Refractory iron deficiency anemia as an early manifestation of autoimmune gastritis in a teenager / Anemia ferropénica refractaria como presentación temprana de gastritis autoinmune en un adolescente

Abstract Autoimmune gastritis is an underdiagnosed disease in the pediatric population due to the absence of specific signs and symptoms and late clinical manifestations. Iron deficiency anemia has recently been identified as an early hematological manifestation, allowing an early diagnostic approach. We present the case of a Colombian teenager, with no history of autoimmunity, with refractory iron deficiency. He underwent extension studies; biopsies and serology compatible with autoimmune gastritis were documented, requiring parenteral iron in its evolution. This pathology is underdiagnosed in our context since early diagnosis requires a high index of suspicion to prevent associated complications.

Resumen La gastritis autoinmune es una enfermedad subdiagnosticada en la población pediátrica. Lo anterior se debe a la ausencia de signos y síntomas específicos y manifestaciones clínicas tardías. Recientemente se ha identificado la anemia ferropénica como una manifestación hematológica precoz, lo que permite un enfoque diagnóstico temprano. Se presenta el caso de un adolescente colombiano, sin antecedentes de autoinmunidad, con ferropenia refractaria, en el que se realizaron estudios de extensión y se documentaron biopsias y serología compatible con gastritis autoinmune, con requerimiento de hierro parenteral en su evolución. Esta patología es subdiagnosticada en nuestro medio, ya que el diagnóstico temprano requiere un alto índice de sospecha, lo que permite la prevención de las complicaciones asociadas.

Study on Risk Factors for Gastric Polyp Formation in Autoimmune Gastritis / 胃肠病学

Background: Autoimmune gastritis (AIG) can lead to hypergastrinemia and enterochromaffin ⁃ like cell hyperplasia, thereby increasing the risk of gastric neuroendocrine neoplasms and gastric adenocarcinoma. However, research on the association between AIG and gastric polyps is limited. Aims: To investigate the risk factors for the development of gastric polyps in AIG patients. Methods: The clinical data of 103 AIG patients visited the Chinese People’s Armed Police Force Sichuan Provincial Corps Hospital from June 2019 to June 2023 was collected retrospectively. The parameters analyzed included gender, age, anti⁃parietal cell antibody, anti⁃intrinsic factor antibody, pepsinogen (PG)I, PGII, ratio for PGI/ II, gastrin ⁃ 17 (G ⁃ 17), OLGA and OLGIM staging, size, location and pathological types of gastric polyps, vitamin B12, Helicobacter pylori infection and presence of anemia at the year AIG diagnosed. Univariate and multivariate Logistic regression analyses were performed to identify the risk factors for gastric polyps in AIG patients. The predictive performance of the variables was assessed by ROC curve analysis. Results: Among the 103 AIG patients enrolled in the study, 67 (65.05%) were females, and the median age was 58 years old. Fourteen (13.59%) patients had gastric polyps. Compared to patients without gastric polyps, those with gastric polyps had significantly higher levels of serum G ⁃ 17 (P< 0.000 1). Multivariate Logistic regression analysis indicated that G⁃ 17 was an independent risk factor for gastric polyps in AIG patients (OR=1.047, 95% CI: 1.017 ⁃ 1.078, P=0.002). The area under the curve (AUC) of G ⁃ 17 and the Logistic regression model in predicting the gastric polyp formation in AIG patients was 0.811 and 0.884, respectively. The optimal cutoff value of G⁃17 was 69.50 pmol/L, with the sensitivity and specificity of 92.9% and 67.4%, respectively. Conclusions: Serum G⁃17 is a potential prognostic factor for AIG. The optimal cutoff value for predicting the development of gastric polyp is 69.50 pmol/L.

