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Autoimmune Gastritis


Presentation

  • 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]
  • BACKGROUND: Autoimmune gastritis may present as pernicious anaemia arising from vitamin B12 malabsorption, but also with iron deficiency anaemia due to iron malabsorption. These different clinical presentations might have a genetic basis.[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]
  • Pernicious anemia (53.6%), iron deficiency anemia (34.8%), gastric autoantibodies (68.8%), and autoimmune disorders (41.7%) were present.[ncbi.nlm.nih.gov]
  • Autoimmune gastritis presents an age-dependent frequency in children and adolescents with T1D but is rarely symptomatic.[ncbi.nlm.nih.gov]
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]
  • We ask about general symptoms (anxious mood, depressed mood, fatigue, pain, and stress) regardless of condition. Last updated: July 15, 2019[patientslikeme.com]
  • As AIG is associated with other autoimmune diseases, symptoms such as fatigue may also be due to thyroid hypofunction in the presence of autoimmune thyroiditis (Hashimoto’s disease).[ncbi.nlm.nih.gov]
Aspiration
  • Where appropriate, patients underwent radioiodine uptake and scintigraphic mapping, ultrasonography-assisted fine needle aspiration biopsy, and a thyrotropin-releasing hormone test for serial thyrotropin measurements and detection of anti–thyrotropin[jamanetwork.com]
  • Simple intragastric pH measurement during gastroscopy from aspirates would be quick and cheap, but concerns have been raised that this does not reflect gastric acid secretion or volume of acid secretion [ 34 , 36 ].[ncbi.nlm.nih.gov]
  • Simple intragastric pH measurement during gastroscopy from aspirates would be quick and cheap, but concerns have been raised that this does not reflect gastric acid secretion or volume of acid secretion [ 34, 36 ].[ncbi.nlm.nih.gov]
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]
  • Patients referring with non-specific abdominal symptoms such as bloating, diarrhea and iron/B(12) deficiency should be investigated for the presence of AIG. Copyright 2012 S. Karger AG, Basel.[ncbi.nlm.nih.gov]
  • The patients (seven women, two men, mean age 64 years) presented with nonspecific abdominal or reflux symptoms (n 8) and diarrhea (n 1).[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
  • There is a close relationship between autonomic nervous system dysfunction and delayed gastric emptying.[ncbi.nlm.nih.gov]
  • Autoimmune gastritis is an important etiology to explain the finding of delayed gastric emptying on a radionuclide test.[ncbi.nlm.nih.gov]
  • OBJECTIVES: Patients with autoimmune gastritis may have symptoms suggestive of delayed gastric emptying.[ncbi.nlm.nih.gov]
  • Achlorhydria itself leads to symptoms such as delayed gastric emptying, small intestinal (and gastric) bacterial overgrowth, and an increase in GI infections such as clostridium difficile colitis.[ncbi.nlm.nih.gov]
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]
Thrombosis
  • Eighteen months later, however, pancreatic insufficiency occurred due to thrombosis of the pancreatic graft. Besides these conditions, iron deficiency, pernicious anemia, and autoimmune gastritis were also diagnosed.[ncbi.nlm.nih.gov]
  • […] peripheral smear may mimic other more serious conditions, such as disseminated intravascular coagulopathy (DIC) or thrombotic thrombocytopenic purpura/hemolytic uremic syndrome (TTP/HUS). 65 Cobalamin deficiencies have been associated with increased risk of thrombosis[dovepress.com]
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]
  • 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]
Renal Impairment
  • She had no history of ulcers, renal impairment or carcinoid syndrome. Fasting serum gastrin was 1846pg/ml. Esophagoduodenal gastroscopy and biopsies revealed chronic gastritis and a pH of 7 with low stomach acid.[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]
  • […] 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]
  • The initial symptoms include paresthesia and numbness of the lower extremities.[dovepress.com]
Dizziness
  • 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]

