Refractory Iron-deficiency Anemia and Autoimmune Atrophic Gastritis in Pediatric Age Group

Miguel, Natalina; Costa, Emília; Santalha, Marta; Lima, Rosa; Vizcaíno, José R.; Pereira, Fernando; Barbot, José

doi:10.1097/mph.0000000000000069

Cited by 16 publications

(18 citation statements)

References 20 publications

(40 reference statements)

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“…The long-term outcome of AIG in children has not been investigated yet. Our findings, in line with those of other authors, have shown no improvement in gastric atrophy, metaplasia, or ECL cell hyperplasia over time, consistently with known progression of AIG in adult patients ( 3 , 4 , 8 , 10 ).…”

Section: Discussionsupporting

confidence: 93%

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Autoimmune Gastritis in the Pediatric Age: An Underestimated Condition Report of Two Cases and Review

et al. 2018

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Background: Diagnosis of pediatric autoimmune gastritis (AIG) in children is important due to poor outcome and risk of malignancy. This condition is often underestimated in the clinico-pathologic diagnostic work-up, leading to delayed time-to-diagnosis. To increase the awareness of this condition in the pediatric population, we present two cases encountered at our institution, discuss their clinical, biological, and histological presentations in relation with evidence from the literature, and propose an algorithm for diagnosis and follow-up of AIG in children.Case presentation: Two patients (12 and 17 years old) presented with iron deficiency anemia and negative family history for autoimmune disorders. In both cases, the final diagnosis of autoimmune gastritis was delayed until pathological examination of endoscopic gastric biopsies showed atrophy of oxyntic glands. Helicobacter pylori search was negative. Follow up biopsies revealed persistent disease. Literature review on this condition shows unclear etiology and poor long term outcome in some patients because of increased risk of malignancy.Conclusions: AIG should be considered in the differential diagnosis of iron deficiency anemia in the pediatric population.Standardized clinico-pathologic work-up is mandatory. Endoscopic follow-up should be performed due to the risk of malignancy.

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Section: Discussionsupporting

confidence: 93%

“…The same observation was made by other authors who followed-up pediatric patients with H. pylori infection and AIG ( 9 , 10 ). However, as H. pylori eradication is a simple procedure most of the times, regular search and treatment in case of positivity are recommended ( 8 ).…”

Section: Discussionmentioning

confidence: 99%

Autoimmune Gastritis in the Pediatric Age: An Underestimated Condition Report of Two Cases and Review

et al. 2018

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“…Several studies have shown that refractory or unexplained IDA should increase clinicians’ suspicion of AMAG not only in adults but also in pediatric population. 59 – 61 PA is the most common cause of cobalamin deficiency. 62 Although the underlying mechanisms of how cobalamin deficiency causes megaloblastosis have not been fully elucidated, it is believed that it is due to cobalamin’s essential role in DNA synthesis.…”

Section: Clinical Manifestationsmentioning

confidence: 99%

Autoimmune atrophic gastritis: current perspectives

Minalyan¹,

Benhammou²,

Artashesyan³

et al. 2017

CEG

105

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At present there is no universally accepted classification for gastritis. The first successful classification (The Sydney System) that is still commonly used by medical professionals was first introduced by Misiewicz et al in Sydney in 1990. In fact, it was the first detailed classification after the discovery of Helicobacter pylori by Warren and Marshall in 1982. In 1994, the Updated Sydney System was proposed during the International Workshop on the Histopathology of Gastritis followed by the publication in The American Journal of Surgical Pathology by Dixon et al. Using the new classification, distinction between atrophic and nonatrophic gastritis was revised, and the visual scale grading was incorporated. According to the Updated Sydney System Classification, atrophic gastritis is categorized into multifocal (H. pylori, environmental factors, specific diet) and corpus-predominant (autoimmune). Since metaplasia is a key histological characteristic in patients with atrophic gastritis, it has been recommended to use the word “metaplastic” in both variants of atrophic gastritis: autoimmune metaplastic atrophic gastritis (AMAG) and environmental metaplastic atrophic gastritis. Although there are many overlaps in the course of the disease and distinction between those two entities may be challenging, the aim of this review article was to describe the etiology, epidemiology, pathogenesis, diagnosis, clinical manifestations and treatment in patients with AMAG. However, it is important to mention that H. pylori is the most common etiologic factor for the development of gastritis in the world.

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“…Interestingly, 3 of these patients had normal VitB12 levels 18 . Autoimmune gastritis has been reported in children with IDA, 17‐19 type 1 diabetes mellitus, 20 Sjögren syndrome, 21 autoimmune thyroid disease, 22,23 and autoimmune hepatitis 24 . We identified Behcet's disease in a child with AIG which represents a new coincidence.…”

Section: Discussionmentioning

confidence: 81%

“…Autoimmune atrophic gastritis is a very rare entity in children, and there are only a few reports in the literature 16‐21 . It was first reported in 1972 in a child with hemolytic anemia, thrombocytopenia, and autoantibody 16 .…”

Section: Discussionmentioning

confidence: 99%

Autoimmune atrophic gastritis: The role of Helicobacter pylori infection in children

et al. 2020

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Background Autoimmune atrophic gastritis (AIG) is very rare in children. Despite a better understanding of histopathologic changes and serological markers in this disease, underlying etiopathogenic mechanisms and the effect of Helicobacter pylori (H pylori) infection are not well known. We aimed to investigate the relation between AIG and H pylori infection in children. Materials and Methods We evaluated the presence of AIG and H pylori infection in fifty‐three patients with positive antiparietal cell antibody (APCA). Demographic data, clinical symptoms, laboratory and endoscopic findings, histopathology, and presence of H pylori were recorded. Results The children were aged between 5 and 18 years, and 28 (52.8%) of them were male. Mean age was 14.7 ± 2.6 years (median: 15.3; min‐max: 5.2‐18), and 10 (18.8%) of them had AIG confirmed by histopathology. In the AIG group, the duration of vitamin B12 deficiency was longer (P = .022), hemoglobin levels were lower (P = .018), and APCA (P = .039) and gastrin (P = .002) levels were higher than those in the non‐AIG group. Endoscopic findings were similar between the two groups. Intestinal metaplasia was higher (P = .018) in the AIG group. None of the patients in the AIG group had H pylori infection (P = .004). One patient in the AIG group had enterochromaffin‐like cell hyperplasia. Conclusions Our results show that, in children, H pylori infection may not play a role in AIG. AIG could be associated with vitamin B12 deficiency, iron deficiency, and APCA positivity in children. APCA and gastrin levels should be investigated for the early diagnosis of AIG and intestinal metaplasia.

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Refractory Iron-deficiency Anemia and Autoimmune Atrophic Gastritis in Pediatric Age Group

Cited by 16 publications

References 20 publications

Autoimmune Gastritis in the Pediatric Age: An Underestimated Condition Report of Two Cases and Review

Autoimmune Gastritis in the Pediatric Age: An Underestimated Condition Report of Two Cases and Review

Autoimmune atrophic gastritis: current perspectives

Autoimmune atrophic gastritis: The role of Helicobacter pylori infection in children

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