Autoimmune Diseases and Gastric Cancer Risk: A Systematic Review and Meta-Analysis

Abstract

Purpose Autoimmunity is an alternative etiology of gastric inflammation, the initiating event in the gastric carcinogenic cascade. This mechanism may be an increasingly important cause of gastric cancer with the waning prevalence of its primary etiologic factor, chronic Helicobacter pylori infection. Materials and Methods PubMed and EMBASE were searched up to September 2018. Autoimmunity and 96 specific manifestations were considered for associations with gastric cancer risk. Random effects analysis was used to calculate pooled relative risk estimates (RR) and 95% confidence intervals (CI). Results We found a total of 52 observational studies representing 30 different autoimmune diseases. Overall, the presence of an autoimmune condition was associated with a gastric cancer pooled RR of 1.37 (95% CI, 1.24 to 1.52). Among the 24 autoimmune conditions with two or more independent reports, nine were significantly associated with increased gastric cancer risk: dermatomyositis (RR, 3.69; 95% CI, 1.74 to 7.79), pernicious anemia (RR, 2.84; 95% CI, 2.30 to 3.50), Addison disease (RR, 2.11; 95% CI, 1.26 to 3.53), dermatitis herpetiformis (RR, 1.74; 95% CI, 1.02 to 2.97; n=3), IgG4-related disease (RR, 1.69; 95% CI, 1.00 to 2.87), primary biliary cirrhosis (RR, 1.64; 95% CI, 1.13 to 2.37), diabetes mellitus type 1 (RR, 1.41; 95% CI, 1.20 to 1.67), systemic lupus erythematosus (RR, 1.37; 95% CI, 1.01 to 1.84), and Graves disease (RR, 1.27; 95% CI, 1.06 to 1.52). Conclusion Our analysis documents the wide range of autoimmune diseases associated with gastric cancer. These associations may reflect unreported links between these conditions and autoimmune gastritis. Further studies are warranted to investigate potential causal mechanisms.

Endoscopic and Pathological Characteristics of <b><i>Helicobacter pylori</i></b> Infection-Negative Early Gastric Cancer

“…Third, whereas there are types of gastric neoplasms that do not present with HP infection, such as autoimmune gastritis-related gastric cancer or certain types of hereditary gastric cancer, we did not examine those types in detail. It has been frequently reported that autoimmune gastritis-related gastric cancer usually develops with atrophic mucosa [42], but this conflicted with our criteria for determining HP negativity. Therefore, the possibility of having included autoimmune gastritis-related gastric lesions in this study may be very low.…”

Cancer incidence and factors associated with malignancies in coeliac disease during long‐term follow‐up

“…Moreover, the relative risk of stomach cancer was slightly increased among dermatitis herpetiformis patients. A recent review on the association of autoimmune diseases and stomach cancer reported a similar finding (RR 1.7) for dermatitis herpetiformis, 32 but other studies focussing specifically on the risk of malignancies in dermatitis herpetiformis found no increased risk 5,10,33 . Nevertheless, the number of these cancers observed was small in our cohort and no precise conclusions can thus be drawn.…”

AGA Technical Review on Gastrointestinal Evaluation of Iron Deficiency Anemia

“…Observational studies of patients suspected to have autoimmune gastritis or pernicious anemia have shown a pooled gastric cancer incidence of 0.27% per person-year. 87 However, there was insufficient comparative evidence to support the benefit of surveillance endoscopy. Autoimmune gastritis presents as IDA in young patients and vitamin B-12 deficiency (pernicious anemia) in older patients.…”