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]

Results The presenting features of the 160 patients studied are described in Table 1. Table 1. [bloodjournal.org]

• Anemia

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

  SYNTHESIS: Autoimmune gastritis is characterized by: 1) atrophy of the corpus and fundus; 2) autoantibodies to the parietal cell and to intrinsic factor; 3) achlorhydria; 4) iron deficiency anemia; 5) hypergastrinemia; 6) pernicious anemia may result [ncbi.nlm.nih.gov]

  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]

  Autoimmune gastritis is known to cause pernicious anemia in older adults, with the classic manifestation of megaloblastic anemia and cyanocobalamin deficiency. [scielo.org.co]

• Pathologist

  This disease requires communication between the gastroenterologist and the pathologist; early cases of AMAG may have subtle histologic findings that will be missed without the emphasis of clinical history. [mayoclinic.pure.elsevier.com]

  SHOWING 1-10 OF 181 REFERENCES Neuroendocrine proliferations of the stomach : a pragmatic approach for the perplexed pathologist novel clues to histological diagnosis pylori gastritis : a case – control analysis in the Southwestern United States [semanticscholar.org]

  The assessment of a case relies on effective communications between gastroenterologist and pathologist. [wjgnet.com]

  Clearly, this area represents an area of difficulty amongst pathologists in assigning the precisely correct pathologic diagnosis. [propath.com]

  In conclusion, physicians and pathologists should be aware of AIG existence also in the pediatric population. [frontiersin.org]

• Fatigue

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

  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: January 31, 2019 [patientslikeme.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]

• Weight Loss

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

  This results in malabsorption and diarrhoea with weight loss, anorexia, glossitis, icterus and neurological complaints. Diagnostics AIG is characterised by the presence of autoantibodies against parietal cell antigens (PCA) and IF. [euroimmun.ch]

  loss) Diagnostics Endoscopy: prominent rugae in the gastric fundus Biopsy: foveolar hyperplasia and parietal cell atrophy Complications: Loss of protein → edema Malignant degeneration Therapy: if H. pylori is detected → eradication, otherwise symptomatic [amboss.com]

  However, if an H. pylori infection is present, common symptoms include: stomach pain nausea 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 [healthline.com]

• Congestive Heart Failure

  The liver may become enlarged due to ascites or congestive heart failure. People with lupus also may develop jaundice, a liver condition that gives a yellowish color to the skin. Jaundice in lupus also can be a sign of anemia or pancreatitis. [lupus.org]

  Symptoms of anemia include weakness, light-headedness, vertigo, tinnitus, palpitations, angina and symptoms of congestive heart failure. There are many gastrointestinal manifestations of cobalamin deficiency. [medscape.com]

  Reported symptoms of pernicious anemia are fatigue, lightheadedness, palpitations, angina pectoris and congestive heart failure and mental disturbances. [intechopen.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 due to achlorhydria Diagnosis Relies on combination of clinical, serologic and histopathologic findings Presence of consistent serologic findings are not necessary diagnostic criteria if there are typical histologic lesions; autoantibodies [pathologyoutlines.com]

  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]

• Gastropathy

  This latter gastropathy is due to autoimmune aggression targeting parietal cells through a complex interaction of auto-antibodies against the parietal cell proton pump and intrinsic factor, and sensitized T cells. [ncbi.nlm.nih.gov]

  […] mellitus, autoimmune thyroid disease, thyrogastric autoimmune disease and other polyglandular autoimmune syndromes Sites Atrophic and metaplastic changes restricted to oxyntic mucosa in gastric body and fundus Gastric antrum may demonstrate reactive gastropathy-like [pathologyoutlines.com]

  Many patients may also show signs of foveolar hyperplasia (“reactive gastropathy”), probably reflecting the effect of hypergastrinemia, with a decrease in mucus-producing activity of the integumentary epithelium. [encyclopedia.pub]

