Clinical Profiles, Endoscopic and Laboratory Features and Associated Factors in Patients with Autoimmune Gastritis

Abstract

Background/Aims: Autoimmune gastritis (AIG) may predispose to gastric carcinoid tumors or adenocarcinomas and may also cause unexplained iron and/or vitamin B₁₂ deficiency. The aims of this study were to explore clinical manifestations, endoscopic findings and laboratory features of patients with AIG. Methods: 109 patients with AIG were enrolled into the study. In addition to demographic and clinical data, gastric lesions, serum gastrin, vitamin B₁₂, antiparietal cell antibody (APA), current Helicobacter pylori status, and anti-H. pylori IgG were also investigated. Results: The mean age of the patients was 53.06 ± 12.7 years (range 24–81; 72 (66.1%) women). The most common main presenting symptom was abdominal symptoms in 51 patients, consultation for iron and/or vitamin B₁₂ deficiency in 36, and non-specific symptoms including intermittent diarrhea in 15 patients. Endoscopic lesions were detected in 17 patients, hyperplastic polyps in 8, gastric carcinoid tumor in 4, fundic gland polyps in 3, and adenomatous polyps in 2 patients. H. pylori was negative in all patients in biopsy specimens; however, anti-H. pylori IgG was positive in 30 (27.5%) patients. 91 patients (83.4%) were positive for APA. Conclusion: In patients with AIG, the main symptoms prompted for clinical investigation were: abdominal symptoms, iron/B₁₂ deficiency and non-specific symptoms. 20% of patients with AIG had various gastric lesions including type I gastric carcinoids. None of the patients were positive for H. pylori by means of invasive tests; however, anti-H. pylori IgG was found in 27.5% of patients. Patients referring with non-specific abdominal symptoms such as bloating, diarrhea and iron/B₁₂ deficiency should be investigated for the presence of AIG.

Clinical features and management of type I gastric carcinoids

“…TIGCs are more prevalent in women than in men [9,12], owing to the greater incidence of AIG in women [18]. In Japan, however, TIGC is more common in men than in women [19], perhaps owing to the lower rates of cooccurrence of TIGC and AIG.…”

Upper gastrointestinal symptoms in autoimmune gastritis

“…On the contrary Soykan et al, [12] did not find any significant difference in terms of age, gender, autoimmune diseases, and presence of gastric autoantibodies when compare AG patients with or without symptoms. [12] This might be important because clinical guidelines recommend gastroscopy with biopsies for dyspeptic patients over the age of 55 years and for patients with alarm symptoms (i.e., anemia), [34] and younger dyspeptic patients without anemia generally are not referred to gastroscopy, thus possibly missing the diagnosis of AG.…”

“…[11] These figures seem much lower compared to those observed in our study. In the study by Soykan et al, [12] 46.7% of AG patients present abdominal symptoms, mainly characterized by abdominal bloating and pain, with a minor part complained of upper symptoms such as nausea and belching. It is possible that discrepancy between our results and the previously studies is mainly related to the different method used to collect symptoms.…”

Utility of a laboratory score in the prediction of altered autonomic nervous system function in autoimmune gastritis

“…Continuous hypergastrinemia due to hypochlorhydria stimulates the proliferation of endocrine cells of the corpus, which might give rise to gastric neuroendocrine tumor and gastric cancer (2,3). Symptoms of AIG are non-specific and patients undergo investigations because of vitamin B 12 and/or iron deficiency, commonly reporting vague symptoms which are not specific enough to reach a diagnosis (4).…”