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]

• Inflammation

  Chronic inflammation is a major risk factor for cancer, including gastric cancers and other gastrointestinal cancers. [ncbi.nlm.nih.gov]

  Intestinal metaplasia of the stomach with chronic inflammation. IHC Features:[6] Chromogranin A +ve (demonstrates nodular enterochromaffin-like cell hyperplasia). Gastrin -ve (body of stomach). +ve in antrum. [librepathology.org]

  Conclusions Oxyntic-restricted inflammation, PPM (more than IM), and ECL-cell hyperplasia/neoplasia are the histological AIG hallmarks. Compared with the general population, corpus-restricted inflammation/atrophy does not increase the GC risk. [gut.bmj.com]

• Asymptomatic

  Subjects with asymptomatic parietal cell antibody should be regularly assessed for serum biomarkers for progression to corpus atrophy, development of iron and B12 deficiency anaemia and for associated autoimmune thyroiditis and type 1 diabetes mellitus [ncbi.nlm.nih.gov]

  All those who were asymptomatic and did not report any upper abdominal symptoms were considered eligible. [ar.iiarjournals.org]

  It is generally asymptomatic up to an advanced stage of atrophy and/or dysplasia of the mucosa [1, 2]. [hindawi.com]

  In most patients, AIG remains asymptomatic over many years until reaching advanced stages of atrophy. Symptoms of PA are anaemia, fatigue, light-headedness and tachycardia. [euroimmun.ch]

• 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]

• 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]

• Loss of Appetite

  Other symptoms may include frequent belching, loss of appetite or vomiting. These abruptly appearing signs allow the disease to be detected in good time. [ims.uniklinik-freiburg.de]

  Other possible symptoms include nausea and vomiting, bloating, loss of appetite and heartburn. Complications may include bleeding, stomach ulcers, and stomach tumors. [play.google.com]

  Alcoholic gastritis’ symptoms include pain in the upper abdomen area, loss of appetite, vomiting, or bloating. [plushcare.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]

• Pyrosis

  Changes in taste and loss of appetite Patients may report either constipation or having several semi-solid bowel movements daily Anorexia, nausea, vomiting, heartburn, pyrosis, flatulence and a sense of fullness Brain Altered mental status. [wjgnet.com]

• Jaundice

  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]

• 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]

• 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]

• 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]

• Insomnia

  Signs and Symptoms of Autoimmune Gastritis: Abdominal pain Anemia, 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 [beyondtype1.org]

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]

• Hypochlorhydria

  An increased risk of osteoporosis was reported in patients with long-standing hypochlorhydria. Only few studies reported a possible association between CAAG and 25OHVitamin D (25OHvitD) deficiency. [enets.org]

  Hypochlorhydria leads to G-cell hyperplasia and elevated serum gastrin levels (often > 1000 pg/mL [> 481 pmol/L]). [msdmanuals.com]

  Abstract Chronic atrophic autoimmune gastritis (CAAG) is an organ-specific autoimmune disease characterized by an immune response, which is directed towards the parietal cells and intrinsic factor of the gastric body and fundus and leads to hypochlorhydria [ncbi.nlm.nih.gov]

  It shows a characteristic hypochlorhydria and an associated neuroendocrine cell hyperplasia. Patients with autoimmune gastritis often have pernicious anemia and intrinsic factor autoantibodies and autoantibodies directed against other organs. [humpath.com]

  A complex interaction of autoantibodies against the parietal cell proton pump and sensitized T cells progressively destroy the parietal cells, inducing hypochlorhydria and then achlorhydria, while autoantibodies against the intrinsic factor impair the [semanticscholar.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]

• 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]