Abstract Gastric polyps are often present in the setting of atrophic gastritis. Although the majority of these polyps are nonneoplastic, such as hyperplastic polyps, neoplastic polyps may be present. [ncbi.nlm.nih.gov]

Case Report A 24-year-old male patient presented with a history of lethargy and easy fatigability for about four months. [casereports.in]

• Fatigue

  There was symptomatic improvement in her signs of fatigue. [ncbi.nlm.nih.gov]

  We ask about general symptoms (anxious mood, depressed mood, fatigue, pain, and stress) regardless of condition. Last updated: January 31, 2019 [patientslikeme.com]

  Symptoms such as fatigue, hair loss and restless legs syndrome decrease quality of life; furthermore it results in impaired physical and cognitive development and poor pregnancy outcome. [thieme-connect.com]

  On examination she presented with increasing darkening of the skin and easy fatigue. Investigations showed: plasma cortisol h. 8: in the normal range (29 μg/dl); raised ACTH levels (2976 pmol/ml). [abstracts.eurospe.org]

• Refractory Anemia

  Refractory iron-deficiency anemia and autoimmune atrophic gastritis in pediatric age group: analysis of 8 clinical cases. [frontiersin.org]

• Diarrhea

  Histamine excess can cause diarrhea as can bacterial overgrowth or LC. We present a 57-year-old woman with diarrhea, sporadic epigastric pain, and bloating. [ncbi.nlm.nih.gov]

  The presence and the frequency of GI symptoms (heartburn, regurgitation, early satiety, nausea, vomiting, postprandial fullness, epigastric pain, abdominal pain, constipation, diarrhea, and bloating) were assessed at the time of the first visit through [journals.lww.com]

• Delayed Gastric Emptying

  OBJECTIVES: Patients with autoimmune gastritis may have symptoms suggestive of delayed gastric emptying. [ncbi.nlm.nih.gov]

  gastric emptying (80%), reflux symptoms (25%), peripheral neuropathy (25% cases), autonomic abnormalities and memory loss are less common and occur in 1%–2% of cases. [en.wikipedia.org]

  Delayed gastric emptying has been described in patients with AG.22 A former study reported in autoimmune gastritis patients the presence of postprandial fullness, early satiety, and epigastric pain in 7.1%, 10.1%, and 35.3%, respectively; a subset of [emjreviews.com]

• Tachycardia

  Anemia (irrespective of etiology) results in shortness of breath, dizziness, tachycardia, lightheadedness, and decreased cognitive and physical function. In pregnancy it can lead to poor pregnancy outcome with early birth and underweight newborns. [ncbi.nlm.nih.gov]

• Restless Legs Syndrome

  Hair loss and brittle nails were seen in about half of patients, sleeping disorder in 36.9% and restless legs syndrome in 24.7%. [thieme-connect.com]

  That said, symptomatic patients are mostly females and signs of atrophic gastritis are those associated with iron deficiency: fatigue, restless legs syndrome, brittle nails, hair loss, impaired immune function, and impaired wound healing.[3] And other [en.wikipedia.org]

  Symptoms of iron deficiency arise independently of and prior to anemia-related symptoms, and include fatigue, restless legs syndrome, brittle nails, hair loss, impaired immune function, and impaired wound healing. [ncbi.nlm.nih.gov]

• Paresthesia

  Autoimmune atrophic gastritis is characterized by megaloblastic anemia, anorexia with weight loss, neurologic changes such as numbness and paresthesias. [patientslikeme.com]

  which is characterized by the following symptoms: Weakness Trouble concentrating Shortness of breath Leg cramps Headache Heart palpitations Insomnia Paleness In severe cases, severe B12 deficiency, which is characterized by the following symptoms: Paresthesia [beyondtype1.org]

  […] risk of gastric cancers References:[1][3] Clinical features Intensity of symptoms may be inconsistent and vary widely Hematemesis; (coffee-ground appearance or bright red in color), possibly melena Epigastric pain is possible Nausea, vomiting Abdominal paresthesia [amboss.com]

  […] spasticity (hyperreflexia) Positive Romberg sign Lhermitte’s sign Segmental cutaneous sensory level Autonomic nervous system Postural hypotension Incontinence Impotence Peripheral nervous system Cutaneous sensory loss Hyporeflexia symmetric weakness Paresthesias [wjgnet.com]

• Dizziness

  […] and vomiting loss of appetite unexpected weight loss stomach ulcers iron deficiency anemia (a low level of healthy red blood cells) Autoimmune AG may lead to a B-12 deficiency, which can cause symptoms of anemia, including: weakness lightheadedness dizziness [healthline.com]