  Weinstein WM Gastritis and gastropathies. Sleisenger MHFordtran JSeds. Gastrointestinal Disease. 5th ed. Philadelphia, Pa WB Saunders Co1993;545- 571 Google Scholar 13. [jamanetwork.com]

  Antral Histology The antrum was biopsied in 31 cases (Table 3), and 15 showed features of chemical–bile reflux gastropathy; 10 cases were classified as chronic gastritis; and 6 were classified as chronic active gastritis. [nature.com]

• Tachycardia

  Symptoms of PA are anaemia, fatigue, light-headedness and tachycardia. Moreover, the vitamin B12 deficiency hinders DNA synthesis, which causes megaloblasts to be formed in the bone marrow and the gastrointestinal epithelium. [euroimmun.ch]

  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]

• Suggestibility

  The development of multifocal low-grade dysplasia in 1 patient, a 19-year-old woman, suggests that this condition might have neoplastic potential. [mayoclinic.pure.elsevier.com]

  These findings suggest an autoimmune gastritis; correlation with blood work is suggested. See also Stomach. Gastritis. Chronic gastritis. Anemia. References ↑ Chlumská, A.; Boudová, L.; Benes, Z.; Zámecník, M. (Oct 2005). "Autoimmune gastritis. [librepathology.org]

  The pathogenicity of Helicobacter pylori (H pylori) has been suggested but not established. [insights.ovid.com]

  The fact that it mostly concerns (relatively) young patients may suggest a potential causative relation between those autoimmune disorders and the early development of atrophic gastritis with hypergastrinaemia, which subsequently leads to the occurrence [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]

  Some patients may experience chest pain, tiredness, tinnitus or ringing in the ears, dizziness, lightheadedness, and heart palpitations. [icliniq.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]

• Confusion

  Moreover, the progression sequence of endocrine cell hyperplasia on one end of the spectrum to an unequivocal gastric carcinoid at the opposite end is a problematic and confusing pathologic and clinical dilemma. [propath.com]

  […] symptoms of anemia, including: weakness lightheadedness dizziness chest pain heart palpitations tinnitus (ringing in the ears) A B-12 deficiency can also cause nerve damage, which can lead to: limb numbness and tingling unsteadiness when walking mental confusion [healthline.com]

  If this occurs, a person may notice: confusion unsteadiness when walking tingling or numbness in the arms or legs Diagnosis Firstly, a doctor is likely to perform a physical examination and run tests to diagnose atrophic gastritis. [medicalnewstoday.com]

• 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]

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]

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]

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]

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 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 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]

  (macrocytic anemia) Iron deficiency anemia (microcytic anemia) Case reports 3 year old boy with immune dysregulation, polyendocrinopathy, enteropathy, X linked (IPEX) syndrome (BMC Pediatr 2018;18:191) 12 and 17 year old girls with iron deficiency anemia [pathologyoutlines.com]

• Polyps

  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]

  Macroscopy Mucosa in corpus is thinner than normal with reduced rugal folds Polyps Microscopy Diffuse or multifocal dense lympho plasmacytic infiltration of entire thickness of lamina propria. Lymphoid nodules. [humpath.com]

• 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]

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]

[…] 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]

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]

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]

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]

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]

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 and laboratory diagnosis of pernicious anemia. Immunol Res DOI 10.1007/s12026-016-8841-7. Bizzaro N and A Antico 2014. Diagnosis and classification of pernicious anemia. AutoimmunityReviews 13: 565–568. (July 6, 2016) Zayouna N. [labtestsonline.it]

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]

[…] autoimmune disease and other polyglandular autoimmune syndromes Sites Atrophic and metaplastic changes restricted to oxyntic mucosa in gastric body and fundus Gastric antrum may demonstrate reactive gastropathy-like features but is not overtly inflamed Pathophysiology [pathologyoutlines.com]

We have previously shown that transgenic expression of the H/K ATPase beta-subunit gene in the thymus prevented the development of autoimmune gastritis induced by thymectomy. [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]