Workup

  • 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]
  • From a clinical standpoint, the presence of iron-deficient anemia and thyroxine malabsorption may represent an alert signal for the presence of a gastric disorder in patients with thyroid autoimmunity and should trigger a specific diagnostic workup.[frontiersin.org]
Microcytic Anemia
  • Of the 83 subjects with microcytic anemia, only 18 (22%) were men compared with 35 of 77 (46%) for all other groups combined (χ 2 0.0001).[bloodjournal.org]
  • As expected, the prevalence of microcytic anemia decreased whereas that of macrocytic PA increased with increasing age of patients (data not shown).[jamanetwork.com]
  • 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]
  • Microcytic anemia, the expression of iron deficiency, is a common presenting sign and is caused by achlorhydria, which impairs iron absorption[ 13 ].[wjgnet.com]
Macrocytic Anemia
  • Lab: classically considered to have macrocytic anemia ; however, normocytic and microcystic more common. [2] Etiology: autoimmune. Diagnosis based on serology for antibodies to: [3] Parietal cells. Intrinsic factor.[librepathology.org]
  • Pernicious anemia (PA), the macrocytic anemia also termed as Biermers disease or Addisonian anemia is an autoimmune disorder.[casereports.in]
  • In 10 of these 12 patients, the macrocytic anemia met the criteria of PA; all of these patients belonged to the group with ABG.[jamanetwork.com]
Iron Decreased
  • Besides loss of iron, decreased iron absorption is causative of iron deficiency. This might be due to inflammation at the site of iron uptake, which is found in Crohn’s disease and also coeliac disease.[ncbi.nlm.nih.gov]
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]
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]
  • In addition, the typical parameters for this type of gastritis, such as grade of the periglandular lymphocytic infiltration, grade of glandular destruction and incidence of nodular ECL cell proliferates in the corpus mucosa were determined.[ncbi.nlm.nih.gov]
  • Autoimmune gastritis is characterised by lymphocytic infiltration of the gastric submucosa, with loss of parietal and chief cells and achlorhydria.[ncbi.nlm.nih.gov]
  • Case history of a 21-year-old man with active autoimmune gastritis of the oxyntic mucosa with lymphocytic infiltration of the entire lamina propria, foci of lymphocytic destruction of a number of glands, and hypertrophy of the preserved parietal cells[ncbi.nlm.nih.gov]
  • A retrospective study of biopsy specimens from 40 patients was performed; all of the patients were originally diagnosed with possible AG based on the presence of lymphocytic infiltration and damage to oxyntic glands and/or the presence of metaplastic[ncbi.nlm.nih.gov]
HLA-B8
  • CONCLUSION: As explored with modern DNA-based methods, HLA-DRB1*04 and DQB1*03 alleles, but not HLA-B8-DRB1*03, may predispose to AIG.[ncbi.nlm.nih.gov]

Treatment

  • 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]
  • Further, there is currently no effective treatment other than endoscopic or surgical treatment for such cases.[ncbi.nlm.nih.gov]
  • Stolte M, Bethke B: Elimination of Helicobacter pylori under treatment with omeprazole. Z Gastroenterol 1990;28:271–274.[karger.com]
  • Hp eradication therapy was carried out. 15 months after Hp treatment the Hp IgG antibody titre had decreased to 11 U/ml.[ncbi.nlm.nih.gov]

Prognosis

  • Conference: 13th Annual ENETS conference (2016) Category: Epidemiology/Natural history/Prognosis - Descriptive epidemiology Presenting Author: dr Sara Massironi #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]
  • Karger AG, Basel References Rappel S, Altendorf-Hofmann A, Stolte M: Prognosis of gastric carcinoid tumors. Digestion 1994;56:455–462.[karger.com]
  • […] their levels of B 12 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]

Etiology

  • Autoimmune gastritis is an important etiology to explain the finding of delayed gastric emptying on a radionuclide test.[ncbi.nlm.nih.gov]
  • 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]
  • These differ in their topographical distribution in the stomach, histologic features, and etiology.[mayoclinic.pure.elsevier.com]
  • Lab: classically considered to have macrocytic anemia ; however, normocytic and microcystic more common. [2] Etiology: autoimmune. Diagnosis based on serology for antibodies to: [3] Parietal cells. Intrinsic factor.[librepathology.org]

Epidemiology

  • Cutting edge issues in this disease relate to its epidemiology, immunogenetics, a role for Helicobacter pylori as an infective trigger through molecular mimicry, its immunopathogenesis, associated organ-specific autoimmune diseases, laboratory diagnosis[ncbi.nlm.nih.gov]
  • 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]
  • This review addresses the epidemiology, pathogenesis, diagnosis, clinical consequences, and management of autoimmune gastritis in type 1 diabetic patients.[ncbi.nlm.nih.gov]
  • Conference: 13th Annual ENETS conference (2016) Category: Epidemiology/Natural history/Prognosis - Descriptive epidemiology Presenting Author: dr Sara Massironi #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]
Sex distribution
Age distribution

Pathophysiology

  • 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]
  • Pathophysiology [ edit ] Atrophic gastritis under low power. H&E stain.[en.wikipedia.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]
  • Impact of coexisting irritable bowel syndrome on symptoms and pathophysiological mechanisms in functional dyspepsia . Am J Gastroenterol 2004;99:1152–9. [28]. Kalkan Ç, Soykan I, Soydal Ç, et al.[journals.lww.com]
  • Impact of coexisting irritable bowel syndrome on symptoms and pathophysiological mechanisms in functional dyspepsia. Am J Gastroenterol 2004;99:1152–9. [28]. Kalkan Ç, Soykan I, Soydal Ç, et al.[journals.lww.com]

Prevention

  • We hypothesize that cytokines produced by the "regulator" T cells prevent the clonal expansion of the "effector" autoreactive T cells, and that neonatal thymectomy induces organ-specific autoimmunity in genetically susceptible individuals by the reduction[ncbi.nlm.nih.gov]
  • Treatment usually focuses on vitamin B-12 replacement to prevent problems with pernicious anemia. Common symptoms reported by people with autoimmune atrophic gastritis Reports may be affected by other conditions and/or medication side effects.[patientslikeme.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]
  • This knowledge should permit us to develop strategies to prevent and treat the gastritis.[ncbi.nlm.nih.gov]
  • A knowledge of the histological appearance of the pre-atrophic stage of type A gastritis might be of importance for the possible prevention of pernicious anaemia.(ABSTRACT TRUNCATED AT 250 WORDS).[ncbi.nlm.nih.gov]

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