cancer and neuroendocrine tumors, the precise follow-up of patients with gastric atrophy needs to be better defined. Further longitudinal studies in large cohorts must be performed with long-term follow-up.
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Affiliation(s)
| | - Antonio Antico
- Department of Laboratory Medicine, AULSS2 Marca Trevigiana, Treviso, Italy
| | - Nicola Bizzaro
- Laboratory of Clinical Pathology, Azienda Sanitaria Universitaria Integrata, Udine, Italy
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2
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Kishikawa H, Nishida J. Gastric cancer in patients with Helicobacter pylori-negative autoimmune gastritis. World J Gastrointest Oncol 2025; 17:101661. [DOI: 10.4251/wjgo.v17.i4.101661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2024] [Revised: 01/06/2025] [Accepted: 01/20/2025] [Indexed: 03/25/2025] Open
Abstract
Although Helicobacter pylori (H. pylori) is implicated in the development of most cases of gastric cancer with autoimmune gastritis, cases of gastric cancer have been reported in patients testing negative for H. pylori. Here, we aimed to outline the current research status of the factors involved in the development of gastric cancer in H. pylori-negative autoimmune gastritis. Predictive pathological conditions for the development of gastric cancer in H. pylori-negative autoimmune gastritis are postulated to be: (1) Severe atrophy; (2) Hypergastrinemia; (3) Bile reflux; and (4) Low acidity, which are directly related to the pathophysiology of autoimmune gastritis, as well as smoking and family history, which are not related to autoimmune gastritis. In autoimmune gastritis, where there is a possibility of spontaneous disappearance of H. pylori in advanced atrophy, it is difficult to assess H. pylori. Since H. pylori infection begins in the antrum and subsequently progresses to the proximal stomach, it is interpreted as H. pylori-negative autoimmune gastritis if histologically consistent with autoimmune gastritis in the body with spared antrum, and negative for other H. pylori tests. However, it is essential to examine whether the currently prevailing histological interpretation used to evaluate H. pylori infection status is appropriate.
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Affiliation(s)
- Hiroshi Kishikawa
- Department of Gastroenterology, Ichikawa General Hospital, Tokyo Dental College, Ichikawa 272-8513, Chiba, Japan
| | - Jiro Nishida
- Department of Gastroenterology, Ichikawa General Hospital, Tokyo Dental College, Ichikawa 272-8513, Chiba, Japan
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3
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Li D, Morgan DR, Corral JE, Montgomery EA, Riquelme A, Shah SC. Gastric Cancer Screening in the United States: A Review of Current Evidence, Challenges, and Future Perspectives. Am J Gastroenterol 2025:00000434-990000000-01527. [PMID: 40072512 DOI: 10.14309/ajg.0000000000003301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2024] [Accepted: 12/18/2024] [Indexed: 03/14/2025]
Abstract
Gastric cancer remains a leading cause of cancer-related mortality worldwide. In the United States, gastric cancer incidence and mortality are substantially higher among non-White racial and ethnic groups and new immigrants from high-incidence countries. This is in large part related to the higher prevalence of Helicobacter pylori-associated gastric premalignant changes in these populations. Apart from primary prevention, early detection of gastric cancer is the principal strategy to reduce gastric cancer mortality and improve survival. Extensive evidence in Asian countries has demonstrated the benefits of endoscopic screening in detecting early-stage gastric cancer and reducing gastric cancer-related mortality. By contrast, direct, high-quality US-based data, such as from large clinical trials or observational studies, on important outcomes of gastric cancer screening are still lacking. In this review, we evaluate and summarize the latest global evidence on the epidemiology and predisposing factors of gastric cancer as well as the efficacy, benefits vs. risks, and cost-effectiveness of gastric cancer screening. We further discuss the critical knowledge gaps and challenges in promoting gastric cancer screening in the United States. Dedicated research is urgently needed to enrich the US-based data on gastric cancer primary and secondary prevention to inform clinical practice and reduce gastric cancer-related morbidity and mortality in a cost and resource efficient manner.
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Affiliation(s)
- Dan Li
- Department of Gastroenterology, Kaiser Permanente Medical Center, Santa Clara, California, USA
- Kaiser Permanente Northern California Division of Research, Oakland, California, USA
| | - Douglas R Morgan
- Division of Gastroenterology, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Juan E Corral
- Division of Gastroenterology, Prisma Health, Greenville, South Carolina, USA
| | - Elizabeth A Montgomery
- Department of Pathology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Arnoldo Riquelme
- Department of Gastroenterology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Center for Control and Prevention of Cancer (CECAN), Santiago, Chile
| | - Shailja C Shah
- Division of Gastroenterology, University of California, San Diego, La Jolla, California, USA
- Gastroenterology Section, Jennifer Moreno Department of Veterans Affairs Medical Center, La Jolla, California, USA
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4
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Gunchenko M, Shapiro C, Jain S, Doozandeh H. Aplastic anaemia, pernicious anaemia and autoimmune thyroiditis following an episode of EBV-associated hepatitis. BMJ Case Rep 2025; 18:e262950. [PMID: 40000037 DOI: 10.1136/bcr-2024-262950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2025] Open
Abstract
Epstein-Barr virus (EBV) affects over 90% of the global population and has been linked to several autoimmune disorders. This report describes a patient with EBV-associated hepatitis who subsequently developed aplastic anaemia, pernicious anaemia and autoimmune thyroiditis. The patient was treated with an immunosuppressive regimen with gradual improvement in his pancytopenia and autoimmune thyroiditis. This report highlights the importance of a comprehensive evaluation and close monitoring of patients presenting with acute or recent EBV infection. Clinicians are urged to recognise autoimmune sequelae, as early intervention can be life-saving.
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MESH Headings
- Humans
- Male
- Anemia, Pernicious/complications
- Anemia, Pernicious/diagnosis
- Anemia, Pernicious/drug therapy
- Anemia, Aplastic/complications
- Thyroiditis, Autoimmune/complications
- Thyroiditis, Autoimmune/diagnosis
- Epstein-Barr Virus Infections/complications
- Epstein-Barr Virus Infections/diagnosis
- Immunosuppressive Agents/therapeutic use
- Hepatitis, Viral, Human/virology
- Hepatitis, Viral, Human/diagnosis
- Hepatitis, Viral, Human/drug therapy
- Adult
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Affiliation(s)
- Melissa Gunchenko
- Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Chandler Shapiro
- Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Shivi Jain
- Internal Medicine, Hematology/Oncology, Rush University Medical Center, Chicago, Illinois, USA
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5
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Thain A, Hart K, Ahmadi KR. Addressing the Gaps in the Vitamin B12 Deficiency 2024 NICE Guidelines: Highlighting the Need for Better Recognition, Diagnosis, and Management of Pernicious Anaemia. Eur J Clin Nutr 2025:10.1038/s41430-025-01583-4. [PMID: 39984701 DOI: 10.1038/s41430-025-01583-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2024] [Revised: 01/28/2025] [Accepted: 02/11/2025] [Indexed: 02/23/2025]
Abstract
The 2024 NICE guidelines on vitamin B12 deficiency have significant implications for the diagnosis and management of pernicious anaemia (PA), the commonest non-dietary cause of such deficiency. This perspective discusses the guidelines in relation to PA itself, suggests that clearer diagnostic protocols are required, and calls for clinician education to improve the patient journey for those with PA.
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Affiliation(s)
- Alfie Thain
- School of Biosciences, Faculty of Health & Medical Sciences University of Surrey, Guildford, UK.
| | - Kathryn Hart
- School of Biosciences, Faculty of Health & Medical Sciences University of Surrey, Guildford, UK
| | - Kourosh R Ahmadi
- School of Biosciences, Faculty of Health & Medical Sciences University of Surrey, Guildford, UK
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6
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Chen Y, Ji X, Zhao W, Lin J, Xie S, Xu J, Mao J. A real-world study on the characteristics of autoimmune gastritis: A single-center retrospective cohort in China. Clin Res Hepatol Gastroenterol 2025; 49:102556. [PMID: 39961485 DOI: 10.1016/j.clinre.2025.102556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2024] [Revised: 02/05/2025] [Accepted: 02/15/2025] [Indexed: 02/22/2025]
Abstract
BACKGROUND AND AIM Autoimmune gastritis (AIG) was previously considered a rare disease in China, and its clinical characteristics were not fully understood. This study aimed to demonstrate the characteristics of AIG in China and evaluate gastric oxyntic mucosal atrophy using a modified AIG-atrophic staging. METHODS This was a single-center retrospective observational real-world study. The diagnosis of AIG was based on pathological results combined with parietal cell antibody (PCA) and intrinsic factor antibody (IFA) results, and endoscopic findings. RESULTS A total of 745 patients were enrolled, the median age at diagnosis was 58 years old, and 69.9 % were female. The symptoms of AIG patients were nonspecific, and about 2/5 of the cases were asymptomatic. The proportions of cases from modified AIG-atrophic stage 1 to 4 were 0.8 %, 14.1 %, 73.8 %, and 11.3 %, respectively. Approximately 1/5 had autoimmune thyroiditis (AITD). Near 1/2 had one or more comorbidities: iron-deficiency anemia (IDA), pernicious anemia (PA), neuropathy, gastric hyperplastic polyps (GHP), gastric intraepithelial neoplasia (GIN), type 1 gastric neuroendocrine tumors (g-NET), or gastric adenocarcinoma (GAC). There was a high risk of type 1 g-NET (7.0 %) and GAC (9.1 %) in AIG patients. CONCLUSIONS AIG is not rare in China, and its early diagnosis is challenging, accompanied by a high risk of GAC. The modified four-stage AIG-atrophic staging can effectively represent the extent of oxyntic mucosal atrophy and the progression in AIG.
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Affiliation(s)
- Yu Chen
- Department of Gastroenterology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaowei Ji
- Department of Gastroenterology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Weiyi Zhao
- Department of Pathology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jie Lin
- Department of Gastroenterology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Siyuan Xie
- Department of Gastroenterology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jinghong Xu
- Department of Pathology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jianshan Mao
- Department of Gastroenterology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
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Khalaf K, Fujiyoshi Y, Bechara R. Endoscopic and clinical characteristics of autoimmune atrophic gastritis: Retrospective study. Endosc Int Open 2025; 13:a24774666. [PMID: 40012571 PMCID: PMC11863545 DOI: 10.1055/a-2477-4666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 11/19/2024] [Indexed: 02/28/2025] Open
Abstract
Background and study aims Autoimmune atrophic gastritis (AIG) is a rare chronic autoimmune disease characterized by gastric mucosa inflammation and atrophy. Limited clinical data exist about AIG, especially in western populations. In addition, there are no western series on the magnifying endoscopic features in AIG. This study presents a cohort of 63 patients with AIG, reporting their clinical, laboratory, and endoscopic findings. Patients and methods A retrospective analysis was conducted on patients diagnosed with AIG at Kingston Health Sciences Centre, Canada, between January 2016 and December 2023. Data collected from medical records included age, sex, presenting symptoms, laboratory findings, endoscopic features, histopathology reports, and concomitant autoimmune diseases. Results The study included 63 patients with autoimmune gastritis. Positive anti-parietal cell antibodies were found in the majority of patients (84.13%), whereas positive anti-intrinsic factor antibodies were less prevalent (25.40%). Deficiencies in vitamin B12 (49.21%) and iron (76.19%) were observed, along with a high prevalence of anemia (71.43%) and concomitant autoimmune diseases (58.73%). The dominant magnification pattern of atrophy in the body was oval/slit in 57.14% of patients (n=36), followed by tubular in 30.16% (n=19) and foveolar in 12.70% (n=8). Prevalence of neoplasia in our study was 42.86% (n=27). Conclusion This study offers insights into the clinical, laboratory, and magnifying endoscopic features of patients with AIG. It demonstrates the three main magnifying endoscopic appearances of AIG and highlights the significant prevalence of gastric neoplasia, even in the low-risk Western population. These findings emphasize the importance of the endoscopic exam in identifying AIG and notably present the key magnifying endoscopy findings in a Western setting for the first time.
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Affiliation(s)
- Kareem Khalaf
- Division of Gastroenterology, St Michael's Hospital, Toronto, Canada
| | - Yusuke Fujiyoshi
- Division of Gastroenterology, The Ottawa Hospital, University of Ottawa, The Ottawa Hospital Foundation, Ottawa, Canada
| | - Robert Bechara
- Gastroenterology, Kingston Health Sciences Centre, Kingston, Canada
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Massironi S, Gallo C, Lahner E, Sciola V, Cavalcoli F, Lenti MV, Zilli A, Dottori L, De Rossi G, Miceli E, Annibale B, Vecchi M, Cantù P, Di Sabatino A, Invernizzi P, Danese S. Occurrence and characteristics of endoscopic gastric polyps in patients with autoimmune gastritis (AGAPE study): A multicentric cross-sectional study. Dig Liver Dis 2025; 57:198-205. [PMID: 39112216 DOI: 10.1016/j.dld.2024.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Revised: 07/06/2024] [Accepted: 07/22/2024] [Indexed: 09/20/2024]
Abstract
BACKGROUND Autoimmune gastritis (AIG) leads to increased gastrin (G) levels due to hypo-achlorhydria, providing proliferative stimuli on the gastric mucosa. AIMS To evaluate the incidence and characteristics of gastric polyps in AIG patients across six tertiary centers in Italy. METHODS A multicentric, cross-sectional study enrolled patients with AIG diagnosed from January 2000 to June 2023, who underwent at least one endoscopy. Data on demographics, clinical history, biochemical profiles, and endoscopic and histopathological findings were systematically collected. RESULTS Among 612 AIG patients followed for a median of 4 years, 222 (36.3 %) developed at least one gastric polyp. Of these, 214 were non-endocrine lesions detected in 162 patients, including 151 inflammatory (70.5 %), 29 adenomatous (13.6 %), 18 fundic gland polyps (8.4 %), 13 adenocarcinomas (6.1 %), and one MALT lymphoma. Additionally, 108 patients had gastric neuroendocrine neoplasms (gNENs), with 48 also having non-endocrine polyps. Older age and higher gastrin and chromogranin A levels were associated with polyp occurrence. No differences in OLGA/OLGIM stages or Helicobacter pylori status were noted among patients with and without lesions. CONCLUSION This large multicentric study underscores the substantial occurrence of gastric polyps in AIG patients, including notable rates of gNENs and adenocarcinomas, emphasizing the importance of proactive endoscopic surveillance and histopathological examination for effective management.
