High incidence of autoimmune gastritis in patients misdiagnosed with two or more failures of <i>H. pylori</i> eradication

Furuta, Takahisa; Baba, Shigeaki; Yamade, Mihoko; Uotani, Takahiro; Kagami, Takuma; Suzuki, Takahiro; Tani, Shinya; Hamaya, Yasushi; Iwaizumi, Moriya; Osawa, Satoshi; Sugimoto, Ken

doi:10.1111/apt.14849

Cited by 42 publications

(45 citation statements)

References 19 publications

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“…H pylori infection is also known to be an important cause of atrophy and IM, the premalignant lesion of GC . Although there are other causes of atrophy, such as autoimmune gastritis, we could not find autoimmune gastritis in our institution, which is different from the recently published Japanese study . Instead of rare autoimmune gastritis, most of atrophy was related to H pylori in Korea .…”

Section: Introductioncontrasting

confidence: 96%

The prevalence of histologic atrophy and intestinal metaplasia in the corpus has decreased over 15 years in females in the Korean population

et al. 2019

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Background The aim of this study was to investigate the trends of atrophy and intestinal metaplasia (IM) in 2002 subjects without significant gastroduodenal diseases. Materials and Methods A total of 2002 subjects were prospectively enrolled and divided into three periods (2003‐2007, 2008‐2012, and 2013‐2018). Trends of H pylori and atrophy/IM scored by Updated Sydney System were analyzed according to sex, and multivariate logistic analysis was performed for the risk factors for atrophy/IM. Results H pylori‐negative and H pylori‐positive subjects were 1220 (61.0%) and 782 (38.0%), respectively. H pylori positivity decreased from 149/303 (49.2%), 207/515 (40.2%) and 426/1184 (36.0%), in the three periods, respectively (P < 0.001). The prevalence of atrophy (P < 0.001) and IM in the corpus (P < 0.001) significantly decreased over 15 years in females, but not in males. The mean grade of atrophy and IM was higher in males (0.36 and 0.51) than in females (0.28 and 0.41) in the corpus (P = 0.027) and in the antrum (P = 0.006), respectively. Similarly, the mean grade of IM in males (0.34) was higher in females (0.19; P < 0.001) in the corpus. Multivariate analysis showed that old age, study period, and H pylori were statistically significant in atrophy of antrum and corpus, and IM in the corpus. In cases of IM of antrum, old age, H pylori, and smoking were statistically significant. Conclusion A significant decrease in atrophy and IM in the corpus in females over 15 years suggests sex‐ or gender‐specific characteristics.

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Section: Introductioncontrasting

confidence: 96%

The prevalence of histologic atrophy and intestinal metaplasia in the corpus has decreased over 15 years in females in the Korean population

et al. 2019

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“…Some of the patients who underwent treatment were considered to have been incorrectly classified as Hp‐ positive. A previous report suggested that proliferations of urease‐positive bacteria other than Hp under non‐acidic circumstances possibly resulted in positive 13 C‐UBT test results. Thus, such misclassification leads to unnecessary treatment for Hp .…”

Section: Discussionmentioning

confidence: 98%

“…In Japan, the prevalence of AIG was assumed to be very low until about a decade ago . However, possibly on the background of a recent dramatically rapid decrease in Helicobacter pylori ( Hp ) prevalence, reports on AIG are increasing . This multicenter registry study aimed to clarify the characteristics of AIG in Japan and explore its endoscopic appearances.…”

Section: Introductionmentioning

confidence: 99%

Multicenter study of autoimmune gastritis in Japan: Clinical and endoscopic characteristics