  Symptoms include: pain in the chest general fatigue tinnitus or ringing in the ears dizziness lightheadedness heart palpitations A vitamin B-12 deficiency can, in some cases, result in nerve damage. [medicalnewstoday.com]

  The following is a list of type A atrophic gastritis symptoms: Intense chest pains Lightheadedness and dizziness Heart palpitations Ringing in the ears known as tinnitus Physical weakness B12 deficiency, which comes with its own unique list of symptoms [belmarrahealth.com]

  Anemia (irrespective of etiology) results in shortness of breath, dizziness, tachycardia, lightheadedness, and decreased cognitive and physical function. In pregnancy it can lead to poor pregnancy outcome with early birth and underweight newborns. [ncbi.nlm.nih.gov]

• Ataxia

  […] symptoms, patients who developed vitamin B12 deficiency will suffer from gastrointestinal and neurological complaints such as malabsorption, diarrhea, weight loss, glossitis, peripheral numbness, paresthesia with subsequent development of weakness, and ataxia [ncbi.nlm.nih.gov]

• Forgetful

  Furthermore, mental disturbances ranging from forgetfulness to psychosis may arise. Untreated pernicious anemia is fatal [ 11 ]. [ncbi.nlm.nih.gov]

From our clinical observations we hypothesize that other GI causes such as autoimmune gastritis (AG) are far more common and non-invasive evaluation should be included in the primary workup. [thieme-connect.com]

Cases and Review. ( 29765934 ) Saglietti C...Sempoux C 2018 6 Deficiency of micronutrients in patients affected by chronic atrophic autoimmune gastritis: A single-institution observational study. ( 30236765 ) Zilli A...Massironi S 2018 7 Iron deficiency workup [malacards.org]

Discussion and Conclusions In the cases reported here, AIG was a late and unexpected discovery in the diagnostic workup of a refractory anemia. [frontiersin.org]

Laboratory workup All patients had a complete blood count, serum iron, total iron-binding capacity (TIBC), serum ferritin, serum B 12 and folate, sedimentation rate, fibrinogen, and CRP studies performed. [bloodjournal.org]

• Macrocytic Anemia

  It is closely associated with pernicious anemia. General Pathology: loss of parietal cells, gastric atrophy. Lab: classically considered to have macrocytic anemia; however, normocytic and microcystic more common.[2] Etiology: autoimmune. [librepathology.org]

  B12 deficiency macrocytic anemia (60.2%), clinical conditions that are correlated to AIG [3]. [hindawi.com]

  Pernicious anemia (PA), the macrocytic anemia also termed as Biermers disease or Addisonian anemia is an autoimmune disorder. [casereports.in]

• Microcytic Anemia

  The proportion of patients with atrophic gastritis was 9 (69%) of 13 in patients with macrocytic anemia and 13 (41%) of 32 in those with microcytic anemia. [bloodjournal.org]

  […] gastrin levels represented the most reliable tool in the diagnosis of ABG; and the presence of anemia, even microcytic, was suggestive of undiagnosed ABG. [jamanetwork.com]

  In the 14 patients with positivity for both PCA and IFA, microcytic anemia was present in 4 cases (28.6%) and macrocytic anemia in 10 cases (71.4%). [hindawi.com]

  In effect, both of our patients had a history of menorrhagia, which could have contributed to their anemia (5). The study of Hershko et al. has also shown a high prevalence of H. pylori positivity in young patients with AIG and microcytic anemia. [frontiersin.org]

  In a study by Hershko et al[24] low serum vitamin B12 levels were found in 100% macrocytic, 92% normocytic and 46% microcytic patients with CAAG, whereas iron deficiency was found in all the patients with microcytic anemia, but also in 50% of the normocytic [wjgnet.com]

• Poikilocytosis

  Peripheral blood smear showed erythropenia, macrocytic normochromic red blood cells, moderate aniso-poikilocytosis with good number of macro-ovalocytes, leucocytopenia and mild thrombocytopenia, features consistent with pancytopenia and macrocytic anemia [casereports.in]

• Normocytic Anemia

  Although all microcytic patients were anemic, anemia was present in only 62% of the macrocytic and 40% of the normocytic subjects. [bloodjournal.org]

• Lymphocytic Infiltrate

  Compared to NGB, HPG, MAG and CG, AIG displayed more eosinophil infiltration (p < 0.001) and more frequent lymphocyte infiltration of the epithelium, basal predominant inflammation and pancreatic acinar metaplasia (all p > 0.05). [ncbi.nlm.nih.gov]

RESULTS: After 1 and 3 months of treatment, mean hemoglobin in group A increased from 9.5 +/- 1.2 to 11.2 +/- 1.3 and 12.8 +/- 1.3 g/dl, respectively. [ncbi.nlm.nih.gov]

