Autoimmune Gastritis in Type 1 Diabetes: A Clinically Oriented Review

Abstract

Context: Autoimmune gastritis and pernicious anemia are common autoimmune disorders, being present in up to 2% of the general population. In patients with type 1 diabetes or autoimmune thyroid disease, the prevalence is 3-to 5-fold increased. This review addresses the epidemiology, pathogenesis, diagnosis, clinical consequences, and management of autoimmune gastritis in type 1 diabetic patients.Synthesis: Autoimmune gastritis is characterized by: 1) atrophy of the corpus and fundus; 2) autoantibodies to the parietal cell and to intrinsic factor; 3) achlorhydria; 4) iron deficiency anemia; 5) hypergastrinemia; 6) pernicious anemia may result from vitamin B12 deficiency; and 7) in up to 10% of patients, autoimmune gastritis may predispose to gastric carcinoid tumors or adenocarcinomas. This provides a strong rationale for screening, early diagnosis, and treatment. The management of patients with autoimmune gastritis implies yearly determination of gastrin, iron, vitamin B12 levels, and a complete blood count. Iron or vitamin B12 should be supplemented in patients with iron deficiency or pernicious anemia. Whether regular gastroscopic surveillance, including biopsies, is needed in patients with autoimmune gastritis/pernicious anemia is controversial. The gastric carcinoids that occur in these patients generally do not pose a great threat to life, whereas the danger of developing carcinoma is controversial. Nevertheless, awaiting a consensus statement, we suggest performing gastroscopy and biopsy at least once in patients with autoantibodies to the parietal cell, iron-, or vitamin B12-deficiency anemia, or high gastrin levels. Conclusion:The high prevalence of autoimmune gastritis in type 1 diabetic patients and its possible adverse impact on the health of the patient provide a strong rationale for screening, early diagnosis, periodic surveillance by gastroscopy, and treatment.

Factors associated with elevated serum chromogranin A levels in patients with autoimmune gastritis

“…In addition, serum gastrin levels and antiparietal cell antibodies were also investigated in each patient (14). Histologically, a chronic inflammatory infiltrate is associated with the depletion of oxyntic glands, parietal cells, and zymogenic cells in AIG, which affects gastric fundal and corporal mucosa (15). We investigated demographic characteristics of each patient, biochemical data, Helicobacter pylori infection, and histopathological properties of gastric biopsy specimens.…”

Correlation between Visual Evoked Potentials and Vitamin B12 Levels in Patients with Controlled Diabetes Mellitus

“…Type 1 Diabetes Mellitus is an autoimmune condition. It is invariably associated with other organ and non organ specific autoimmune and endocrine conditions leading to development of autoimmune poly-glandular syndromes 15 .…”

Autoimmune Disorders Associated to Type 1 Diabetes Mellitus in Children and Adolescents

“…As regards children, adolescents and young adults with type 1 diabetes, the frequency of parietal cells antibodies is 15.8%, with a close association with older age and duration of disease (De Block et al, 2008, Warncke et al, 2010. Female gender association is controversial.…”

“…In adult general population the frequency of autoimmune gastritis is about 1-2%, and is 3-5 fold increased in patients with type 1 diabetes (De Block et al, 2008). As regards children, adolescents and young adults with type 1 diabetes, the frequency of parietal cells antibodies is 15.8%, with a close association with older age and duration of disease (De Block et al, 2008, Warncke et al, 2010.…”