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]

• 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]

• 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]

• 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]

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

  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]

  Among the 69 patients who were positive for PCA only, 36 (52.2%) had microcytic, and 33 (47.8%) had macrocytic anemia. [hindawi.com]

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

• 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]

  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]

  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]

• 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]

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]

[…] 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]

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]

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]

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]

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]

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

N-nitroso compounds, alcohol intake, high salt intake) References:[1][3] Pathophysiology AMAG Autoimmune destruction of the parietal cells Achlorhydria increased release of gastrin (due to loss of negative feedback) G cell hyperplasia hypergastrinemia [amboss.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]

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]