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Affiliation(s)
- Sara Massironi
- Division of Gastroenterology IRCCS San Gerardo dei Tintori Monza, MB, Italy and Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
| | - Camilla Gallo
- Division of Gastroenterology IRCCS San Gerardo dei Tintori Monza, MB, Italy and Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Edith Lahner
- Sapienza University of Rome, Dept Medical-surgical sciences and translational medicine, Rome, Italy
| | - Valentina Sciola
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Gastroenterology and Endoscopy Unit, Milan, Italy
| | - Federica Cavalcoli
- Gastroenterology and Digestive Endoscopy Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy
| | - Marco Vincenzo Lenti
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy; First Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alessandra Zilli
- Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele, Milan, Italy, and Vita-Salute San Raffaele University, Milan, Italy
| | - Ludovica Dottori
- Sapienza University of Rome, Dept Medical-surgical sciences and translational medicine, Rome, Italy
| | - Gaia De Rossi
- Sapienza University of Rome, Dept Medical-surgical sciences and translational medicine, Rome, Italy
| | - Emanuela Miceli
- First Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Bruno Annibale
- Sapienza University of Rome, Dept Medical-surgical sciences and translational medicine, Rome, Italy
| | - Maurizio Vecchi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Gastroenterology and Endoscopy Unit, Milan, Italy
| | - Paolo Cantù
- Gastroenterology and Digestive Endoscopy Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy
| | - Antonio Di Sabatino
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy; First Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Pietro Invernizzi
- Division of Gastroenterology IRCCS San Gerardo dei Tintori Monza, MB, Italy and Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Silvio Danese
- Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele, Milan, Italy, and Vita-Salute San Raffaele University, Milan, Italy
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Chen F, Gonzalez RS. Evaluation of enterochromaffin-like cell hyperplasia can help categorize patients with Helicobacter-negative atrophic gastritis. Am J Clin Pathol 2024:aqae159. [PMID: 39724194 DOI: 10.1093/ajcp/aqae159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Accepted: 12/19/2024] [Indexed: 12/28/2024] Open
Abstract
OBJECTIVES Atrophic gastritis (AG) is characterized by atrophy of gastric glands-in particular, oxyntic glands-in the setting of chronic inflammation; it is often autoimmune. The diagnosis is confirmed by immunohistochemistry (IHC) for gastrin (to confirm biopsy site), and pathologists often use IHC for neuroendocrine markers to evaluate for enterochromaffin-like cell hyperplasia (ECL-H). The utility of neuroendocrine staining is unclear, and we undertook this study to determine whether ECL pattern provided any additional information in cases of Helicobacter-negative AG. METHODS We reviewed clinicopathologic findings in 184 cases from 184 patients with histologic AG and no evidence of Helicobacter infection. Using neuroendocrine IHC markers, cases were divided into 3 groups: Group 1 showed complete ECL-H (both qualitative and quantitative criteria met), group 2 showed focal ECL-H (qualitative but not quantitative criteria met), and group 3 showed no ECL-H (neither criteria met). RESULTS Group 1 patients were more likely to have positive autoantibody serologies (73%, P = .0007 vs group 2) and higher mean gastrin levels (700 pg/mL, P = .017 vs group 3), and only these patients developed gastric neuroendocrine tumors. Group 2 patients were more likely to take proton pump inhibitors (64%, P = .0002 vs group 1). Group 3 patients were more likely to be male (70%, P = .008 vs group 1) and to have microcytic anemia (44%, P = .022 vs group 2) and less likely to have intestinal metaplasia (50%, P = .044 vs group 1). CONCLUSIONS Stratification based on degree of ECL-H is not necessary for diagnosis of AG but does lead to statistically significant clinical and pathologic differences among groups.
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Affiliation(s)
- Feidi Chen
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA, US
| | - Raul S Gonzalez
- Department of Pathology and Laboratory Medicine, Emory University Hospital, Atlanta, GA, US
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10
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Poveda JC, Park JY, Garcia-Buitrago MT, Singhi A, Alruwaii Z, Kumar S, McDonald OG, Montgomery EA. Autoimmune Metaplastic Atrophic Gastritis (AMAG): Regional Demographics and Their Effect on Prevalence. Int J Surg Pathol 2024:10668969241271311. [PMID: 39350751 DOI: 10.1177/10668969241271311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2025]
Abstract
Autoimmune metaplastic atrophic gastritis (AMAG) is a chronic immune-mediated form of gastritis characterized by damage to oxyntic cells, ultimately resulting in both iron deficiency with or without anemia and pernicious anemia. The current dogma is that AMAG is a disease of White Northern European women of advanced age. We, therefore, sought to examine the prevalence of AMAG in biopsies obtained from populations enriched for self-identified Hispanics for cross-comparison against data from previously reported populations enriched for self-identified White, non-Hispanic patients. To that end, we prospectively collected 1708 sequential gastric biopsies performed at the University of Miami Hospitals/Jackson Health Systems clinics from 1692 patients over a 1-year period as well as pertinent clinical parameters. These Florida data were then compared against data previously collected from the Baltimore population, which has far lower numbers of Hispanic patients. Self-identified race and/or ethnicity were used. From these 1692 patients, we identified 79 patients (4.6%) with AMAG. These included 60 women (76%) and 19 men (24%), with a F:M ratio of 3.1:1. Patients had a median age of 60 years (range: 15-83). Self-identified race and/or ethnicity were: 60 (76.0%) Hispanic, 9 (11.4%) Black, 9 (11.4%) White, and 1 Asian (1.2%). The median age at initial presentation was: 51 years (range: 15-83) in Hispanics, 77.2 years (range: 46-74) in Blacks, 59 years (range: 49-79) in Whites, and 58 years in the only Asian patient. The overall demographics of AMAG largely mirrored the Florida population, with an over-representation of Hispanics (Florida inhabitants self-report as 70% Hispanic). The overall 4.6% prevalence of AMAG in the Florida population differed significantly from the 1.1% in Baltimore (p < .00001), a finding that presumably reflects the large Hispanic population. In fact, the prevalence of AMAG is far higher in Hispanic patients. Awareness of these data should increase recognition of AMAG in this population.
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Affiliation(s)
- Julio C Poveda
- Department of Pathology, University of Miami Health Systems, Jackson Health Systems and Jackson Memorial Hospital Miami, FL, USA
| | - Jason Y Park
- Department of Pathology and the Eugene McDermott Center for Human Growth and Development, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Monica T Garcia-Buitrago
- Department of Pathology, University of Miami Health Systems, Jackson Health Systems and Jackson Memorial Hospital Miami, FL, USA
| | - Aatur Singhi
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Zainab Alruwaii
- Department of Pathology, Dammam Regional Laboratory and Blood Blank, Kingdom of Saudi Arabia
| | - Shria Kumar
- Division of Digestive Health and Liver Diseases, Department of Medicine, Miller School of Medicine at the University of Miami, Miami, FL, USA
- Division of Gastroenterology, University of Miami Health Systems, Jackson Health Systems, and Jackson Memorial Hospital Miami, FL, USA
| | - Oliver G McDonald
- Department of Pathology, University of Miami Health Systems, Jackson Health Systems and Jackson Memorial Hospital Miami, FL, USA
| | - Elizabeth A Montgomery
- Department of Pathology, University of Miami Health Systems, Jackson Health Systems and Jackson Memorial Hospital Miami, FL, USA
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11
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Kubo T, Adachi Y, Sasaki Y, Adachi Y, Yoshida Y, Endo T, Ishii Y, Takahashi H, Goto A. Synchronous cancers of the stomach and esophagus in a patient with autoimmune gastritis and pernicious anemia: a case report and review of the literature. Int Cancer Conf J 2024; 13:367-373. [PMID: 39398913 PMCID: PMC11465013 DOI: 10.1007/s13691-024-00689-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 05/24/2024] [Indexed: 10/15/2024] Open
Abstract
Type-A gastritis/autoimmune gastritis (AIG) has gained renewed attention due to declining Helicobacter pylori infection rates and increasing eradication. AIG is associated with pernicious anemia (PA) and is prone to complicate various tumors, such as gastric cancer and neuroendocrine tumors. This report describes a case of AIG with PA in which gastric and esophageal cancers arose simultaneously. An 86-year-old woman had been diagnosed with PA and AIG 9 years earlier. As routine blood tests revealed high levels of carcinoembryonic antigen, she underwent esophagogastroduodenoscopy, which revealed a type 0-IIa lesion in the middle part of the stomach and a type 0-IIa + IIb lesion in the lower esophagus. Endoscopic submucosal dissection was performed on both lesions, since neither distant nor lymph node metastases were identified. Histological examination showed gastric tubular adenocarcinoma and esophageal squamous cell carcinoma. Immunohistology revealed that cells from neither cancer expressed gastrin, gastrin receptor, or p53. Whole-exome sequencing showed 8 gene mutations in the esophageal cancer and 6 mutations in 5 genes in the gastric cancer. The reason for the lack of p53 immunostaining was that TP53 was mutated in these cancers, although TP53 mutations differed. Thus, TP53 mutations may not be detected by immunostaining alone. When treating patients with AIG/PA, clinicians must be aware of the possibility of esophageal cancer coexisting with gastric cancer.
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Affiliation(s)
- Toshiyuki Kubo
- Division of Gastroenterology, Department of Internal Medicine, Sapporo Shirakaba-dai Hospital, 2-18 Tsukisamu-Higashi, Toyohira-Ku, Sapporo, 062-0052 Japan
| | - Yasushi Adachi
- Division of Gastroenterology, Department of Internal Medicine, Sapporo Shirakaba-dai Hospital, 2-18 Tsukisamu-Higashi, Toyohira-Ku, Sapporo, 062-0052 Japan
- Department of Gastroenterology and Hepatology, Sapporo Medical University School of Medicine, S-1, W-16, Chuo-Ku, Sapporo, 060-8543 Japan
| | - Yasushi Sasaki
- Department of Biology, Sapporo Medical University School of Medicine, S-1, W-16, Chuo-Ku, Sapporo, 060-8543 Japan
| | - Yasuyo Adachi
- Division of Gastroenterology, Department of Internal Medicine, Sapporo Shirakaba-dai Hospital, 2-18 Tsukisamu-Higashi, Toyohira-Ku, Sapporo, 062-0052 Japan
| | - Yukinari Yoshida
- Division of Gastroenterology, Department of Internal Medicine, Sapporo Shirakaba-dai Hospital, 2-18 Tsukisamu-Higashi, Toyohira-Ku, Sapporo, 062-0052 Japan
| | - Takao Endo
- Division of Gastroenterology, Department of Internal Medicine, Sapporo Shirakaba-dai Hospital, 2-18 Tsukisamu-Higashi, Toyohira-Ku, Sapporo, 062-0052 Japan
| | - Yoshifumi Ishii
- Department of Pathology, Sapporo Shirakaba-dai Hospital, 2-18 Tsukisamu-Higashi, Toyohira-Ku, Sapporo, 062-0052 Japan
| | - Hiroaki Takahashi
- Department of Gastroenterology and Hepatology, Keiyukai-daini Hospital, Hondori 13-chome kita7-1, Shiroishi-Ku, Sapporo, 003-0027 Japan
| | - Akira Goto
- Division of Gastroenterology, Department of Internal Medicine, Sapporo Shirakaba-dai Hospital, 2-18 Tsukisamu-Higashi, Toyohira-Ku, Sapporo, 062-0052 Japan
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12
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Tonegato M, Panozzo MP, Antico A, Bizzaro N. Improving the Diagnosis of Autoimmune Gastritis: From Parietal Cell Antibodies to H+/K+ ATPase Antibodies. Diagnostics (Basel) 2024; 14:1721. [PMID: 39202208 PMCID: PMC11354099 DOI: 10.3390/diagnostics14161721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2024] [Accepted: 08/05/2024] [Indexed: 09/03/2024] Open
Abstract
Parietal cell autoantibodies (PCAs), which recognize the enzyme H+/K+-ATPase as a target, are considered to be a diagnostic marker of autoimmune gastritis and pernicious anemia; these conditions are characterized by the presence of corpus atrophic gastritis. Circulating PCAs can be detected using several analytical methods that are commonly available in the clinical laboratory. Traditionally, indirect immunofluorescence (IIF) on rodent or primate stomach tissue is used as a screening test for the detection of PCAs. However, IIF suffers from a high inter-observer variability and lacks standardization. In addition, like immunoblotting, results are expressed only in a qualitative or semi-quantitative manner. Based on the few available studies that are reviewed herein, quantitative enzyme-linked immunosorbent assays (ELISAs) and fluorescence enzyme immunoassays (FEIAs) using purified H+/K+-ATPase perform better than IIF in the detection of PCAs, displaying higher sensitivity and utility in monitoring the disease. In light of their higher diagnostic accuracy, these solid-phase methods should be preferred to IIF in the screening of autoimmune atrophic gastritis. The use of methods to detect antibodies versus a specific subunit of H+/K+-ATPase (α or β) is currently confined to the world of research. Further investigation is required to define the clinical utility of H+/K+-ATPase subunit detection.
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Affiliation(s)
- Michela Tonegato
- Department of Laboratory Medicine, AULSS2 Marca Trevigiana, 31100 Treviso, Italy; (M.T.); (A.A.)
| | - Maria Piera Panozzo
- Department of Laboratory Medicine, AULSS7 Pedemontana, 36061 Santorso, Italy;
| | - Antonio Antico
- Department of Laboratory Medicine, AULSS2 Marca Trevigiana, 31100 Treviso, Italy; (M.T.); (A.A.)
| | - Nicola Bizzaro
- Laboratory of Clinical Pathology, Azienda Sanitaria Universitaria Integrata, 33100 Udine, Italy
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13
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Yuan F, Huang Z, Yao D, Sun J. A Case of Pernicious Anemia with Concurrent Beta-Thalassemia Minor. J Blood Med 2024; 15:351-357. [PMID: 39132285 PMCID: PMC11317050 DOI: 10.2147/jbm.s473075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 07/23/2024] [Indexed: 08/13/2024] Open
Abstract
Vitamin B12 is essential for various bodily functions, and its deficiency may cause hematological manifestations. We report a case of a previously healthy 65-year-old female who was admitted to our hospital with reduced sense of taste and painful tongue. The serum level of vitamin B12 was decreased. However, her complete blood count did not show any evidence of macrocytosis, instead, her mean corpuscular volume was low. Gene sequencing indicated an β-thalassemia minor and that probably masked the megaloblastic features of vitamin B12 deficiency.
