Autoimmune Gastritis: Update and New Perspectives in Therapeutic Management

Abstract

Purpose of Review Diagnosis of autoimmune gastritis (AIG) is often delayed because of the absence of typical symptoms. Clinical guidelines are lacking which results in inadequate treatment and poor cancer screening. This review presents an overview of current management options and aims at raising awareness for this often-neglected disease. Recent Findings Autoimmune gastritis is mostly thought of as a disease of the elderly with vitamin B12 deficiency and pernicious anemia. Today it is recognized that AIG is found with a similar prevalence among all age-groups, with iron deficiency being a frequent feature. Conventional therapy consists of adequate iron and vitamin B12 supplementation as well as symptomatic approaches. The associated risk for gastric adenocarcinoma and gastric neuroendocrine tumors requires regular endoscopic follow up. Novel therapies aiming to reduce gastric atrophy and cancer risk are currently under development. Summary Treatment of autoimmune gastritis should focus on optimizing supplementation of deficiencies and include cancer prevention measures. Clinical research should address the possibility to arrest the inflammatory process and to prevent progression of AIG. International guidelines on management and endoscopic screening intervals should be set up.

Creating a Framework for Treating Autoimmune Gastritis—The Case for Replacing Lost Acid

“…The combined effect of iron and B12 deficiencies produces symptoms of fatigue, weakness, shortness of breath, hair loss, or sleep disorders [ 10 ]. Prolonged B12 deficiency can cause a host of neurologic symptoms, including changes in cognitive function and mood disorders, as well as sensory, motor, and autonomic neuropathies.…”

“…As in B12 deficiency, the overall clinical picture is most important. Orgler et al recommend that patients with nonspecific GI symptoms and/or iron deficiency—with or without anemia—should be evaluated for AIG through laboratory testing that includes PCA, IFA, and serum gastrin, in addition to a complete blood count, measures of iron status (transferrin saturation, transferrin, ferritin), and measures of B12 status [ 10 ]. Elevated PCA levels are generally indicative of AIG; however, sensitivity and specificity may differ considerably between assays [ 11 ].…”

“…The AGA guidelines recommend that all patients with atrophic gastritis be evaluated for H. pylori infection and treated for eradication if positive [ 15 ]. Orgler et al are in the process of developing a symptom scoring instrument to provide a more systematic approach to AIG diagnosis [ 10 ].…”

“…Despite the limited scope of BHCL studies in humans, BHCL appears to be tolerated in healthy stomachs and by the majority of subjects with functional dyspepsia. Experts in AIG recommend trials of BHCL to ameliorate the GI side effects of hypochlorhydria [ 10 , 39 ].…”

Autoimmune gastritis

“…пожизненно. Как и в случае с показателями железа, пациенты должны регулярно проверяться на дефицит витамина B 12 и при необходимости проводить заместительную терапию [22].…”