Autoimmune Gastropathy in Type 1 Diabetic Patients With Parietal Cell Antibodies

Abstract

OBJECTIVE -Approximately 15-20% of type 1 diabetic patients exhibit parietal cell antibodies (PCAs) targeting gastric H ϩ /K ϩ ATPase. We examined whether iron deficiency anemia, pernicious anemia, and autoimmune gastritis, which may predispose to gastric tumors, were more frequent in PCA ϩ than in PCA -patients. RESULTS -Autoimmune gastritis (AG) was present in 57% of PCA ϩ and 10% of PCA -cases (OR 12.5, P Ͻ 0.0001). PCA positivity (␤ ϭ 1.44; P ϭ 0.04) and hypergastrinemia (␤ ϭ 0.01; P ϭ 0.026), but not HP, age, diabetes duration, sex, and HLA-DQ type were risk factors for AG. Iron deficiency anemia (OR 3.9, P ϭ 0.015), pernicious anemia (OR ϭ 4.6, P ϭ 0.022), and hypochlorhydria (OR ϭ 20.0, P ϭ 0.0002) were more frequent in AG ϩ individuals. HP infection was present in 47 patients but did not influence corpus histology or gastrinemia. (Pre)malignant lesions were found in 26% of PCA ϩ subjects: ECL cell hyperplasia in 7 AG ϩ patients, comprising 1 with a gastric carcinoid tumor, and corpus intestinal metaplasia in 11 AG ϩ patients, including 1 with linitis plastica. RESEARCH DESIGN AND METHODS CONCLUSIONS -PCAϩ type 1 diabetic patients should be screened for autoimmune gastritis, iron deficiency, and pernicious anemia. Particularly hypergastrinemic PCA ϩ patients with autoimmune gastritis are at increased risk for (pre)malignant gastric lesions.

Distinct clinical and laboratory characteristics of latent autoimmune diabetes in adults in relation to type 1 and type 2 diabetes mellitus

“…Patients with autoimmune diabetes are likely to be presented with an additional autoimmune condition of endocrine (thyroid and adrenal glands) or non-endocrine organs (thyroid and adrenal glands) [23] . Regarding endocrine organ-specific autoimmune conditions, anti-TPO (thyroid peroxidase)/anti-thyroglobulin (anti-Tg) antibodies, marker for autoimmune thyroid disease can be detected in about one fifth of patients with T1D, while anti-adrenal autoantibodies, marker for Addison's disease are rather less common in T1D, being found in less than 2% [49,50] . Regarding non-endocrine organs, autoimmune gastritis, characterised by the presence of anti-parietal-cell antibodies can be found in about one tenth of patients with autoimmune diabetes, while celiac disease, characterised by an immunological signature of anti-endomysial, anti-Tg and anti-gliadin antibodies, with a prevalence of 11% is consider to be common in T1D [50,51] .…”

“…Regarding endocrine organ-specific autoimmune conditions, anti-TPO (thyroid peroxidase)/anti-thyroglobulin (anti-Tg) antibodies, marker for autoimmune thyroid disease can be detected in about one fifth of patients with T1D, while anti-adrenal autoantibodies, marker for Addison's disease are rather less common in T1D, being found in less than 2% [49,50] . Regarding non-endocrine organs, autoimmune gastritis, characterised by the presence of anti-parietal-cell antibodies can be found in about one tenth of patients with autoimmune diabetes, while celiac disease, characterised by an immunological signature of anti-endomysial, anti-Tg and anti-gliadin antibodies, with a prevalence of 11% is consider to be common in T1D [50,51] . Regarding organ specific autoantibodies in LADA, the recent NIRAD study 6 suggests a higher frequency of organ-specific antibodies in subjects with high anti-GAD65 titres [52] .…”

Mechanisms and factors associated with gastrointestinal symptoms in patients with diabetes mellitus

“…Quando comparados com indivíduos não diabéticos, esta porcentagem tende a cair para 2 a 10% 40 . Sob outra análise, 20 a 40% dos pacientes com anticorpos contra as células parietais gástricas têm DMT1 17 .…”

Organ specific autoimmune disorders in type 1 diabetes mellitus

“…In a study from Italy, conducted to document associated skin lesions in DM, 54 it was found that vitiligo was present in 9% of patients with T1DM, compared to 0.8% among patients with T2DM. 55 …”

“…56 It was also observed that, APC antibody positive patients, especially who are hypergastrenemic, are a high-risk group for pre malignant lesions and APC antibodies and PA screening was proposed in all patients with T1DM. 55 Kakleas et al, 57 reported that at baseline 7.22% of patients with T1DM had APC antibody and at follow-up, 7.21% had these antibodies. This study also proposed periodic APC autoantibody screening for the T1DM is known to be associated with organ specific autoantibodies.…”