Terao

Suzuki

Yaita

et al. 2019

Digestive Endoscopy

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Background and Aim In Japan, the prevalence of autoimmune gastritis (AIG) is assumed to be very low. With the recent rapid decrease in Helicobacter pylori (Hp) prevalence, reports on AIG are increasing. This multicenter registry study aimed to clarify the characteristics of AIG, especially its endoscopic appearance. Methods A total of 245 patients with AIG from 11 institutions in Japan from January 2010 to October 2016 were included, and their clinical and endoscopic findings were evaluated. Results Mean age was 67.2 ± 11.4 years, and 63.7% of the participants were women. The most common approach to diagnose AIG was endoscopic examination. Repeated incorrect treatment for Hp infection, due to a false‐positive result in 13C‐urea breath test, ranked third among the basis for diagnosis of AIG. Associated gastric lesions were type 1 neuroendocrine tumor (11.4%), adenocarcinoma (9.8%), and hyperplastic polyps (21.1%). Corpus pan‐atrophy was the most common appearance (90.1%); however, remnant oxyntic mucosa was found in 31.5% of the patients (flat, localized type, 48.6%). Sticky adherent dense mucus and scattered minute whitish protrusions were also observed in approximately 30% of the patients. Despite the prevailing presumption of the antral mucosa remaining normal, 42.3% of the patients presented with various extents of atrophy, and patchy redness and circular wrinkle‐like patterns were both observed in approximately 20% of the patients. Conclusions The present study showed some prominent clinical characteristics and endoscopic findings of AIG. We believe that our study will facilitate the diagnosis of potential AIG.

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“…H pylori infection, an additional risk factor for gastric cancer, must be ruled out by histology and, in case of histological doubts (eg presence of active inflammation in gastric mucosa, development of atrophy in the antrum or incisura angularis), by antigen stool test. In fact, false‐positive urea breath test results are common in AAG, due to hypo‐achlorhydria . Finally, there now seems to be enough evidence to support the follow‐up of PCA‐positive individuals with non‐atrophic gastric mucosa.…”

Section: Discussionmentioning

confidence: 99%

Natural history of autoimmune atrophic gastritis: a prospective, single centre, long‐term experience

Miceli

Vanoli

Lenti

et al. 2019

Aliment Pharmacol Ther

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Summary Background Autoimmune atrophic gastritis (AAG) is an immune‐mediated disorder characterised by destruction of gastric oxyntic mucosa Aim To explore gastric histopathological evolution in a cohort of AAG patients over a prolonged follow‐up Methods Single centre prospective study enrolling consecutive patients with histologically confirmed AAG between 2000 and 2018. All AAG patients undergoing endoscopic follow‐up every 1‐3 years were classified as having stages 1, 2 or 3 according to atrophy severity (mild, moderate and severe). AAG patients with either glandular or neuroendocrine dysplasia/neoplasia were classified as having stage 4. Disease stage progression, and changes in serum anti‐parietal cell antibody (PCA), chromogranin A and gastrin‐17 were assessed. Results In total, 282 AAG patients (mean age 60.3 years; F:M ratio 2.4:1; median follow‐up 3 years, interquartile range 1‐7) were enrolled. All patients with stages 1 or 2 progressed to stage 2 or 3 over time with a steady trend (P = .243) and regression from a severe to a milder stage was never noticed. Disease progression of patients with stages 1 or 2 occurred within the first 3 years. PCA positivity rate did not change over time. Stage 3 patients had higher gastrin‐17 levels compared to patients with stages 1 and 2 (median 606 vs 295 pg/mL; P < .001). In stage 3, the hazard ratio for the risk of developing stage 4 was 6.6 (95% CI 1.5‐29; P = .001). Conclusions AAG is a steadily progressive disease, in which stages 1 and 2 always progress to stage 3. The risk of developing a complicated disease stage is greater in patients with more severe gastric lesions.

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High incidence of autoimmune gastritis in patients misdiagnosed with two or more failures of H. pylori eradication

Abstract: AIG patients were often misdiagnosed as refractory to eradication therapy, probably because achlorhydria in AIG might allow urease-positive bacteria other than H. pylori to colonise the stomach, causing positive C-UBT results.

Cited by 42 publications

References 19 publications

The prevalence of histologic atrophy and intestinal metaplasia in the corpus has decreased over 15 years in females in the Korean population

The prevalence of histologic atrophy and intestinal metaplasia in the corpus has decreased over 15 years in females in the Korean population

Multicenter study of autoimmune gastritis in Japan: Clinical and endoscopic characteristics

Natural history of autoimmune atrophic gastritis: a prospective, single centre, long‐term experience

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