Stolte M, Bethke B: Elimination of Helicobacter pylori under treatment with omeprazole. Z Gastroenterol 1990;28:271–274. [karger.com]

Conference: 13th Annual ENETS conference (2016) Category: Epidemiology/Natural history/Prognosis - Descriptive epidemiology Presenting Author: dr Sara Massironi Authors: #1339 Netazepide, a Gastrin/CCK2 Receptor Antagonist, Can Eradicate Gastric Neuroendocrine [enets.org]

Rappel S et al: [Carcinoid tumors of the stomach in atrophic autoimmune gastritis: classification, differential diagnosis and prognosis.] Verh Dtsch Ges Pathol. 80:199-207, 1996. [humpath.com]

[…] the cord gastric carcinoid tumors 4,5 Fluoroscopy Upper gastrointestinal fluoroscopic studies are non-specific but may demonstrate 1,2 : decreased/absent fundal folds narrow tubular stomach (fundal diameter small/absent areae gastricae Treatment and prognosis [radiopaedia.org]

[…] have their levels of B12 and iron monitored for the rest of their life.[1][2][3] In some cases, periodic endoscopy may also be recommended due to the increased risk of certain types of cancer .[1][2][3] Last updated: 11/28/2016 The long-term outlook (prognosis [rarediseases.info.nih.gov]

These differ in their topographical distribution in the stomach, histologic features, and etiology. [mayoclinic.pure.elsevier.com]

This presentation may be more common than is presently recognized because biopsies of the polyps alone will not show histologic features of atrophic gastritis or reveal the etiology of the polyp itself. [ncbi.nlm.nih.gov]

Therapeutic emphasis depends on the underlying etiology: substitution of vitamin B12 (AMAG) or H. pylori eradication therapy (helicobacter-associated atrophic gastritis). [amboss.com]

Abstract Western countries are seeing a constant decline in the incidence of Helicobacter pylori-associated gastritis, coupled with a rising epidemiological and clinical impact of autoimmune gastritis. [ncbi.nlm.nih.gov]

Conference: 13th Annual ENETS conference (2016) Category: Epidemiology/Natural history/Prognosis - Descriptive epidemiology Presenting Author: dr Sara Massironi Authors: #1339 Netazepide, a Gastrin/CCK2 Receptor Antagonist, Can Eradicate Gastric Neuroendocrine [enets.org]

Epidemiology of Helicobacter pylori infection. Helicobacter 13 (Suppl. 1), 1–6 (2008). 10. Malaty, H. M. Epidemiology of Helicobacter pylori infection. Best Pract. Res. Clin. Gastroenterol. 21, 205–214 (2007). 11. Graham, D. Y. [nature.com]

A marked increase in fundic mucosal histidine decarboxylase activity as well as hypergastrinemia appears to be the pathophysiologic response to achlorhydria caused by autoimmunity against gastric H+,K(+)-ATPase. [ncbi.nlm.nih.gov]

[…] with other autoimmune diseases (e.g., autoimmune thyroiditis) EMAG Helicobacter pylori infection (most important risk factor of atrophic gastritis overall) Dietary factors (e.g., N-nitroso compounds, alcohol intake, high salt intake) References:[1][3] Pathophysiology [amboss.com]

Pathophysiology[edit] Atrophic gastritis under low power. H&E stain. [en.wikipedia.org]

Duodenal implications in the pathophysiology of functional dyspepsia. J Neurogastroenterol Motil. 16, 251-257. Tack, J, Caenepeel, P, Arts, J, Lee, KJ, Sifrim, D, and Janssens, J (2005). [jnmjournal.org]

Pathophysiological effects of long term acid suppression in man. Dig Dis Sci. 1995;40(suppl 2)96S- 120S Google Scholar Crossref 29. Ania BJSuman VJFairbanks VFMelton LJ Prevalence of anemia in medical practice: community versus referral patients. [jamanetwork.com]

The standardization of autoimmune gastritis histology reports and classifications in diagnostic practice is a prerequisite for implementing definitive secondary prevention strategies based on multidisciplinary diagnostic approaches integrating endoscopy [ncbi.nlm.nih.gov]

[…] binding of intrinsic factor to Vitamin B12 Type 2 antibody reacts with free or complexed Vitamin B12 to prevent its biological activity Microscopic (histologic) description Glandular atrophy predominantly in gastric body / fundus with deep or diffuse [pathologyoutlines.com]

The clinical goal of managing AMAG is to identify dysplastic or malignant lesions of the stomach as well as to ensure the proper management of vitamin B12 deficiency to prevent the hematologic and neurologic adverse events of pernicious anemia. [mayoclinic.pure.elsevier.com]