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Affiliation(s)
- Fuzhen Yuan
- Department of General Practice, Longgang District Central Hospital of Shenzhen, Shenzhen, 5181116, People’s Republic of China
| | - Zhenhua Huang
- Department of General Practice, Longgang District Central Hospital of Shenzhen, Shenzhen, 5181116, People’s Republic of China
- Shenzhen Clinical College of Medicine, Guangzhou University of Chinese Medicine, Shenzhen, 5181116, People’s Republic of China
| | - Dingye Yao
- Department of General Practice, Longgang District Central Hospital of Shenzhen, Shenzhen, 5181116, People’s Republic of China
- Shenzhen Clinical College of Medicine, Guangzhou University of Chinese Medicine, Shenzhen, 5181116, People’s Republic of China
| | - Junsheng Sun
- Department of General Practice, Longgang District Central Hospital of Shenzhen, Shenzhen, 5181116, People’s Republic of China
- Shenzhen Clinical College of Medicine, Guangzhou University of Chinese Medicine, Shenzhen, 5181116, People’s Republic of China
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14
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Castellana C, Eusebi LH, Dajti E, Iascone V, Vestito A, Fusaroli P, Fuccio L, D’Errico A, Zagari RM. Autoimmune Atrophic Gastritis: A Clinical Review. Cancers (Basel) 2024; 16:1310. [PMID: 38610988 PMCID: PMC11010983 DOI: 10.3390/cancers16071310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 03/22/2024] [Accepted: 03/26/2024] [Indexed: 04/14/2024] Open
Abstract
Autoimmune atrophic gastritis (AAG) is a chronic condition characterized by the presence of atrophy in the oxyntic mucosa due to anti-parietal cell antibodies. This review provides a comprehensive and up-to-date overview of autoimmune atrophic gastritis, reporting recent evidence on epidemiology, pathogenesis, diagnosis, clinical presentation, risk of malignancies, and management. The prevalence of AAG has been estimated at between 0.3% and 2.7% in the general population. The diagnosis of AAG is based on a combination of the serologic profile and the histological examination of gastric biopsies. Patients with AAG are often asymptomatic but can also have dyspeptic or reflux symptoms. The atrophy of the oxyntic mucosa leads to iron and vitamin B12 malabsorption, which may result in anemia and neurological affections. Autoimmune atrophic gastritis is associated with an increased risk of type I neuroendocrine tumors (NETs) and gastric cancer, with an incidence rate of 2.8% and 0.5% per person/year, respectively. Management is directed to reinstate vitamins and iron and to prevent malignancies with endoscopic surveillance. In conclusion, atrophic autoimmune gastritis is an infrequent condition, often asymptomatic and misdiagnosed, that requires an early diagnosis for appropriate vitamin supplementation and endoscopic follow-up for the early diagnosis of NETs and gastric cancer.
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Affiliation(s)
- Chiara Castellana
- Department of Medical Sciences and Surgery, University of Bologna, 40138 Bologna, Italy; (C.C.); (L.H.E.); (E.D.); (V.I.); (L.F.); (A.D.)
- Gastroenterology Unit, IRCCS—Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Leonardo Henry Eusebi
- Department of Medical Sciences and Surgery, University of Bologna, 40138 Bologna, Italy; (C.C.); (L.H.E.); (E.D.); (V.I.); (L.F.); (A.D.)
- Gastroenterology Unit, IRCCS—Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Elton Dajti
- Department of Medical Sciences and Surgery, University of Bologna, 40138 Bologna, Italy; (C.C.); (L.H.E.); (E.D.); (V.I.); (L.F.); (A.D.)
| | - Veronica Iascone
- Department of Medical Sciences and Surgery, University of Bologna, 40138 Bologna, Italy; (C.C.); (L.H.E.); (E.D.); (V.I.); (L.F.); (A.D.)
- Gastro-Esophageal Organic Diseases Unit, IRCCS—Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Amanda Vestito
- Gastroenterology Unit, IRCCS—Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Pietro Fusaroli
- Department of Medical Sciences and Surgery, University of Bologna, 40138 Bologna, Italy; (C.C.); (L.H.E.); (E.D.); (V.I.); (L.F.); (A.D.)
- Gastroenterology Unit, Hospital of Imola, 40026 Imola, Italy
| | - Lorenzo Fuccio
- Department of Medical Sciences and Surgery, University of Bologna, 40138 Bologna, Italy; (C.C.); (L.H.E.); (E.D.); (V.I.); (L.F.); (A.D.)
- Gastroenterology Unit, IRCCS—Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Antonietta D’Errico
- Department of Medical Sciences and Surgery, University of Bologna, 40138 Bologna, Italy; (C.C.); (L.H.E.); (E.D.); (V.I.); (L.F.); (A.D.)
- Pathology Unit, IRCCS—Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Rocco Maurizio Zagari
- Department of Medical Sciences and Surgery, University of Bologna, 40138 Bologna, Italy; (C.C.); (L.H.E.); (E.D.); (V.I.); (L.F.); (A.D.)
- Gastro-Esophageal Organic Diseases Unit, IRCCS—Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
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15
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Rugge M, Genta RM, Malfertheiner P, Dinis-Ribeiro M, El-Serag H, Graham DY, Kuipers EJ, Leung WK, Park JY, Rokkas T, Schulz C, El-Omar EM. RE.GA.IN.: the Real-world Gastritis Initiative-updating the updates. Gut 2024; 73:407-441. [PMID: 38383142 DOI: 10.1136/gutjnl-2023-331164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 12/18/2023] [Indexed: 02/23/2024]
Abstract
At the end of the last century, a far-sighted 'working party' held in Sydney, Australia addressed the clinicopathological issues related to gastric inflammatory diseases. A few years later, an international conference held in Houston, Texas, USA critically updated the seminal Sydney classification. In line with these initiatives, Kyoto Global Consensus Report, flanked by the Maastricht-Florence conferences, added new clinical evidence to the gastritis clinicopathological puzzle.The most relevant topics related to the gastric inflammatory diseases have been addressed by the Real-world Gastritis Initiative (RE.GA.IN.), from disease definitions to the clinical diagnosis and prognosis. This paper reports the conclusions of the RE.GA.IN. consensus process, which culminated in Venice in November 2022 after more than 8 months of intense global scientific deliberations. A forum of gastritis scholars from five continents participated in the multidisciplinary RE.GA.IN. consensus. After lively debates on the most controversial aspects of the gastritis spectrum, the RE.GA.IN. Faculty amalgamated complementary knowledge to distil patient-centred, evidence-based statements to assist health professionals in their real-world clinical practice. The sections of this report focus on: the epidemiology of gastritis; Helicobacter pylori as dominant aetiology of environmental gastritis and as the most important determinant of the gastric oncogenetic field; the evolving knowledge on gastric autoimmunity; the clinicopathological relevance of gastric microbiota; the new diagnostic horizons of endoscopy; and the clinical priority of histologically reporting gastritis in terms of staging. The ultimate goal of RE.GA.IN. was and remains the promotion of further improvement in the clinical management of patients with gastritis.
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Affiliation(s)
- Massimo Rugge
- Department of Medicine-DIMED, University of Padova, Padua, Italy
- Azienda Zero, Veneto Tumour Registry, Padua, Italy
| | - Robert M Genta
- Gastrointestinal Pathology, Inform Diagnostics Research Institute, Dallas, Texas, USA
- Pathology, Baylor College of Medicine, Houston, Texas, USA
| | - Peter Malfertheiner
- Medizinische Klinik und Poliklinik II, Ludwig Maximilian Universität Klinikum München, Munich, Germany
- Klinik für Gastroenterologie, Hepatologie und Infektiologie, Otto-von-Guericke Universität Magdeburg, Magdeburg, Germany
| | - Mario Dinis-Ribeiro
- Porto Comprehensive Cancer Center & RISE@CI-IPO, University of Porto, Porto, Portugal
- Gastroenterology Department, Portuguese Institute of Oncology of Porto, Porto, Portugal
| | - Hashem El-Serag
- Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas, USA
- Houston VA Health Services Research & Development Center of Excellence, Michael E DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
| | - David Y Graham
- Department of Medicine, Michael E DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
| | - Ernst J Kuipers
- Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Jin Young Park
- International Agency for Research on Cancer, Lyon, France
| | - Theodore Rokkas
- Gastroenterology, Henry Dunant Hospital Center, Athens, Greece
| | | | - Emad M El-Omar
- Microbiome Research Centre, University of New South Wales, Sydney, New South Wales, Australia
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16
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Kiryukhin AP, Tertychnyy AS, Pavlov PV, Fedorenko AA, Nagornaya DP, Marenich NS, Losik EA, Yuryeva EY, Lapina TL. Autoimmune Gastritis: Focus on Endoscopic and Morphological Characteristics. RUSSIAN JOURNAL OF GASTROENTEROLOGY, HEPATOLOGY, COLOPROCTOLOGY 2024; 34:58-69. [DOI: 10.22416/1382-4376-2024-34-1-58-69] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2025]
Abstract
Aim: tosystematize the literature data on endoscopic semiotics and morphological changes in the gastric mucosa in autoimmune gastritis.Key points. Autoimmune gastritis is associated with an increased risk of developing adenocarcinoma and neuroendocrine tumours of the stomach. Clarification of diagnostic criteria for autoimmune gastritis is essential for gastroenterological practice. The diagnosis is based on the results of endoscopic and histological examination, and on data from laboratory tests. Isolated atrophy of the mucous membrane of the body of the stomach, the presence of difficult-to-wash creamy mucus, changes in the mucous membrane like “shed skin”, and the presence of whitish globule-like foci are typical endoscopic signs of autoimmune gastritis. Widespread pseudopyloric metaplasia, focal intestinal and pseudopancreatic metaplasia, hyperplasia of the ridges of the mucous membrane of the body of the stomach and their relationship to the glandular layer as in the antrum allow during a morphological study considering clinical data to suspect and verify autoimmune gastritis.Conclusion. During instrumental examination, knowledge of endoscopic symptoms and pathognomonic morphological changes is important for the timely diagnosis of autoimmune gastritis.
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Affiliation(s)
- A. P. Kiryukhin
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - A. S. Tertychnyy
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - P. V. Pavlov
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - A. A. Fedorenko
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - D. P. Nagornaya
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - N. S. Marenich
- Morozov Children's City Clinical Hospital of the Moscow Health Department
| | - E. A. Losik
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - E. Yu. Yuryeva
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - T. L. Lapina
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
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17
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Kriķe P, Appel MS, Shums Z, Poļaka I, Kojalo I, Rudzīte D, Tolmanis I, Kiršners A, Bogdanova I, Aleksandravica I, Norman GL, Leja M. Autoimmune gastritis serological biomarkers in gastric cancer patients. Eur J Cancer Prev 2024; 33:29-36. [PMID: 38167662 DOI: 10.1097/cej.0000000000000826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
The role of autoimmunity in the pathogenesis of gastric cancer remains controversial. We studied antiparietal cell antibody (anti-PCA) and anti-intrinsic factor antibody (anti-IFA) levels and their associations with pepsinogen I/pepsinogen II levels in patients with gastric adenocarcinoma compared to a control group with mild or no atrophy of the stomach mucosa. Plasma levels of anti-PCA and anti-IFA were measured by ELISA (Inova Diagnostics Inc, San Diego, California, USA). The cutoff value for anti-PCA and anti-IFA positivity was ≥25 units. Altogether 214 patients (126 men, 88 women, median age 64.46, range: 35-86) with confirmed gastric adenocarcinoma and 214 control cases paired for age and sex were included in the study. Positive anti-PCA was present in 22 (10.3%) gastric cancer patients and controls (P ≥ 0.999); positive anti-IFA in 6 (2.8%) and 4 (1.9.%), P < 0.232, respectively. We did not find significant differences in anti-PCA and anti-IFA positivity between gastric cancer patients and the control group; further investigation is required to better understand the potential involvement of autoimmune gastritis in the development of gastric cancer.
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Affiliation(s)
- Petra Kriķe
- Institute of Clinical and Preventive Medicine & Faculty of Medicine, University of Latvia
- Pauls Stradins Clinical University Hospital, Riga, Latvia
| | - Meret Sophia Appel
- Institute of Clinical and Preventive Medicine & Faculty of Medicine, University of Latvia
| | - Zakera Shums
- Headquarters & Technology Center Autoimmunity, Werfen, San Diego, California, USA
| | - Inese Poļaka
- Institute of Clinical and Preventive Medicine & Faculty of Medicine, University of Latvia
| | - Ilona Kojalo
- Institute of Clinical and Preventive Medicine & Faculty of Medicine, University of Latvia
| | | | | | - Arnis Kiršners
- Institute of Clinical and Preventive Medicine & Faculty of Medicine, University of Latvia
| | - Inga Bogdanova
- Institute of Clinical and Preventive Medicine & Faculty of Medicine, University of Latvia
- Riga East University Hospital
- Academic Histology Laboratory, Riga, Latvia
| | - Ilona Aleksandravica
- Institute of Clinical and Preventive Medicine & Faculty of Medicine, University of Latvia
| | - Gary L Norman
- Headquarters & Technology Center Autoimmunity, Werfen, San Diego, California, USA
| | - Mārcis Leja
- Institute of Clinical and Preventive Medicine & Faculty of Medicine, University of Latvia
- Riga East University Hospital
- Digestive Diseases Centre GASTRO
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18
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Kaibysheva V, Tykhonov S, Kashin S, Kuvaev R, Kraynova E, Baculina N, Fedorov E, Drapkina O. Algorithm of autoimmune gastritis diagnosis and treatment. RUSSIAN JOURNAL OF PREVENTIVE MEDICINE 2024; 27:101. [DOI: 10.17116/profmed202427091101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2025]
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19
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Chen YY, Guo WJ, Shi YF, Su F, Yu FH, Chen RA, Wang C, Liu JX, Luo J, Tan HY. Management of type 1 gastric neuroendocrine tumors: an 11-year retrospective single-center study. BMC Gastroenterol 2023; 23:440. [PMID: 38097952 PMCID: PMC10722838 DOI: 10.1186/s12876-023-03079-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 12/07/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Type 1 gastric neuroendocrine tumors (NETs) are relatively rare to the extent that some physicians have little experience in diagnosing and treating them. The purpose of this study was to increase the understanding of the disease by analyzing and summarizing the management and prognoses of patients with type 1 gastric NETs at our center. METHODS The data of 229 patients (59.4% female) with type 1 gastric NETs who were treated at our center during 2011-2022 were retrospectively analyzed. RESULTS The average patient age was 50.5 ± 10.8 years. Multiple tumors affected 72.5% of the patients; 66.4% of the tumors were < 1 cm, 69.4% were NET G1, and 2.2% were stage III-IV. A total of 76.9% of the patients had received endoscopic management, 60.7% had received traditional Chinese medicine treatment, 10.5% received somatostatin analogues treatment, and 6.6% underwent surgical resection. Seventy patients (41.2%) experienced the first recurrence after a median follow-up of 31 months (range: 2-122 months), and the median recurrence-free time was 43 months. The 1-, 2-, and 3-year cumulative recurrence-free survival rates were 71.8%, 56.8%, and 50.3%, respectively. During a median follow-up of 39 months (range: 2-132 months), one patient had bilateral pulmonary metastasis, and no disease-related deaths were observed. CONCLUSION Type 1 gastric NETs have a high recurrence rate and a long disease course, underscoring the importance of long-term and comprehensive management.