Study on the risk factors of type 1 gastric neuroendocrine tumor in 123 cases of autoimmune gastritis / 中华消化杂志

Objective:To investigate the risk factors of type 1 gastric neuroendocrine tumor (g-NET) in patients with autoimmune gastritis(AIG).Methods:From September 1, 2016 to February 28, 2022, 123 patients with AIG visited the First Affiliated Hospital of Zhengzhou University were retrospectively enrolled, including 37 cases with type 1 g-NET and 86 cases without type 1g-NET. The clinical data, serological indicators, and endoscopic manifestation of all the patients were analyzed, including the age at the time of AIG diagnosis (hereinafter referred to as the age at diagnosis), levels of gastrin 17 and pepsinogen Ⅰ (PGⅠ), presence or absence of gastric fundus and gastric body polyps, etc. The independent risk factors of type 1 g-NET in AIG patients were analyzed by univariate and multivariate logistic regression. The receiver operating characteristic curve (ROC) was plotted to analyze the optimal cut-off value, sensitivity and specificity of the independent risk factors in predicting type 1 g-NET in AIG patients. Independent sample t test, Mann-Whitney U test and chi-square test were used for statistical analysis. Results:Compared with those of the AIG patients without type 1 g-NET, the age at diagnosis of AIG patients with type 1 g-NET was younger ((57.49±11.16) years old vs. (48.49±10.96) years old), the level of gastrin 17 was higher (200.21 ng/L, 121.85 ng/L to 244.40 ng/L vs. 244.40 ng/L, 182.50 ng/L to 248.02 ng/L), and the proportion of patients with gastric fundus and gastric body polyps was higher(18.6%, 16/86 vs. 56.8%, 21/37), and the differences were statistically significant( t=-4.13, Z=-3.06, χ2=17.90; P<0.001, =0.002 and <0.001). The results of univariate logistic analysis showed that the age at diagnosis ( OR=0.931, 95% confidence interval (95% CI)0.895 to 0.967), gastrin 17( OR=1.012, 95% CI 1.005 to 1.019), PGⅠ( OR=0.974, 95% CI 0.950 to 0.998)and gastric fundus and gastric body polyps( OR=5.742, 95% CI 2.461 to 13.399)were the influencing factors of type 1 g-NET in AIG patients ( P<0.001, =0.001, =0.033 and <0.001). The results of multivariate logistic regression analysis indicated that the age at diagnosis( OR=0.921, 95% CI 0.881 to 0.964), gastrin 17( OR=1.011, 95% CI 1.001 to 1.020), gastric fundus and gastric body polyps( OR=7.696, 95% CI 2.710 to 21.857)were the independent risk factors of type 1 g-NET in AIG patients ( P<0.001, =0.024 and <0.001). The results of ROC analysis demonstrated that the optimal cut-off values for the age at diagnosis and gastrin 17 in predicting type 1 g-NET were 56.50 years old and 206.40 ng/L, respectively; with sensitivity of 83.8% and 70.3%, respectively, and specificity of 54.7% for both ( P<0.001 and=0.003). Conclusion:The age at diagnosis< 56.50 years old, gastrin 17>206.40 ng/L and the presence of gastric fundus and gastric body polyps are independent risk factors of type 1 g-NET in AIG patients.

Gastritis autoinmune: diagnóstico y manejo de una entidad subdiagnosticada / Autoimmune gastritis: diagnosis and management of an underdiagnosed disease

Autoimmune gastritis (AIG) or chronic atrophic gastritis type A, is a chronic inflammatory disease that affects the body and fundus mucosa of the stomach. It is an underdiagnosed entity, whose clinical presentation has a broad spectrum, which may include asymptomatic patients; hematological manifestations such as iron deficiency anemia, vitamin B12 deficiency anemia (so called pernicious); non-specific digestive symptoms like dyspepsia; neurological and psychiatric manifestations. AIG is associated with other autoimmune diseases, mainly hypothyroidism ("Tyrogastric Syndrome") and type 1 diabetes. It is characterized by the development of anti-parietal cell and anti-intrinsic factor antibodies, decrease in pepsinogen I (PGI) level with low PGI/PGII ratio (< 3), and high level of gastrin. Endoscopic findings are not sufficient for the diagnosis of gastric atrophy. The use of the Sydney pathological report protocol and the OLGA/OLGIM system to evaluate the severity of gastritis have improved their diagnosis and the possibility to establish the risk of developing gastric neoplasms. The importance of its diagnosis and surveillance is based on the development of type 1 neuroendocrine gastric neoplasms, in addition to an increased risk of the incidence of gastric adenocarcinoma. Currently, an individualized endoscopic surveillance seems reasonable, with a minimum interval of 3 years.

