Upper gastrointestinal symptoms in autoimmune gastritis

Abstract

Autoimmune gastritis is often suspected for its hematologic findings, and rarely the diagnosis is made for the presence of gastrointestinal symptoms. Aims of this cross-sectional study were to assess in a large cohort of patients affected by autoimmune gastritis the occurrence and the pattern of gastrointestinal symptoms and to evaluate whether symptomatic patients are characterized by specific clinical features.Gastrointestinal symptoms of 379 consecutive autoimmune gastritis patients were systematically assessed and classified following Rome III Criteria. Association between symptoms and anemia pattern, positivity to gastric autoantibodies, Helicobacter pylori infection, and concomitant autoimmune disease were evaluated.In total, 70.2% of patients were female, median age 55 years (range 17–83). Pernicious anemia (53.6%), iron deficiency anemia (34.8%), gastric autoantibodies (68.8%), and autoimmune disorders (41.7%) were present. However, 56.7% of patients complained of gastrointestinal symptoms, 69.8% of them had exclusively upper symptoms, 15.8% only lower and 14.4% concomitant upper and lower symptoms. Dyspepsia, subtype postprandial distress syndrome was the most represented, being present in 60.2% of symptomatic patients. Univariate and multivariate analyses showed that age <55 years (OR 1.6 [CI:1–2.5]), absence of smoking habit (OR 2.2 [CI:1.2–4]), and absence of anemia (OR 3.1 [CI:1.5–6.4]) were independent factors associated to dyspepsia.Autoimmune gastritis is associated in almost 60% of cases with gastrointestinal symptoms, in particular dyspepsia. Dyspepsia is strictly related to younger age, no smoking, and absence of anemia.

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

“…AAG diagnosis can be challenging due to its proteoform clinical presentation, especially in early stages, thus leading to substantial diagnostic delay as recently reported by us . Torbenson et al described in a few cases early alterations that may precede the onset of atrophy, namely focal or diffuse lymphoplasmacytic infiltrate in the lamina propria, focal atrophy, parietal cell pseudo‐hypertrophy and enterochromaffin‐like (ECL) cell hyperplasia.…”

Chinese consensus on chronic gastritis (2017, Shanghai)

“…The incidence rates of primary hyperparathyroidism and type 1 diabetes mellitus (T1DM) in patients having autoimmune gastritis and pernicious anemia are 3–5‐fold higher than those in healthy individuals . A recent cross‐sectional study abroad included 379 patients with clinically diagnosed autoimmune gastritis, of which 60.2% with digestive symptoms had postprandial distress syndrome (PDS). The independent factors were age <55 years (odds ratio [OR] 1.6, 95% confidence interval [CI] 1–2.5), the absence of smoking (OR 2.2, 95% CI 1.2–4.05), and absence of anemia (OR 3.1, 95% CI 1.5–6.4).…”

“…42 The incidence rates of primary hyperparathyroidism and type 1 diabetes mellitus (T1DM) in patients having autoimmune gastritis and pernicious anemia are 3-5-fold higher than those in healthy individuals. 43,44 A recent cross-sectional study abroad 45 Lymphocytic gastritis: villous or verrucous gastritis with erosion can be endoscopically observed, and appearance of >25 lymphocytes in every 100 epithelial cells in the epithelium of gastric mucosa is regarded as the pathologic feature. It has diverse clinical manifestations.…”

Helicobacter pylori infection and nonmalignant diseases

“…Pernicious anemia was diagnosed in 53.6% of the patients and iron deficiency anemia in 34.8%. H. pylori was positive in 26.1% of cases . In the study by Villanacci et al .…”

“…Few studies have addressed hematologic findings in patients with autoimmune gastritis. Carabotti et al . performed a cross‐sectional study in Italy enrolling 379 autoimmune gastritis patients with gastrointestinal symptoms.…”