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Affiliation(s)
- Ying-Ying Chen
- Beijing University of Chinese Medicine, 11 North Third Ring East Road, Beijing, 100029, China
- Department of Integrative Oncology, China-Japan Friendship Hospital, No. 2 Yinghuadong Street, Beijing, 100029, China
| | - Wen-Juan Guo
- Department of Gastroenterology, China-Japan Friendship Hospital, No. 2 Yinghuadong Street, Beijing, 100029, China
| | - Yan-Fen Shi
- Department of Pathology, China-Japan Friendship Hospital, No. 2 Yinghuadong Street, Beijing, 100029, China
| | - Fei Su
- Department of Integrative Oncology, China-Japan Friendship Hospital, No. 2 Yinghuadong Street, Beijing, 100029, China
| | - Fu-Huan Yu
- Beijing University of Chinese Medicine, 11 North Third Ring East Road, Beijing, 100029, China
- Department of Integrative Oncology, China-Japan Friendship Hospital, No. 2 Yinghuadong Street, Beijing, 100029, China
| | - Ru-Ao Chen
- Beijing University of Chinese Medicine, 11 North Third Ring East Road, Beijing, 100029, China
- Department of Integrative Oncology, China-Japan Friendship Hospital, No. 2 Yinghuadong Street, Beijing, 100029, China
| | - Chao Wang
- Department of Integrative Oncology, China-Japan Friendship Hospital, No. 2 Yinghuadong Street, Beijing, 100029, China
| | - Ji-Xi Liu
- Digestive Disease Center, Beijing United Family Hospital, No. 2 Jiangtai Road, Beijing, 100015, China
| | - Jie Luo
- Department of Pathology, China-Japan Friendship Hospital, No. 2 Yinghuadong Street, Beijing, 100029, China.
| | - Huang-Ying Tan
- Department of Integrative Oncology, China-Japan Friendship Hospital, No. 2 Yinghuadong Street, Beijing, 100029, China.
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20
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Shah SC, Boeder S, Piazuelo MB, Li D. The Stomach Looks Suspicious, But Is It Pernicious? Gastroenterology 2023; 165:1342-1351. [PMID: 37640254 PMCID: PMC11058005 DOI: 10.1053/j.gastro.2023.08.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/18/2023] [Accepted: 08/18/2023] [Indexed: 08/31/2023]
Affiliation(s)
- Shailja C Shah
- Gastroenterology Section, Jennifer Moreno Department of Veterans Affairs Medical Center, La Jolla, California; Division of Gastroenterology, University of California, San Diego, La Jolla, California.
| | - Schafer Boeder
- Division of Endocrinology and Metabolism, University of California, San Diego, La Jolla, California
| | - M Blanca Piazuelo
- Division of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee; Center for Mucosal Inflammation and Cancer, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Dan Li
- Department of Gastroenterology, Kaiser Permanente Northern California, Santa Clara, California; Division of Research, Kaiser Permanente Northern California, Oakland, California
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21
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Beduleva L, Sidorov A, Terentiev A, Ivanov P, Menshikov I. Treatment with IgG Fc fragments bearing regRF epitopes prevents destruction of the gastric mucosa in experimental autoimmune gastritis model. Int J Biol Macromol 2023; 252:126444. [PMID: 37607652 DOI: 10.1016/j.ijbiomac.2023.126444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 08/18/2023] [Accepted: 08/18/2023] [Indexed: 08/24/2023]
Abstract
Autoimmune gastritis (AIG) is the autoimmune disease of the stomach characterized by the destruction of the oxyntic mucosa, which stops producing acid and becomes both functionally and morphologically atrophic. There is no specific treatment for AIG. Previously, we identified a new immunoregulatory factor (regulatory rheumatoid factor (regRF)), the stimulation production of which reduces certain experimental autoimmune diseases. Epitopes specific to the regulatory rheumatoid factor (regRF epitopes) can be obtained on IgG Fc fragments. In the rat AIG model, the therapeutic efficacy of IgG Fc fragments bearing regRF epitopes was tested. Treatment with IgG Fc fragments bearing regRF epitopes reduced T lymphocytic infiltration of oxyntic mucosa and prevented its damage in the AIG rat model, while in rats treated with placebo, T lymphocytic infiltration of the mucosa, loss of parietal cells, including severe were observed. Therefore, IgG Fc fragments bearing regRF epitopes are a potential therapeutic agent for treating autoimmune gastritis in its early stages.
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Affiliation(s)
- Liubov Beduleva
- Laboratory of Molecular and Cell Immunology, Department of Immunology and Cell Biology, Udmurt State University, 1 Universitetskaya St, Izhevsk 426034, Russian Federation; Laboratory of Biocompatible Materials, Udmurt Federal Research Center UB RAS, 34 T. Baramzinoy St, Izhevsk 426067, Russian Federation.
| | - Alexandr Sidorov
- Laboratory of Molecular and Cell Immunology, Department of Immunology and Cell Biology, Udmurt State University, 1 Universitetskaya St, Izhevsk 426034, Russian Federation; Laboratory of Biocompatible Materials, Udmurt Federal Research Center UB RAS, 34 T. Baramzinoy St, Izhevsk 426067, Russian Federation
| | - Alexey Terentiev
- Laboratory of Molecular and Cell Immunology, Department of Immunology and Cell Biology, Udmurt State University, 1 Universitetskaya St, Izhevsk 426034, Russian Federation; Laboratory of Biocompatible Materials, Udmurt Federal Research Center UB RAS, 34 T. Baramzinoy St, Izhevsk 426067, Russian Federation
| | - Pavel Ivanov
- Laboratory of Molecular and Cell Immunology, Department of Immunology and Cell Biology, Udmurt State University, 1 Universitetskaya St, Izhevsk 426034, Russian Federation
| | - Igor Menshikov
- Laboratory of Molecular and Cell Immunology, Department of Immunology and Cell Biology, Udmurt State University, 1 Universitetskaya St, Izhevsk 426034, Russian Federation; Laboratory of Biocompatible Materials, Udmurt Federal Research Center UB RAS, 34 T. Baramzinoy St, Izhevsk 426067, Russian Federation
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22
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Rustgi SD, McKinley M, McBay B, Zylberberg HM, Gomez SL, Hur C, Kastrinos F, Gupta S, Kim MK, Itzkowitz SH, Shah SC. Epidemiology of Gastric Malignancies 2000-2018 According to Histology: A Population-Based Analysis of Incidence and Temporal Trends. Clin Gastroenterol Hepatol 2023; 21:3285-3295.e8. [PMID: 36792000 PMCID: PMC10809276 DOI: 10.1016/j.cgh.2023.01.037] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 01/20/2023] [Accepted: 01/31/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND & AIMS Gastric cancer (GC) remains a leading cause of cancer and cancer-related mortality. Recent reports suggest noncardia GC is increasing in certain U.S. POPULATIONS However, whether these trends are driven by gastric adenocarcinoma (GA) or other histologies, including neuroendocrine tumors (NETs), lymphoma, or gastrointestinal stromal tumors (GISTs), is unclear. METHODS We analyzed the Surveillance, Epidemiology and End Results-18 cancer registry (2000-2018) to determine age-standardized incidence rates (ASIR) and annual percentage change (APC) trends for histologically-confirmed GCs, stratified by anatomic location (noncardia vs cardia), age group (20-49 vs 50+ years), sex, race, and ethnicity. Joinpoint regression modeling estimated the statistical significance of trend comparisons. RESULTS Of 74,520 individuals with noncardia GC, most (66.2%) were GA, with the next largest categories being non-mucosa-associated lymphoid tissue (non-MALT) lymphomas (6.9%), GIST (6.7%), NET (6.4%), and MALT lymphoma (5.6%). Noncardia GA ASIR was significantly higher than other histologies and demonstrated the greatest differences by race and ethnicity. APCs for GA and MALT, both Helicobacter pylori-associated cancers, declined significantly over time, which was driven primarily by trends among individuals ≥50 years-old. NET and GIST APCs significantly increased irrespective of age group, with the highest APCs observed among non-Hispanic white individuals. Cardia GC was rarer than noncardia GC and comprised primarily by GA (87.9%). Cardia GC incidence fell during the study period, which was primarily driven by decline in cardia GA. CONCLUSIONS GA was the most common histology. On the basis of our findings, the rise in noncardia GC among certain U.S. populations appears predominantly driven by NET and GIST, not GA. Further studies are needed to clarify underlying etiologies for these findings.
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Affiliation(s)
- Sheila D Rustgi
- Division of Digestive and Liver Diseases, Columbia University Irving Medical Center, New York, New York
| | - Meg McKinley
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California; Greater Bay Area Cancer Registry, University of California San Francisco, San Francisco, California
| | - Brandon McBay
- Department of Public Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Haley M Zylberberg
- Division of Digestive and Liver Diseases, Columbia University Irving Medical Center, New York, New York
| | - Scarlett L Gomez
- Greater Bay Area Cancer Registry, University of California San Francisco, San Francisco, California; Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, California
| | - Chin Hur
- Division of Digestive and Liver Diseases, Columbia University Irving Medical Center, New York, New York
| | - Fay Kastrinos
- Division of Digestive and Liver Diseases, Columbia University Irving Medical Center, New York, New York
| | - Samir Gupta
- Gastroenterology Section, VA San Diego Healthcare System, San Diego, California; Division of Gastroenterology, University of California, San Diego, San Diego, California
| | - Michelle Kang Kim
- Dr Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Steven H Itzkowitz
- Dr Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Shailja C Shah
- Gastroenterology Section, VA San Diego Healthcare System, San Diego, California; Division of Gastroenterology, University of California, San Diego, San Diego, California.
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Zhang Z, Zhu T, Zhang L, Xing Y, Yan Z, Li Q. Critical influence of cytokines and immune cells in autoimmune gastritis. Autoimmunity 2023; 56:2174531. [PMID: 36762543 DOI: 10.1080/08916934.2023.2174531] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Gastric cancer (GC) is a type of the most common cancers. Autoimmune gastritis (AIG) and infection with Helicobacter pylori (HP) are the risk factors of triggering GC. With the emphasis on the treatment of HP, the incidence and prevalence of HP infection in population is decreasing. However, AIG lacks accurate diagnosis and treatment methods, which occupies high cancer risk factors. AIG is controlled by the immune environment of the stomach, including immune cells, inflammatory cells, and infiltrating intercellular material. Various immune cells or cytokines play a central role in the process of regulating gastric parietal cells. Abnormal expression levels of cytokines involved in immunity are bound to face the risk of tumorigenesis. Therefore, it is particularly important for preventing or treating AIG and avoiding the risk of gastric cancer to clarify the confirmed action mode of immune cells and cytokines in the gastric system. Herein, we briefly reviewed the role of the immune environment under AIG, focussing on describing these double-edged effects between immune cells and cytokines, and pointing out potential research challenges.
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Affiliation(s)
- Zepeng Zhang
- Kunshan Hospital of Chinese Medicine, Suzhou, Jiangsu, China
| | - Tongtong Zhu
- Kunshan Hospital of Traditional Chinese and Western Medicine, Suzhou, Jiangsu, China
| | - Lei Zhang
- Kunshan Hospital of Chinese Medicine, Suzhou, Jiangsu, China
| | - Yanchao Xing
- School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Zhiqiang Yan
- Kunshan Hospital of Chinese Medicine, Suzhou, Jiangsu, China
| | - Qingsong Li
- Kunshan Hospital of Chinese Medicine, Suzhou, Jiangsu, China
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24
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Yu YF, Tong KK, Shangguan XL, Yang XY, Wu JY, Hu G, Yu R, Tan CC. Research status and hotspots of autoimmune gastritis: A bibliometric analysis. World J Gastroenterol 2023; 29:5781-5799. [PMID: 38075850 PMCID: PMC10701335 DOI: 10.3748/wjg.v29.i42.5781] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/18/2023] [Accepted: 10/30/2023] [Indexed: 11/13/2023] Open
Abstract
BACKGROUND As an emerging potential risk factor for gastric cancer, autoimmune gastritis (AIG) has garnered increasing attention from researchers. AIM To analyze the research overview and popular topics in the field of AIG using bibliometrics. METHODS Relevant publications on AIG in the Web of Science Core Collection were collated, and data visualization and analysis of the number of publications, countries, institutions, journals, authors, keywords, and citations were performed using software such as VOSviewer, CiteSpace, and Scimago Graphic. RESULTS In total, 316 relevant articles were included in the analysis. From 2015 to 2022, the number of publications increased annually. The countries, institutions, authors, and journals with the highest number of publications in this field were Italy, Monash University, Toh BH, and Internal Medicine. The main keywords used in this field of research were pathogenesis, Helicobacter pylori, autoantibody, parietal cell antibody, atrophic gastritis, classification, diagnosis, autoimmune disease, risk, cancer, gastric cancer, vitamin B12 deficiency, and pernicious anemia. The following directions may be popular for future research: (1) The role of Helicobacter pylori in the pathogenesis of AIG; (2) diagnostic criteria for AIG and reference values for serum antibodies; (3) comorbidity mechanisms between AIG and other autoimmune diseases; (4) specific risks of AIG complicating gastric and other cancers; and (5) the role of vitamin B12 supplementation in patients with early-stage AIG. CONCLUSION This bibliometric analysis reported on popular topics and emerging trends in AIG, with diagnosis and prognosis being research hotspots in this field.
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Affiliation(s)
- Yun-Feng Yu
- The First Hospital, Hunan University of Chinese Medicine, Changsha 410007, Hunan Province, China
| | - Ke-Ke Tong
- The Hospital of Hunan University of Traditional Chinese Medicine, Hunan University of Traditional Chinese Medicine, Changde 415213, Hunan Province, China
| | - Xue-Li Shangguan
- The First Hospital, Hunan University of Chinese Medicine, Changsha 410007, Hunan Province, China
| | - Xin-Yu Yang
- College of Chinese Medicine, Hunan University of Chinese Medicine, Changsha 410208, Hunan Province, China
| | - Jing-Yi Wu
- The Third Hospital, Zhejiang Chinese Medical University, Hangzhou 310005, Zhejiang Province, China
| | - Gang Hu
- The First Hospital, Hunan University of Chinese Medicine, Changsha 410007, Hunan Province, China
| | - Rong Yu
- The First Hospital, Hunan University of Chinese Medicine, Changsha 410007, Hunan Province, China
| | - Chuan-Chuan Tan
- The First Hospital, Hunan University of Chinese Medicine, Changsha 410007, Hunan Province, China
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25
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Underwood T, Le J, Campbell K, Smiley L. Pernicious anemia: A case report of diligence to diagnosis. Nurse Pract 2023; 48:37-40. [PMID: 37884022 DOI: 10.1097/01.npr.0000000000000113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
ABSTRACT The symptoms of pernicious anemia might resemble those of other common disorders and can be nonspecific, requiring extensive diagnostic workup. The provider must be aware of the harm pernicious anemia can do if undiagnosed and untreated and must understand that diligence and persistence are crucial for an accurate diagnosis.