La gastritis autoinmune (GAI) o gastritis crónica atrófica tipo A, es una enfermedad inflamatoria crónica que afecta la mucosa del cuerpo y fondo del estómago. La GAI es una entidad subdiagnosticada, cuya presentación clínica es de amplio espectro, puede incluir pacientes asintomáticos; manifestaciones hematológicas, tales como anemia ferropriva, anemia por déficit de vitamina B12 (anemia perniciosa); digestivas inespecíficas tipo dispepsia; neurológicas y psiquiátricas. La GAI está asociada a otras enfermedades autoinmunes, principalmente hipotiroidismo ("síndrome tirogástrico") y diabetes tipo 1. Se caracteriza por el desarrollo de anticuerpos anti células parietales y anti factor intrínseco, bajo nivel de pepsinógeno I (PGI) con una baja relación PGI/PGII (< 3), e hipergastrinemia. Los hallazgos endoscópicos no son suficientes para el diagnóstico de atrofia gástrica. El uso de protocolo de Sydney de reporte patológico y sistema OLGA/OLGIM para evaluar la severidad de gastritis han mejorado su diagnóstico y objetivado su riesgo de desarrollar neoplasias gástricas. La importancia de su diagnóstico y seguimiento está basada en el desarrollo de neoplasias gástricas neuroendocrinas tipo 1, además de un riesgo incrementado de la incidencia de adenocarcinoma gástrico, entre otros. Actualmente, parece razonable un seguimiento endoscópico individualizado, siendo un intervalo mínimo de 3 años.

Gastritis autoinmunitaria. Abordaje diagnóstico y su relación con los síndromes poliglandulares autoinmunitarios / Autoimmune gastritis. Diagnostic approach and its relationship with autoimmune polyglandular syndromes

La gastritis autoinmunitaria (GAI) es una entidad subdiagnosticada; la mayoría de veces pasa inadvertida con graves consecuencias para la calidad de vida de la persona por sus complicaciones asociadas. Forma, además, parte de un grupo de trastornos autoinmunitarios conocidos como síndromes poliglandulares autoinmunitarios. Hace muchos años la GAI era un trastorno solitario; sin embargo, la reciente asociación con el Helicobacter pylori (HP) ha generado nuevo interés diagnóstico, manejo e incluso prevención de su desarrollo si se sospecha oportunamente. (AU)

Autoimmune gastritis (GAI) is an underdiagnosed entity, most often goes unnoticed with serious consequences on quality of life of the person by their associated complications. It is also part of disorders known as autoimmune polyglandular syndromes. Many years ago the GAI was a lonely disorder, however, the recent association with Helicobacter pylori (HP) has generated new interest in the diagnosis, management and even prevention when clinical suspicion exist. (AU)

Intrinsic factor antibody negative atrophic gastritis; is it different from pernicious anaemia.

Introduction: H. pylori gastritis and autoimmune gastritis are the two main types of chronic atrophic gastritis. Parietal cell antibody (PCA) and intrinsic factor antibody (IFA) are characteristic of autoimmune gastritis, of which IFA is more specific. Patients who are IFA negative are considered under the category of chronic atrophic gastritis. Aim: To differentiate IFA positive from IFA negative chronic atrophic gastritis. Methods: Fifty consecutive patients of biopsy proven chronic atrophic gastritis were included in this study. All patients underwent haematological and biochemical tests including serum LDH, vitamin B12 and fasting serum gastrin levels. PCA and IFA antibodies were tested in all patients. Multiple gastric biopsies from body and antrum of the stomach were taken and evaluated for presence of intestinal metaplasia, endocrine cell hyperplasia, carcinoid and H. pylori infection. Patients were grouped as group A (IFA positive) and group B (IFA negative). The mean laboratory values and histological parameters were compared between the two groups using appropriate statistical methods. Results: Eighteen patients were in group A (mean age 55.5±13 years, male: female = 16:2) and thirty-two in group B (mean age 49.7±13 years, male: female = 25:7). There was no statistically significant difference between median values of haemoglobin, MCV, LDH, Vitamin B12 and serum gastrin in both the groups. None of the histological parameters showed any significant difference. Conclusion: There was no statistically significant difference in haematological, biochemical and histological parameters in IFA positive and negative gastritis. These may be the spectrum of the same disease, where H. pylori may be responsible for initiating the process.