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26
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TONEGATO M, PANOZZO MP. Confronto tra diversi metodi immunologici per la ricerca degli anticorpi anti-cellule parietali gastriche. LA RIVISTA ITALIANA DELLA MEDICINA DI LABORATORIO 2023; 19. [DOI: 10.23736/s1825-859x.23.00200-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2025]
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Beduleva L, Fomina K, Sidorov A, Terentiev A, Ivanov P, Menshikov I. Rat Experimental Autoimmune Gastritis Model. Immunol Invest 2023; 52:1023-1038. [PMID: 37962068 DOI: 10.1080/08820139.2023.2283103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
BACKGROUND Autoimmune gastritis (AIG) is an autoimmune disease of the stomach characterized by the destruction of the oxyntic mucosa, which stops producing acid and becomes both functionally and morphologically atrophic. The pathogenic mechanisms behind the disease are still poorly understood. There is no early diagnosis and specific AIG therapy. To elucidate the pathogenesis of AIG, to search for early diagnostic markers, as well as to test new therapeutic approaches, an adequate and easily reproducible experimental model for autoimmune gastritis (EAG) is needed. Existing EAG models have some limitations, including slow development of signs, absence of advanced gastritis, irrational use of animals to obtain antigen. The aim was to find out whether it is possible to cause autoimmune gastritis similar to human disease in Wistar rats through immunization with a homologous gastric mucosa extract. METHODS Wistar rats were immunized with gastric mucosa extract. Histology studies and evaluation of serological parameters were performed 56 and 91 days later. RESULTS Destruction of oxyntic glands by infiltrating T lymphocytes were detected in rats on 56 and 91 days after initial immunization with gastric mucosa extract. Hyperplasia of enterochromaffin-like (ECL) cells was detected on the 91st day. Antral mucosa remained unchanged. CONCLUSION Wistar rats, immunized with gastric mucosa extract, developed EAG similar to human AIG. The advantages of received EAG model are the ease of obtaining, the rapid development of oxyntic mucosa damage, which may progress to ECL cell hyperplasia.
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Affiliation(s)
- Liubov Beduleva
- Laboratory of Molecular and Cell Immunology, Department of Immunology and Cell Biology, Udmurt State University, Izhevsk, Russian Federation
- Laboratory of Biocompatible Materials, Udmurt Federal Research Center UB RAS, Izhevsk, Russian Federation
| | - Kseniya Fomina
- Laboratory of Molecular and Cell Immunology, Department of Immunology and Cell Biology, Udmurt State University, Izhevsk, Russian Federation
- Laboratory of Biocompatible Materials, Udmurt Federal Research Center UB RAS, Izhevsk, Russian Federation
| | - Alexandr Sidorov
- Laboratory of Molecular and Cell Immunology, Department of Immunology and Cell Biology, Udmurt State University, Izhevsk, Russian Federation
- Laboratory of Biocompatible Materials, Udmurt Federal Research Center UB RAS, Izhevsk, Russian Federation
| | - Alexey Terentiev
- Laboratory of Molecular and Cell Immunology, Department of Immunology and Cell Biology, Udmurt State University, Izhevsk, Russian Federation
- Laboratory of Biocompatible Materials, Udmurt Federal Research Center UB RAS, Izhevsk, Russian Federation
| | - Pavel Ivanov
- Laboratory of Molecular and Cell Immunology, Department of Immunology and Cell Biology, Udmurt State University, Izhevsk, Russian Federation
| | - Igor Menshikov
- Laboratory of Molecular and Cell Immunology, Department of Immunology and Cell Biology, Udmurt State University, Izhevsk, Russian Federation
- Laboratory of Biocompatible Materials, Udmurt Federal Research Center UB RAS, Izhevsk, Russian Federation
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28
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Wang X, Lu CJ, Li H, Zhang JY, Zheng JW, Wu N, Yang WL, Yu J, Huang WF. Clinicopathological characteristics of autoimmune gastritis: A single-center retrospective study. Clin Res Hepatol Gastroenterol 2023; 47:102154. [PMID: 37311519 DOI: 10.1016/j.clinre.2023.102154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 05/28/2023] [Accepted: 06/05/2023] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND AIM Autoimmune gastritis (AIG) is a prominent risk factor for pernicious anemia (PA) and gastric neoplasia. This study aimed to investigate the clinicopathological characteristics of AIG patients in China, with a focus on those who had positive anti-intrinsic factor antibodies (AIFA). METHODS A total of 103 AIG patients who were diagnosed between January 2018 and August 2022 were reviewed in a large academic tertiary teaching hospital. Patients were divided into two groups based on the presence or absence of AIFA, and their serologic and histopathological characteristics were analyzed. RESULTS The mean age of the 103 AIG patients was 54.16±11.92 years (range 23-79), with 69 (66.99%) being women. AIFA were present in 28.16% of patients. Patients with AIFA-positive had a higher risk of PA than those with AIFA-negative, as demonstrated by a larger mean corpuscular volume (MCV), lower hemoglobin level, and lower vitamin B-12 level (P<0.05). There were no statistically significant differences in gastric histopathology, gastrin level, and pepsinogen level when patients were divided into AIFA-positive and AIFA-negative group. Of the 103 cases, 34 (33.01%) were concomitant with other autoimmune diseases, with autoimmune thyroid diseases being the most common (25.24%, 26/103). Thyroid peroxidase antibody, which accounted for 45.45% (25/55), was the most prevalent thyroid antibody, followed by anti-thyroglobulin antibody (34.55%, 19/55), thyroid stimulating antibody (12.73%, 7/55), and thyrotropin receptor antibody (3.64%, 2/55). CONCLUSION This study highlights the increased risk of severe anemia in AIFA-positive AIG patients, particularly for PA. Clinicians should consider the presence of AIFA as a warning sign for PA and prioritize early diagnosis and appropriate treatment to prevent serious complications.
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Affiliation(s)
- Xu Wang
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Chun-Jing Lu
- Department of Blood Transfusion, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, China
| | - Hua Li
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China; The School of Clinical Medicine, Fujian Medical University, Fuzhou, China
| | - Jin-Yan Zhang
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China; The School of Clinical Medicine, Fujian Medical University, Fuzhou, China
| | - Jian-Wei Zheng
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Na Wu
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Wei-Lin Yang
- Endoscopy Center, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Juan Yu
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.
| | - Wei-Feng Huang
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China; The School of Clinical Medicine, Fujian Medical University, Fuzhou, China.
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29
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Meyers TM, Reeves PT, Lombardo JL, Anisowicz SK, Larson NS, Rogers PL. Autoimmune gastritis as an unexpected cause of diarrhea in a young adult with type I diabetes: a case report. J Med Case Rep 2023; 17:342. [PMID: 37507704 PMCID: PMC10386669 DOI: 10.1186/s13256-023-04039-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 06/13/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Type 1 diabetes mellitus (T1DM) is a lifelong diagnosis that involves immune-mediated damage of pancreatic beta cells and subsequent hyperglycemia, manifesting as: polyuria, polydipsia, polyphagia, and weight loss. Treatment of type 1 diabetes centers on insulin administration to replace or supplement the body's own insulin with the goal of achieving euglycemia and preventing or minimizing complications. Patients with T1DM are at risk for developing other autoimmune conditions, most commonly thyroid or celiac disease. CASE PRESENTATION A 20-year-old African American female with T1DM was referred by her endocrinologist to pediatric gastroenterology for 2 months of nocturnal, non-bloody diarrhea, left lower quadrant pain, and nausea; she was also being followed by neurology for complaints of lower extremity paresthesias and pain. The patient's initial lab-workup was remarkable for a low total Immunoglobulin A (IgA) level of < 6.7 mg/dL. As IgA deficiency is associated with an increased risk of celiac disease, the patient underwent upper and lower endoscopy, which was grossly unremarkable; however, histology revealed a pattern consistent with autoimmune gastritis. Subsequent serum evaluation was remarkable for an elevated fasting gastrin level and an elevated parietal cell antibody level without macrocytic anemia, iron deficiency, or vitamin B12 depletion. The patient was diagnosed with autoimmune gastritis (AIG) and subsequently initiated on parenteral B12 supplementation therapy with improvement in her neurologic and gastrointestinal symptoms. CONCLUSION This case illustrates the importance of recognition of red flag findings in a patient with known autoimmune disease. Following well-established health maintenance recommendations for individuals with T1DM ensures that common comorbidities will be detected. Autoimmune gastritis, while a rarer pathology in the pediatric population, deserves consideration in patients with pre-existing autoimmune conditions and new gastrointestinal or neurologic symptoms, as AIG can be associated with poor outcomes and risk of malignancy. Initial lab findings associated with an eventual diagnosis of AIG typically include anemia, iron deficiency, or Vitamin B12 deficiency. However, as demonstrated in this case, symptoms of AIG can rarely present before anemia or Vitamin B12 deficiency develops. To prevent permanent neurological damage, parenteral Vitamin B12 therapy must be considered even in the absence of Vitamin B12 deficiency, especially in those patients already experiencing neurological symptoms.
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Affiliation(s)
- Taylor M Meyers
- Department of Pediatrics, Walter Reed National Military Medical Center, 4494 Palmer Road North, Bethesda, MD, 20814, USA.
| | - Patrick T Reeves
- Department of Pediatrics, Walter Reed National Military Medical Center, 4494 Palmer Road North, Bethesda, MD, 20814, USA
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Jamie L Lombardo
- Department of Pediatrics, Walter Reed National Military Medical Center, 4494 Palmer Road North, Bethesda, MD, 20814, USA
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Sarah K Anisowicz
- Department of Pediatrics, Walter Reed National Military Medical Center, 4494 Palmer Road North, Bethesda, MD, 20814, USA
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Noelle S Larson
- Department of Pediatrics, Walter Reed National Military Medical Center, 4494 Palmer Road North, Bethesda, MD, 20814, USA
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Philip L Rogers
- Department of Pediatrics, Walter Reed National Military Medical Center, 4494 Palmer Road North, Bethesda, MD, 20814, USA
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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Ozhiganova NV, Belkovets AV, Kruchinina MV. Early diagnosis of autoimmune gastritis. EXPERIMENTAL AND CLINICAL GASTROENTEROLOGY 2023:12-18. [DOI: 10.31146/1682-8658-ecg-212-4-12-18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2025]
Abstract
Early diagnosis of autoimmune gastritis (AIG) is quite difficult in a physician’s daily practice. Since the disease is asymptomatic for a long time, it is often diagnosed already with severe atrophy with the loss of a large number of gastric glands and potentially significant pernicious anemia, and sometimes with the onset of cancer. Morphological and endoscopic changes do not occur immediately and are not specific in patients with AIG. In this case, non-invasive diagnostics play a key role. The diagnostics of AIG are often done in patients with vitamin B12 and iron deficiency. However, the development of these deficiencies can take a long time. The non-invasive technique with the determination of such biomarkers as pepsinogen I, II (PGI, PG II), their ratio, gastrin-17, as well as Helicobacter pylori (H. pylori) infection, including a cytotoxic (CagA +) strain, is used to exclude preclinical stages of AIG. The titer determination of anti-parietal cell antibodies and the anti-intrinsic factor antibodies allows identifying the immune nature of gastritis. But recent studies show that these markers can be negative in some patients. This article actualizes the problem of early diagnosis of AIG and demonstrates the importance of practical application of currently existing non-invasive methods for the diagnosis of stomach diseases.
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Affiliation(s)
- N. V. Ozhiganova
- Research Institute of Internal and Preventive Medicine- branch of the Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences
| | - A. V. Belkovets
- Research Institute of Internal and Preventive Medicine- branch of the Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences; Novosibirsk State Medical University
| | - M. V. Kruchinina
- Research Institute of Internal and Preventive Medicine- branch of the Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences; Novosibirsk State Medical University
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31
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Livzan MA, Mozgovoi SI, Gaus OV, Shimanskaya AG, Kononov AV. Histopathological Evaluation of Gastric Mucosal Atrophy for Predicting Gastric Cancer Risk: Problems and Solutions. Diagnostics (Basel) 2023; 13:2478. [PMID: 37568841 PMCID: PMC10417051 DOI: 10.3390/diagnostics13152478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 07/19/2023] [Accepted: 07/24/2023] [Indexed: 08/13/2023] Open
Abstract
Patients suffering from chronic gastritis and developing gastric mucosa atrophy are at increased risk of the development of gastric cancer. The diagnosis of chronic atrophic gastritis (CAG) is a complex procedure involving a detailed history taking, a thorough physical examination and the use of laboratory and instrumental diagnostic methods among which the endoscopy of the upper digestive tract is the cornerstone because it allows the assessment of the topography of gastritis and identification of erosions and areas of intestinal metaplasia with the use of NBI endoscopy. However, the diagnosis of CAG requires morphological examination of the gastric mucosa. So, in addition to assessing macroscopic changes in the gastric mucosa, it is necessary to take biopsy specimens in accordance with the protocols for their morphological and immunohistochemical examination. In the absence of specific diagnostic stigmas of CAG, close cooperation between a clinician, endoscopist and pathologist is necessary. The article presents systematized data on the histopathological assessment of the gastric mucosa atrophy to predict the risk of gastric cancer.
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Affiliation(s)
- Maria A. Livzan
- Department of Internal Medicine and Gastroenterology, Omsk Sate Medical University, 644099 Omsk, Russia;
| | - Sergei I. Mozgovoi
- Department of Pathological Anatomy, Omsk Sate Medical University, 644099 Omsk, Russia
| | - Olga V. Gaus
- Department of Internal Medicine and Gastroenterology, Omsk Sate Medical University, 644099 Omsk, Russia;
| | - Anna G. Shimanskaya
- Department of Pathological Anatomy, Omsk Sate Medical University, 644099 Omsk, Russia
| | - Alexei V. Kononov
- Department of Pathological Anatomy, Omsk Sate Medical University, 644099 Omsk, Russia
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32
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Gubanova AV, Livzan MA, Krolevets TS, Mozgovoi SI, Rubtsov AV, Stepanchenko MA. Autoimmune gastritis and stomach cancer: assessing the risks. EXPERIMENTAL AND CLINICAL GASTROENTEROLOGY 2023:112-119. [DOI: 10.31146/1682-8658-ecg-211-3-112-119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/17/2024]
Abstract
The purpose of this publication is to systematize available data on the risks of developing stomach cancer in patients with a chronic autoimmune gastritis with a demonstration of the clinical case of a patient with a chronic autoimmune gastritis and a neuroendocrine gastric tumor of the type 1. Discussion: the article discusses the risks of stomach cancer in patients with chronic autoimmune gastritis. A mechanism for the formation of a neuroendocrine gastric tumor of the type 1, associated with autoimmune gastritis, is given. A clinical example of a patient with a long history of dyspepsia, the presence of concomitant changes in the results of laboratory tests, describes an algorithm for diagnosis of autoimmune gastritis and associated neuroendocrine tumors. The risks of the development in patients with autoimmune gastritis of formidable complications as an adenocarcinoma of the stomach are considered. Conclusion: Chronic autoimmune gastritis is a precancerous diseases of the stomach, with the progressive atrophy of the gastric body mucosa, and associated with an increased risk of developing neuroendocrine gastric tumor of the type 1 and adenocarcinoma of the stomach. Patients with autoimmune gastritis need dynamic outpatient observation, with endoscopic control and assessment of the degree and stage of gastritis in OLGA system, with immunogistochemistry to evaluate the risks of stomach cancer and timely implementation of the necessary measures of carcinoprection.
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33
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Lenti MV, Broglio G, Di Sabatino A. Unravelling the risk of developing gastric cancer in autoimmune gastritis. Gut 2023; 72:1429-1430. [PMID: 35981867 DOI: 10.1136/gutjnl-2022-328345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 08/10/2022] [Indexed: 12/08/2022]
Affiliation(s)
- Marco Vincenzo Lenti
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy
- First Department of Internal Medicine, San Matteo Hospital Foundation, Pavia, Italy
| | - Giacomo Broglio
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy
- First Department of Internal Medicine, San Matteo Hospital Foundation, Pavia, Italy
| | - Antonio Di Sabatino
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy
- First Department of Internal Medicine, San Matteo Hospital Foundation, Pavia, Italy
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Rossi RE, Elvevi A, Sciola V, Mandarino FV, Danese S, Invernizzi P, Massironi S. Paradoxical association between dyspepsia and autoimmune chronic atrophic gastritis: Insights into mechanisms, pathophysiology, and treatment options. World J Gastroenterol 2023; 29:3733-3747. [PMID: 37398891 PMCID: PMC10311608 DOI: 10.3748/wjg.v29.i23.3733] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/23/2023] [Accepted: 05/06/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Autoimmune gastritis (AIG) is a progressive, chronic, immune-mediated inflammatory disease characterized by the destruction of gastric parietal cells leading to hypo/anacidity and loss of intrinsic factor. Gastrointestinal symptoms such as dyspepsia and early satiety are very common, being second in terms of frequency only to anemia, which is the most typical feature of AIG.
AIM To address both well-established and more innovative information and knowledge about this challenging disorder.
METHODS An extensive bibliographical search was performed in PubMed to identify guidelines and primary literature (retrospective and prospective studies, systematic reviews, case series) published in the last 10 years.
RESULTS A total of 125 records were reviewed and 80 were defined as fulfilling the criteria.
CONCLUSION AIG can cause a range of clinical manifestations, including dyspepsia. The pathophysiology of dyspepsia in AIG is complex and involves changes in acid secretion, gastric motility, hormone signaling, and gut microbiota, among other factors. Managing dyspeptic symptoms of AIG is challenging and there are no specific therapies targeting dyspepsia in AIG. While proton pump inhibitors are commonly used to treat dyspepsia and gastroesophageal reflux disease, they may not be appropriate for AIG. Prokinetic agents, antidepressant drugs, and non-pharmacological treatments may be of help, even if not adequately evidence-based supported. A multidisciplinary approach for the management of dyspepsia in AIG is recommended, and further research is needed to develop and validate more effective therapies for dyspepsia.
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Affiliation(s)
- Roberta Elisa Rossi
- Gastroenterology and Endoscopy Unit, IRCCS Humanitas Research Hospital, Rozzano 20089, Milan, Italy
| | - Alessandra Elvevi
- Gastroenterology Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza 20900, Italy and Department of Medicine and Surgery, University of Milano-Bicocca, Monza 20900, Italy
| | - Valentina Sciola
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano 20100, Italy
| | | | - Silvio Danese
- Department of Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele, Milan 20132, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan 20132, Italy
| | - Pietro Invernizzi
- Gastroenterology Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza 20900, Italy and Department of Medicine and Surgery, University of Milano-Bicocca, Monza 20900, Italy
| | - Sara Massironi
- Gastroenterology Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza 20900, Italy and Department of Medicine and Surgery, University of Milano-Bicocca, Monza 20900, Italy
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Sukhbaatar N, Schöller M, Fritsch SD, Linke M, Horer S, Träger M, Mazić M, Forisch S, Gonzales K, Kahler JP, Binder C, Lassnig C, Strobl B, Müller M, Scheiber-Mojdehkar B, Gundacker C, Dabsch S, Kain R, Hengstschläger M, Verhelst SHL, Weiss G, Theurl I, Weichhart T. Duodenal macrophages control dietary iron absorption via local degradation of transferrin. Blood 2023; 141:2878-2890. [PMID: 37018657 PMCID: PMC10646810 DOI: 10.1182/blood.2022016632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 02/15/2023] [Accepted: 02/15/2023] [Indexed: 04/07/2023] Open
Abstract
Iron is an essential cellular metal that is important for many physiological functions including erythropoiesis and host defense. It is absorbed from the diet in the duodenum and loaded onto transferrin (Tf), the main iron transport protein. Inefficient dietary iron uptake promotes many diseases, but mechanisms regulating iron absorption remain poorly understood. By assessing mice that harbor a macrophage-specific deletion of the tuberous sclerosis complex 2 (Tsc2), a negative regulator of mechanistic target of rapamycin complex 1 (mTORC1), we found that these mice possessed various defects in iron metabolism, including defective steady-state erythropoiesis and a reduced saturation of Tf with iron. This iron deficiency phenotype was associated with an iron import block from the duodenal epithelial cells into the circulation. Activation of mTORC1 in villous duodenal CD68+ macrophages induced serine protease expression and promoted local degradation of Tf, whereas the depletion of macrophages in mice increased Tf levels. Inhibition of mTORC1 with everolimus or serine protease activity with nafamostat restored Tf levels and Tf saturation in the Tsc2-deficient mice. Physiologically, Tf levels were regulated in the duodenum during the prandial process and Citrobacter rodentium infection. These data suggest that duodenal macrophages determine iron transfer to the circulation by controlling Tf availability in the lamina propria villi.
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Affiliation(s)
- Nyamdelger Sukhbaatar
- Center of Pathobiochemistry and Genetics, Medical University of Vienna, Vienna, Austria
| | - Maria Schöller
- Center of Pathobiochemistry and Genetics, Medical University of Vienna, Vienna, Austria
| | | | - Monika Linke
- Center of Pathobiochemistry and Genetics, Medical University of Vienna, Vienna, Austria
| | - Stefanie Horer
- Center of Pathobiochemistry and Genetics, Medical University of Vienna, Vienna, Austria
| | - Manuela Träger
- Center of Pathobiochemistry and Genetics, Medical University of Vienna, Vienna, Austria
| | - Mario Mazić
- Center of Pathobiochemistry and Genetics, Medical University of Vienna, Vienna, Austria
| | - Stephan Forisch
- Center of Pathobiochemistry and Genetics, Medical University of Vienna, Vienna, Austria
| | - Karine Gonzales
- Center of Pathobiochemistry and Genetics, Medical University of Vienna, Vienna, Austria
| | - Jan Pascal Kahler
- Laboratory of Chemical Biology, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
| | - Carina Binder
- Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - Caroline Lassnig
- Biomodels Austria and Institute of Animal Breeding and Genetics, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Birgit Strobl
- Biomodels Austria and Institute of Animal Breeding and Genetics, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Mathias Müller
- Biomodels Austria and Institute of Animal Breeding and Genetics, University of Veterinary Medicine Vienna, Vienna, Austria
| | | | - Claudia Gundacker
- Center of Pathobiochemistry and Genetics, Medical University of Vienna, Vienna, Austria
| | - Stefanie Dabsch
- Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Renate Kain
- Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - Markus Hengstschläger
- Center of Pathobiochemistry and Genetics, Medical University of Vienna, Vienna, Austria
| | - Steven H. L. Verhelst
- Laboratory of Chemical Biology, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
| | - Günter Weiss
- Department of Internal Medicine II, Medical University of Innsbruck, Innsbruck, Austria
| | - Igor Theurl
- Department of Internal Medicine II, Medical University of Innsbruck, Innsbruck, Austria
| | - Thomas Weichhart
- Center of Pathobiochemistry and Genetics, Medical University of Vienna, Vienna, Austria
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36
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Terao S, Suzuki S, Kushima R. Histopathologic diagnosis of ultra-early autoimmune gastritis: A case report. Clin Case Rep 2023; 11:e7458. [PMID: 37361662 PMCID: PMC10290196 DOI: 10.1002/ccr3.7458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 03/30/2023] [Accepted: 05/24/2023] [Indexed: 06/28/2023] Open
Abstract
We describe an ultra-early stage of autoimmune gastritis (AIG) that occurs prior to the well-known early-stage AIG. The key pathology is the shortening of the second layer with degenerated parietal cells. In the management of patients with autoimmune diseases, AIG should be considered even if the endoscopy findings are normal.
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Affiliation(s)
- Shuichi Terao
- Department of Internal MedicineKakogawa Central City HospitalKakogawaJapan
| | - Shiho Suzuki
- Department of Internal MedicineKakogawa Central City HospitalKakogawaJapan
| | - Ryoji Kushima
- Department of PathologyShiga University of Medical ScienceOtsuJapan
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Meinhardt C, List S, Chamieh AE, Fehrendt H, Meves V, Mohamed M, Müller J, Deneke T, Geismann C, Elsässer A, Arlt A, Halbfass P. High prevalence of incidental endoscopic findings at routine endoscopy after atrial fibrillation ablation: Do we need a screening endoscopy for the upper gastrointestinal tract in the general population? Eur J Intern Med 2023; 111:54-62. [PMID: 36797118 DOI: 10.1016/j.ejim.2023.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 01/07/2023] [Accepted: 02/10/2023] [Indexed: 02/16/2023]
Abstract
INTRODUCTION High-power short-duration ablation (HPSD) is an effective therapy for atrial fibrillation with thermal esophageal injury as a rare but relevant side effect. AIM AND METHODS In this retrospective single-center analysis we evaluated the incidence and relevance of ablation-induced findings and the prevalence of ablation-independent incidental gastrointestinal findings. For 15 months all patients undergoing ablation were screened by postablation esophagogastroduodenoscopy. Pathological findings were followed up and treated if necessary. RESULTS 286 consecutive patients (66±10 years; 54.9% male) were included. 19.6% of patients showed ablation-associated alterations (10.8% esophageal lesions, 10.8% gastroparesis, 1.7% both findings). Logistic multivariable regression analysis confirmed an influence of lower BMI on the occurrence of RFA-associated endoscopic findings (OR 0.936, 95% CI 0.878-0.997, p<0.05). 48.3% of patients demonstrated incidental gastrointestinal findings. In 1.0% neoplastic lesions were present, 9.4% showed precancerous lesions and in 4.2% neoplastic lesions of unknown dignity were found requiring further diagnostics or therapy. 18.1% of patients demonstrated findings associated with a potentially increased risk of bleeding under anticoagulation. Patients with clinically relevant incidental findings were significantly more often male, 68.8% vs. 49.5% (p<0.01). CONCLUSION HPSD ablation is safe, no devasting complication occurred in any patient. It resulted in 19.6% ablation-induced thermal injury whereas incidental findings of the upper GI tract were found in 48.3% of patients. Due to the high prevalence of 14.7% of findings requiring further diagnostics, therapy, or surveillance in a cohort that is mimicking the general population, screening endoscopy of the upper GI tract seems to be reasonable in the general population.
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Affiliation(s)
- Christian Meinhardt
- Department of Internal Medicine and Gastroenterology, Carl von Ossietzky University Oldenburg, Germany
| | - Stephan List
- Department of Internal Medicine and Invasive Cardiology, Carl von Ossietzky University Oldenburg, Germany
| | - Alexander Elias Chamieh
- Department of Internal Medicine and Gastroenterology, Carl von Ossietzky University Oldenburg, Germany
| | - Hinrich Fehrendt
- Department of Internal Medicine and Gastroenterology, Carl von Ossietzky University Oldenburg, Germany
| | - Volker Meves
- Department of Internal Medicine and Gastroenterology, Carl von Ossietzky University Oldenburg, Germany
| | - Moustafa Mohamed
- Department of Internal Medicine and Gastroenterology, Carl von Ossietzky University Oldenburg, Germany
| | - Julian Müller
- Department of Invasive Electrophysiology, Heart Center Bad Neustadt, Bad Neustadt an der Saale, Germany
| | - Thomas Deneke
- Department of Invasive Electrophysiology, Heart Center Bad Neustadt, Bad Neustadt an der Saale, Germany
| | - Claudia Geismann
- Department of Internal Medicine I, Laboratory of Molecular Gastroenterology & Hepatology, UKSH-Campus Kiel, Germany
| | - Albrecht Elsässer
- Department of Internal Medicine and Invasive Cardiology, Carl von Ossietzky University Oldenburg, Germany
| | - Alexander Arlt
- Department of Internal Medicine and Gastroenterology, Carl von Ossietzky University Oldenburg, Germany.
| | - Philipp Halbfass
- Department of Internal Medicine and Invasive Cardiology, Carl von Ossietzky University Oldenburg, Germany
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Osmola M, Hemont C, Chapelle N, Vibet MA, Tougeron D, Moussata D, Lamarque D, Bigot-Corbel E, Masson D, Blin J, Leroy M, Josien R, Mosnier JF, Martin J, Matysiak-Budnik T. Atrophic Gastritis and Autoimmunity: Results from a Prospective, Multicenter Study. Diagnostics (Basel) 2023; 13:diagnostics13091599. [PMID: 37174990 PMCID: PMC10178247 DOI: 10.3390/diagnostics13091599] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/25/2023] [Accepted: 04/26/2023] [Indexed: 05/15/2023] Open
Abstract
Despite a global decrease, gastric cancer (GC) incidence appears to be increasing recently in young, particularly female, patients. The causal mechanism for this "new" type of GC is unknown, but a role for autoimmunity is suggested. A cascade of gastric precancerous lesions, beginning with chronic atrophic gastritis (CAG), precedes GC. To test the possible existence of autoimmunity in patients with CAG, we aimed to analyze the prevalence of several autoantibodies in patients with CAG as compared to control patients. Sera of 355 patients included in our previous prospective, multicenter study were tested for 19 autoantibodies (anti-nuclear antibodies, ANA, anti-parietal cell antibody, APCA, anti-intrinsic factor antibody, AIFA, and 16 myositis-associated antibodies). The results were compared between CAG patients (n = 154), including autoimmune gastritis patients (AIG, n = 45), non-autoimmune gastritis patients (NAIG, n = 109), and control patients (n = 201). ANA positivity was significantly higher in AIG than in NAIG or control patients (46.7%, 29%, and 27%, respectively, p = 0.04). Female gender was positively associated with ANA positivity (OR 0.51 (0.31-0.81), p = 0.005), while age and H. pylori infection status were not. Myositis-associated antibodies were found in 8.9% of AIG, 5.5% of NAIG, and 4.4% of control patients, without significant differences among the groups (p = 0.8). Higher APCA and AIFA positivity was confirmed in AIG, and was not associated with H. pylori infection, age, or gender in the multivariate analysis. ANA antibodies are significantly more prevalent in AIG than in control patients, but the clinical significance of this finding remains to be established. H. pylori infection does not affect autoantibody seropositivity (ANA, APCA, AIFA). The positivity of myositis-associated antibodies is not increased in patients with CAG as compared to control patients. Overall, our results do not support an overrepresentation of common autoantibodies in patients with CAG.
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Affiliation(s)
- Malgorzata Osmola
- Department of Hematology, Transplantation and Internal Medicine, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Caroline Hemont
- Department of Immunology, University Hospital of Nantes, 44093 Nantes, France
| | - Nicolas Chapelle
- Institut des Maladies de l'Appareil Digestif (IMAD), Hepato-Gastroenterology & Digestive Oncology, University Hospital of Nantes, Hôtel Dieu, Place Alexis Ricordeau, CEDEX 1, 44093 Nantes, France
- Institut National de la Santé et de la Recherche Médicale (INSERM) U1064 Centre de Recherche Translationnelle en Transplantation et Immunologie (CR2TI), 44093 Nantes, France
- Faculty of Medicine, University of Nantes, 44300 Nantes, France
| | - Marie-Anne Vibet
- Department of Biostatistics, Centre Hospitalier Universitaire de Nantes, 44093 Nantes, France
| | - David Tougeron
- Department of Hepato-Gastroenterology, Poitiers University Hospital, University of Poitiers, 86000 Poitiers, France
| | - Driffa Moussata
- Department of Hepato-Gastroenterology, University Hospital of Tours, 37044 Tours, France
| | - Dominique Lamarque
- Department of Hepato-Gastroenterology, Ambroise-Paré Hospital, AP-HP, Paris Saclay University, University of Versailles Saint-Quentin-en-Yvelines, Institut National de la Santé et de la Recherche Médicale (INSERM), Infection and Inflammation, 91190 Paris, France
| | - Edith Bigot-Corbel
- Faculty of Medicine, University of Nantes, 44300 Nantes, France
- Department of Biochemistry, University Hospital of Nantes, 44093 Nantes, France
| | - Damien Masson
- Faculty of Medicine, University of Nantes, 44300 Nantes, France
- Department of Biochemistry, University Hospital of Nantes, 44093 Nantes, France
| | - Justine Blin
- Faculty of Medicine, University of Nantes, 44300 Nantes, France
- Department of Biochemistry, University Hospital of Nantes, 44093 Nantes, France
- Institut National de la Santé et de la Recherche Médicale (INSERM) U1235 the Enteric Nervous System in Gut and Brain Disorders (TENS), 44300 Nantes, France
| | - Maxime Leroy
- Department of Biostatistics, Centre Hospitalier Universitaire de Nantes, 44093 Nantes, France
| | - Regis Josien
- Department of Immunology, University Hospital of Nantes, 44093 Nantes, France
- Institut National de la Santé et de la Recherche Médicale (INSERM) U1064 Centre de Recherche Translationnelle en Transplantation et Immunologie (CR2TI), 44093 Nantes, France
- Faculty of Medicine, University of Nantes, 44300 Nantes, France
| | - Jean-François Mosnier
- Faculty of Medicine, University of Nantes, 44300 Nantes, France
- Department of Pathology, University Hospital of Nantes, 44093 Nantes, France
| | - Jérôme Martin
- Department of Immunology, University Hospital of Nantes, 44093 Nantes, France
- Institut National de la Santé et de la Recherche Médicale (INSERM) U1064 Centre de Recherche Translationnelle en Transplantation et Immunologie (CR2TI), 44093 Nantes, France
- Faculty of Medicine, University of Nantes, 44300 Nantes, France
| | - Tamara Matysiak-Budnik
- Institut des Maladies de l'Appareil Digestif (IMAD), Hepato-Gastroenterology & Digestive Oncology, University Hospital of Nantes, Hôtel Dieu, Place Alexis Ricordeau, CEDEX 1, 44093 Nantes, France
- Institut National de la Santé et de la Recherche Médicale (INSERM) U1064 Centre de Recherche Translationnelle en Transplantation et Immunologie (CR2TI), 44093 Nantes, France
- Faculty of Medicine, University of Nantes, 44300 Nantes, France
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Poveda JC, Chahar S, Garcia-Buitrago MT, Montgomery EA, McDonald OG. The Morphologic Spectrum of Gastric Type 1 Enterochromaffin-Like Cell Neuroendocrine Tumors. Mod Pathol 2023; 36:100098. [PMID: 36913909 PMCID: PMC10121960 DOI: 10.1016/j.modpat.2023.100098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/09/2022] [Accepted: 01/04/2023] [Indexed: 01/11/2023]
Abstract
Although most well-differentiated gastric neuroendocrine tumors (gNETs) arise from enterochromaffin-like (ECL) cells in patients with autoimmune metaplastic atrophic gastritis (AMAG), the morphologic spectrum of these type 1 ECL-cell gNETs is not well defined. The extent of metaplastic progression in the background mucosa of AMAG patients with gNETs is likewise unclear. Here we report the histomorphology of 226 gNETs, including 214 type 1 gNETs (78 cases from 50 AMAG patients) pooled from a population with high AMAG prevalence. Most type 1 gNETs were ≤1.0 cm, of low grade, and multifocal, consistent with the results of previous reports. However, a high proportion (70/214, 33%) displayed unusual gNET morphologies not previously appreciated in AMAG patients. Unlike other type 1 gNETs with conventional neuroendocrine tumor morphologies, unconventional type 1 gNETs displayed cribriform networks of atrophic cells embedded within myxoid matrix (secretory-cribriform variant, 59%), sheets of deceptively bland discohesive cells resembling inflammatory infiltrates (lymphoplasmacytoid variant, 31%), or wreath-like arrangements of columnar cells wrapped around collagenous cores (pseudopapillary variant, 14%). Another unusual feature was that unconventional gNETs grew laterally within the mucosa (50/70, 71%) and were only rarely sampled from the submucosa (3/70, 4%). These features also differed from the conspicuous radial nodules (99/135, 73%) and frequent submucosal involvement (57/135, 42%) observed for conventional gNETs (P < .0001). Irrespective of morphology, type 1 gNETs were nearly always detected at first AMAG diagnosis (45/50, 90%) and tended to persist thereafter (34/43, 79%), despite similar clinical symptoms and laboratory values between AMAG patients with gNETs and those without. However, unlike AMAG patients without gNETs (n = 50), the background mucosa in patients with gNETs (n = 50) had already progressed to the morphologic equivalent of end-stage metaplasia (P < .0001). This included diffuse loss of parietal cells (92% vs 52%), complete intestinal metaplasia (82% vs 40%), and pancreatic metaplasia (56% vs 6%). Thus, type 1 ECL-cell gNETs are morphologically heterogeneous with a high prevalence of unconventional gNET morphologies. They tend to present silently at first AMAG diagnosis as multifocal lesions that persist within fields of mature metaplasia.
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Affiliation(s)
- Julio C Poveda
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, Florida
| | - Satyapal Chahar
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, Florida
| | - Monica T Garcia-Buitrago
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, Florida
| | - Elizabeth A Montgomery
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, Florida
| | - Oliver G McDonald
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, Florida; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida.
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40
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Costanzo G, Sambugaro G, Mandis G, Vassallo S, Scuteri A. Pancytopenia Secondary to Vitamin B12 Deficiency in Older Subjects. J Clin Med 2023; 12:jcm12052059. [PMID: 36902847 PMCID: PMC10003837 DOI: 10.3390/jcm12052059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 02/28/2023] [Accepted: 03/02/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND Vitamin B12 (cobalamin CBL) is a water-soluble vitamin required to form hematopoietic cells (red blood cells, white blood cells, and platelets). It is involved in the process of synthesizing DNA and myelin sheath. Deficiencies of vitamin B12 and/or folate can cause megaloblastic anemia (macrocytic anemia with other features due to impaired cell division). Pancytopenia is a less frequent exordium of severe vitamin B12 deficiency. Vitamin B12 deficiency can also cause neuropsychiatric findings. In addition to correcting the deficiency, an essential aspect of management is determining the underlying cause because the need for additional testing, the duration of therapy, and the route of administration may differ depending on the underlying cause. METHODS Here, we present a series of four patients hospitalized for megaloblastic anemia (MA) in pancytopenia. All patients diagnosed with MA were studied for a clinic-hematological and etiological profile. RESULTS All the patients presented with pancytopenia and megaloblastic anemia. Vitamin B12 deficiency was documented in 100% of cases. There was no correlation between the severity of anemia and deficiency of the vitamin. Overt clinical neuropathy was present in none of the cases of MA, while subclinical neuropathy was seen in one case. The etiology of vitamin B12 deficiency was pernicious anemia in two cases and low food intake in the remaining cases. CONCLUSION This case study emphasizes the role of vitamin B12 deficiency as a leading cause of pancytopenia among adults.
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Affiliation(s)
- Giulia Costanzo
- S.C. di Medicina Interna, Policlinico Universitario Monserrato “Duilio Casula”—AOU di Cagliari, 09123 Cagliari, Italy
| | - Giada Sambugaro
- Scuola Specializzazione Allergologia e Immunologia Clinica, Universita’ di Cagliari, 09124 Cagliari, Italy
| | - Giulia Mandis
- Scuola Specializzazione Medicina Interna, Universita’ di Cagliari, 09124 Cagliari, Italy
| | - Sofia Vassallo
- Scuola Specializzazione Allergologia e Immunologia Clinica, Universita’ di Cagliari, 09124 Cagliari, Italy
| | - Angelo Scuteri
- S.C. di Medicina Interna, Policlinico Universitario Monserrato “Duilio Casula”—AOU di Cagliari, 09123 Cagliari, Italy
- Dipartimento Scienze Mediche e Sanita’ Pubblica, Universita’ di Cagliari, 09124 Cagliari, Italy
- Correspondence:
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41
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Polyakova V, Bodunova N, Rumyantsev K, Khatkov I, Bordin D, Bilyalov A, Sviridov P, Yanova T. Genetic Determinants of Autoimmune Gastritis. BIONANOSCIENCE 2023. [DOI: 10.1007/s12668-023-01068-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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42
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Hu H, Li R, Shao L, Zhang Q, Xu R, Zhang S. Gastric lesions in patients with autoimmune metaplastic atrophic gastritis: a retrospective study in a single center. Scand J Gastroenterol 2022; 57:1296-1303. [PMID: 35645153 DOI: 10.1080/00365521.2022.2081061] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES The presence of autoimmune metaplastic atrophic gastritis (AMAG) may lead to an increased risk of associated gastric neoplastic lesions. This study aims to investigate the prevalence of gastric neoplasia in AMAG patients and to explore the possibility of PGI/II ratio as a predictor for AMAG diagnosis. PATIENTS AND METHODS Retrospective audit of 135 patients diagnosed with AMAG on endoscopic gastric biopsy between January 2017 and December 2020 at Beijing Friendship Hospital. The study was registered in Chinese Clinical Trial Registry (ChiCTR2000041163). RESULTS A total of 135 patients (the mean age 61.9 ± 10.9 years,109 female) had histologically confirmed AMAG. 31.1% (42/135) had AMAG without neoplasia on the initial biopsy; 37% (50/135) had multiple type 1 gastric neuroendocrine tumors (g-NETs), 36 grade 1 and 14 grade 2, the median diameter was 5 mm (range 1-25); 31.9% (43/135) had multiple gastric hyperplastic polyps (GHPs), including 15 cases of GHPs with neoplastic transformation, the median diameter was 14.5 mm (range 3-50). 3.7% (5/135) had single gastric low-grade dysplasia/adenoma, the median diameter was 5 mm (range 3-15). 5.9% (8/135) had single or double gastric high-grade dysplasia or adenocarcinoma, the median diameter was 15 mm (range 8-43). 40.7% (55/135) had pepsinogen (PG) I< 10 ng/ml, 45.9% (62/135) had PG I/II ratio ≤1 and each group had a median of PG I/II ratio <1. CONCLUSIONS Lower serum PG I level and PGI/II ratio may be a predictor to indicate the diagnosis of AMAG. It's necessary to perform regular endoscopic surveillance for AMAG patients to recognize associated gastric neoplasia timely.
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Affiliation(s)
- Haiyi Hu
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Diseases, Beijing Digestive Disease Center, Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases, Beijing, PR China
| | - Rongxue Li
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Diseases, Beijing Digestive Disease Center, Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases, Beijing, PR China
| | - Linlin Shao
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Diseases, Beijing Digestive Disease Center, Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases, Beijing, PR China
| | - Qian Zhang
- Clinical Epidemiology and EBM Unit, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Disease, Beijing, PR China
| | - Rui Xu
- Department of Pathology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Diseases, Beijing, PR China
| | - Shutian Zhang
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Diseases, Beijing Digestive Disease Center, Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases, Beijing, PR China
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Cifuentes JDG, Sparkman J, Graham DY. Management of upper gastrointestinal symptoms in patients with autoimmune gastritis. Curr Opin Gastroenterol 2022; 38:600-606. [PMID: 36165039 PMCID: PMC9561041 DOI: 10.1097/mog.0000000000000878] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE OF REVIEW Autoimmune gastritis is characterized by atrophy of acid secreting parietal cells resulting in achlorhydria. Upper gastrointestinal symptoms are common in autoimmune gastritis and frequently result in prescriptions for acid suppressant medications despite the inability of the stomach to secrete acid. Evidence-based recommendations for management of gastrointestinal symptoms in autoimmune gastritis are lacking. RECENT FINDINGS The most common symptoms in patients with autoimmune gastritis are dyspepsia, heartburn, and regurgitation. Gastroesophageal reflux should be confirmed by pH-impedance testing and is typically weakly acid or alkaline. Therapy for reflux focuses on mechanical prevention of reflux (i.e., elevation of the head of the bed and alginates) or when severe, antireflux surgery. The etiology of dyspepsia in autoimmune gastritis is unclear and largely unstudied. In the first half of the 20th century, oral administration of acid to "aid digestion" was widely used with reported success. However, randomized, placebo-controlled trials are lacking. Here, we provide suggestions for attempting gastric acidification therapy. SUMMARY Upper GI symptoms are common in autoimmune gastritis. Their pathogenesis and therapy remain incompletely understood. Acid suppressant medications are useless and should be discontinued. A trial of acid replacement therapy is recommended especially in the form of placebo-controlled trials.
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Affiliation(s)
| | | | - David Y. Graham
- Department of Medicine, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
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Staley K, Ahmadi KR, Carter K, Cowan K, Seage H, Visser P, Ward N, Hooper M. Research priorities in pernicious anaemia: James Lind Alliance Priority Setting Partnership. BMJ Open 2022; 12:e065166. [PMID: 36002205 PMCID: PMC9413171 DOI: 10.1136/bmjopen-2022-065166] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES To form a James Lind Alliance (JLA) Priority Setting Partnership (PSP) to determine research priorities related to the cause, diagnosis, treatment and management of pernicious anaemia (PA) from the perspectives of patients, carers and clinicians. DESIGN The PSP conducted two surveys and a workshop to identify the Top 10 questions for research. A first survey identified questions relating to the cause, diagnosis, treatment and management of PA. A literature search checked whether any of these questions had already been answered. A second survey asked respondents to identify and rank their top 10 questions from the list of questions from the first survey. An online workshop used an adapted nominal group technique to agree a final Top 10. RESULTS In the first survey, 933 people submitted 3480 responses that were categorised and summarised to generate a long list of 40 questions. None had been answered by previous research. The combined rankings from the 1068 patients, carers and clinicians who took part in the second survey identified a short list of 16 questions. These were discussed at the final workshop to agree the final Top 10. The number one question was about an accurate and reliable diagnostic test for PA. The other nine questions were about making treatment safe and effective, understanding why people with PA vary in their need for treatment, links to other conditions, and how to encourage clinicians to take PA seriously and provide long-term care. CONCLUSIONS This JLA PSP enabled patients, carers and clinicians to work together to agree the Top 10 uncertainties relating to the cause, diagnosis, management and treatment of PA. Addressing any of these questions will greatly benefit the end-users of research, the people whose daily lives and decisions will be directly affected by generating high quality research evidence.
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Affiliation(s)
| | - Kourosh R Ahmadi
- School of Biosciences and Medicine, University of Surrey, Guildford, UK
| | | | | | - Heidi Seage
- School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | | | - Nicola Ward
- Leicester School of Pharmacy, De Montfort University, Leicester, UK
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Shrestha SR, Shrestha PR, Yadav AK, Shrestha S, Shrestha A, Katwal P. Rare case of pernicious anaemia from a university hospital of Nepal: A case report. Ann Med Surg (Lond) 2022; 80:104151. [PMID: 36045793 PMCID: PMC9422178 DOI: 10.1016/j.amsu.2022.104151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 07/01/2022] [Accepted: 07/06/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction Pernicious Anaemia is a rare autoimmune disorder prevalent among 0.1% of the general population and is characterised by decreased cobalamin absorption. This condition is overlooked because of its rarity, insidious onset of non-specific symptoms and clinically asymptomatic state. Elevated serum intrinsic factor antibody level along with reduced Vitamin B12 level confirms the diagnosis. Case presentation Pallor and abdominal tenderness was present. Haematological investigations showed elevated platelet count, elevated Mean Cell Volume reduced haemoglobin level(11.4 g/dl), reduced Vitamin B12 and high serum intrinsic factor antibody level. Serum parietal cell antibody was positive. The patient responded well to parenteral Vitamin B12. Discussion In Pernicious anaemia, serum intrinsic factor antibody and parietal cell antibody are high which are responsible for reduced Vitamin B12 absorption. Studies have also shown positive correlation between H pylori and Pernicious Anaemia. Neurological symptoms are less common but may present as paraesthesia, changes in gait or spasticity due to peripheral neuropathy. It is also associated with autoimmune diseases. Untreated pernicious anaemia can lead to neurological and gastrointestinal complications. Conclusion Pernicious Anaemia is an overlooked condition because of its insidious onset of non-specific symptoms, clinically asymptomatic state, rarity and therefore timely diagnosis of Pernicious Anaemia still remains a challenge.
Presentation of a case of Pernicious Anaemia that is uncommon in the Asian population. Incidence correlated with Helicobacter pylori infection. Presence of autoantibodies against both intrinsic factors and parietal cells specific to the disease. Disease entity requiring correction by replacement with parenteral or oral Vitamin B12.
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Potapova MV, Broyaka NA, Skvortsov KY, Konobeeva EV. Helicobacter pylori roles in haematology disease pathogenesis. СИБИРСКИЙ НАУЧНЫЙ МЕДИЦИНСКИЙ ЖУРНАЛ 2022; 42:18-35. [DOI: 10.18699/ssmj20220302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2025]
Affiliation(s)
- M. V. Potapova
- Saratov State Medical University n.a. V.I. Razumovsky of Minzdrav of Russia
| | - N. A. Broyaka
- Saratov State Medical University n.a. V.I. Razumovsky of Minzdrav of Russia
| | | | - E. V. Konobeeva
- Saratov State Medical University n.a. V.I. Razumovsky of Minzdrav of Russia
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Kametaka D, Iwamuro M, Takahashi T, Hirabata A, Hamada K, Kono Y, Kanzaki H, Kawano S, Tanaka T, Otsuka F, Kawahara Y, Okada H. Characterization of Gastric Tissue-Resident T Cells in Autoimmune and Helicobacter pylori-Associated Gastritis. Curr Issues Mol Biol 2022; 44:2443-2452. [PMID: 35735608 PMCID: PMC9221633 DOI: 10.3390/cimb44060167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 05/20/2022] [Accepted: 05/24/2022] [Indexed: 11/16/2022] Open
Abstract
Data regarding the in-depth surface marker profiles of gastric tissue-resident lymphocytes in autoimmune and Helicobacter pylori-associated gastritis are lacking. In this study, we investigated potential differences in lymphocyte composition between these profiles. We enrolled patients with autoimmune (n = 14), active (current infection of H. pylori in the stomach; n = 10), and inactive gastritis (post-eradication of H. pylori; n = 20). Lymphocytes were isolated from the greater curvature of the stomach and lesser curvature of the body and analyzed using flow cytometry. The CD8+/CD3+ and CD4+/CD3+ ratios differed between the samples. Body CD4+/antrum CD4+, which is calculated by dividing the CD4+/CD3+ ratio in the body by that in the antrum, was significantly higher in autoimmune gastritis (3.54 ± 3.13) than in active (1.47 ± 0.41) and inactive gastritis (1.42 ± 0.77). Antrum CD8+/CD4+ in autoimmune gastritis (7.86 ± 7.23) was also higher than that in active (1.49 ± 0.58) and inactive gastritis (2.84 ± 2.17). The area under the receiver operating characteristic curve of antrum CD8+/CD4+ was 0.842, and the corresponding optimal cutoff point was 4.0, with a sensitivity of 71.4% and a specificity of 93.3%. We propose that an antrum CD8+/CD4+ ratio > 4.0 is a potential diagnostic marker for autoimmune gastritis.
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Affiliation(s)
- Daisuke Kametaka
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan; (D.K.); (K.H.); (Y.K.); (H.K.); (S.K.); (H.O.)
- Department of Gastroenterology, Iwakuni Clinical Center, 1-1-1 Atago-cho, Iwakuni, Yamaguchi 740-8510, Japan
| | - Masaya Iwamuro
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan; (D.K.); (K.H.); (Y.K.); (H.K.); (S.K.); (H.O.)
| | - Takahide Takahashi
- Division of Medical Support, Okayama University Hospital, Okayama 700-8558, Japan; (T.T.); (A.H.)
| | - Araki Hirabata
- Division of Medical Support, Okayama University Hospital, Okayama 700-8558, Japan; (T.T.); (A.H.)
| | - Kenta Hamada
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan; (D.K.); (K.H.); (Y.K.); (H.K.); (S.K.); (H.O.)
| | - Yoshiyasu Kono
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan; (D.K.); (K.H.); (Y.K.); (H.K.); (S.K.); (H.O.)
| | - Hiromitsu Kanzaki
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan; (D.K.); (K.H.); (Y.K.); (H.K.); (S.K.); (H.O.)
| | - Seiji Kawano
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan; (D.K.); (K.H.); (Y.K.); (H.K.); (S.K.); (H.O.)
| | - Takehiro Tanaka
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan;
| | - Fumio Otsuka
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan;
| | - Yoshiro Kawahara
- Department of Practical Gastrointestinal Endoscopy, Okayama University Hospital, Okayama 700-8558, Japan;
| | - Hiroyuki Okada
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan; (D.K.); (K.H.); (Y.K.); (H.K.); (S.K.); (H.O.)
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Lenti MV, Vanoli A, Miceli E, Arpa G, Di Stefano M, Soriano S, Capuano F, Gentile A, Aronico N, Coppola L, Pasini A, Luinetti O, Mauro A, Paulli M, Klersy C, Corazza GR, Di Sabatino A. Increase of Deep Intraepithelial Lymphocytes in the Oxyntic Mucosa of Patients With Potential and Overt Autoimmune Gastritis. Front Immunol 2022; 13:866167. [PMID: 35603187 PMCID: PMC9114815 DOI: 10.3389/fimmu.2022.866167] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 03/31/2022] [Indexed: 01/23/2023] Open
Abstract
Pathological correlates of potential autoimmune gastritis (AIG), defined by anti-parietal cell antibody (PCA) positivity in the absence of gastric atrophy, have never been described. We herein aimed to assess intraepithelial lymphocyte (IEL) infiltration in gastric corpus of AIG patients. From 2000 to 2021, among 53 potential AIG patients, we focused on nine (median age 61 years, IQR 53-82; four females) who subsequently developed overt AIG. IEL infiltration of the oxyntic mucosa was assessed before and after developing overt AIG by measuring deep and superficial CD3+ IEL. AIG patients with different degrees of corpus atrophy, healthy controls (HC), active H. pylori gastritis, celiac disease (CD), and Hashimoto’s thyroiditis patients were included as controls. Of note, deep, but not superficial, CD3+ IEL count was higher (p<0.001) in potential AIG compared to HC and H. pylori gastritis. Deep CD3+ IEL infiltration did not change before or after the evolution into atrophy (median 9.6, IQR 8.8-12.4, vs 11.3, IQR 9.4-12.9). No difference was found in deep CD3+ IEL infiltration among potential, mild, and severe AIG, and compared to Hashimoto’s thyroiditis or CD. A deep CD3+ IEL cut-off of >7/100 epithelial cells allowed discrimination of any AIG stage and severity (AUC=0.842). We conclude that an increased deep CD3+ IEL infiltration of the oxyntic mucosa could represent a marker of potential AIG. Prospective studies including a larger number of potential AIG patients are needed.
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Affiliation(s)
- Marco Vincenzo Lenti
- Department of Internal Medicine, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Alessandro Vanoli
- Department of Pathology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Emanuela Miceli
- Department of Internal Medicine, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Giovanni Arpa
- Department of Pathology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Michele Di Stefano
- Department of Internal Medicine, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Simone Soriano
- Department of Internal Medicine, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Francesca Capuano
- Department of Pathology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Antonella Gentile
- Department of Internal Medicine, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Nicola Aronico
- Department of Internal Medicine, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Luigi Coppola
- Department of Internal Medicine, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Alessandra Pasini
- Department of Internal Medicine, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Ombretta Luinetti
- Department of Pathology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Aurelio Mauro
- Department of Internal Medicine, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Marco Paulli
- Department of Pathology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Catherine Klersy
- Unit of Clinical Epidemiology and Biometry, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Gino Roberto Corazza
- Department of Internal Medicine, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Antonio Di Sabatino
- Department of Internal Medicine, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Policlinico San Matteo, University of Pavia, Pavia, Italy
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Assa A, Borrelli O, Broekaert I, Saccomani MD, Dolinsek J, Martin-de-Carpi J, Mas E, Miele E, Sila S, Thomson M, Tzivinikos C, Benninga MA. Helicobacter pylori-negative Chronic Gastritis in Children: A Systematic Review. J Pediatr Gastroenterol Nutr 2022; 74:956-967. [PMID: 35175996 DOI: 10.1097/mpg.0000000000003414] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES To systematically review the current evidence on Helicobacter pylori-negative chronic gastritis including natural history, available therapies and outcomes. METHODS Articles providing data on the prevalence, treatment or outcomes of Helicobacter pylori-negative gastritis were identified through a systematic search in the MEDLINE and EMBASE databases. All original research articles from human studies until October 31, 2021, were included. RESULTS A total of 54 studies were included consisted of eosinophilic gastritis (n = 9), autoimmune gastritis (n = 11), collagenous gastritis (n = 16), focally enhanced gastritis (n = 6), lymphocytic gastritis (n = 5) and other causes including idiopathic gastritis and chronic renal failure related (n = 7). Most of the included studies were either cross-sectional or longitudinal cohorts except for collagenous gastritis, which mainly included case reports and case series. The prevalence of paediatric eosinophilic gastritis ranges between 5 and 7/100,000 and patients have generally favourable outcome with 50% to 70% clinical and histological response to either corticosteroids or elimination diets. Autoimmune gastritis and collagenous gastritis are extremely rare entities, commonly present with refractory iron deficiency anaemia, while lymphocytic gastritis is relatively common (10%-45%) in children with coeliac disease. Data on treatments and outcomes of autoimmune, collagenous, and focally enhanced gastritis are lacking with limited data implying poor response to therapy in the former 2 diagnoses. CONCLUSIONS Helicobacter pylori-negative gastritis is uncommonly reported, mainly in small cohorts, mixed adult-paediatric cohorts or as sporadic case reports. As common symptoms are not specific, thus not always result in an endoscopic evaluation, the true prevalence of these distinct disorders may be underestimated, and thus under reported.
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Affiliation(s)
- Amit Assa
- The Juliet Keidan institute of Pediatric Gastroenterology and Nutrition, Shaare Zedek Medical Center, The Hebrew University, Jerusalem, Israel
| | - Osvaldo Borrelli
- Division of Neurogastroenterology & Motility, Department of Paediatric Gastroenterology, Great Ormond Street Hospital, London, UK
| | - Ilse Broekaert
- Department of Paediatrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | | | - Jernej Dolinsek
- Department of pediatrics, University Medical Center Maribor, Ljubljanska 5, Maribor, Slovenia
| | - Javier Martin-de-Carpi
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Hospital Sant Joan de Deu, Barcelona, Spain
| | - Emmanuel Mas
- Unité de Gastroenterologie, Hepatologie, Nutrition et Maladies Héréditaires du Metabolisme, Hôpital des Enfants, and IRSD, Universite de Toulouse, INSERM, INRAE, ENVT, UPS, Toulouse, France
| | - Erasmo Miele
- Department of Translational Medical Science, Section of Pediatrics, University of Naples "Federico II", Naples, Italy
| | - Sara Sila
- Referral Centre for Pediatric Gastroenterology and Nutrition, Children's Hospital Zagreb, Zagreb, Croatia
| | - Mike Thomson
- Centre for Paediatric Gastroenterology, Sheffield Children's Hospital NHS Foundation Trust, Weston Bank, Sheffield, UK
| | - Christos Tzivinikos
- Paediatric Gastroenterology Department, Al Jalila Children's Specialty Hospital, Mohammed Bin Rashid University, Dubai Medical College, Dubai, United Arab Emirates
| | - Marc A Benninga
- Department ofPaediatrics, Emma Children's Hospital, Amsterdam University Medical Center, Amsterdam, The Netherlands
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Venerito M, Sulzer S, Jechorek D. [Clinical management of autoimmune gastritis]. Dtsch Med Wochenschr 2022; 147:451-459. [PMID: 35405749 DOI: 10.1055/a-1520-3562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Autoimmune gastritis (AIG) is a chronic immune-mediated inflammation of the gastric corpus/fundus mucosa leading to progressive atrophy of the oxyntic gastric glands (AOM) and their consecutive loss of function. Possible clinical consequences of AIG include iron deficiency anemia, pernicious anemia, gastric neuroendocrine tumors (gNET), and gastric adenocarcinoma. This article provides a review of interdisciplinary aspects of the diagnosis and treatment of AIG.
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