Autoimmune atrophic gastritis: current perspectives

Artem Minalyan, Jihane N Benhammou, Aida Artashesyan, Michael S Lewis, Joseph R Pisegna, Artem Minalyan, Jihane N Benhammou, Aida Artashesyan, Michael S Lewis, Joseph R Pisegna

Abstract

At present there is no universally accepted classification for gastritis. The first successful classification (The Sydney System) that is still commonly used by medical professionals was first introduced by Misiewicz et al in Sydney in 1990. In fact, it was the first detailed classification after the discovery of Helicobacter pylori by Warren and Marshall in 1982. In 1994, the Updated Sydney System was proposed during the International Workshop on the Histopathology of Gastritis followed by the publication in The American Journal of Surgical Pathology by Dixon et al. Using the new classification, distinction between atrophic and nonatrophic gastritis was revised, and the visual scale grading was incorporated. According to the Updated Sydney System Classification, atrophic gastritis is categorized into multifocal (H. pylori, environmental factors, specific diet) and corpus-predominant (autoimmune). Since metaplasia is a key histological characteristic in patients with atrophic gastritis, it has been recommended to use the word "metaplastic" in both variants of atrophic gastritis: autoimmune metaplastic atrophic gastritis (AMAG) and environmental metaplastic atrophic gastritis. Although there are many overlaps in the course of the disease and distinction between those two entities may be challenging, the aim of this review article was to describe the etiology, epidemiology, pathogenesis, diagnosis, clinical manifestations and treatment in patients with AMAG. However, it is important to mention that H. pylori is the most common etiologic factor for the development of gastritis in the world.

Keywords: autoimmune gastritis; gastric carcinoid; pernicious anemia.

Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Human gastric biopsy showing gastric gland atrophy.
Figure 2
Figure 2
Human gastric biopsy showing lymphocytic infiltrate.

References

    1. Andres E, Serraj K. Optimal management of pernicious anemia. J Blood Med. 2012;3:97–103.
    1. Park JY, Lam-Himlin D, Vemulapalli R. Review of autoimmune meta-plastic atrophic gastritis. Gastrointest Endosc. 2013;77(2):284–292.
    1. Carmel R, Johnson CS. Racial patterns in pernicious anemia. Early age at onset and increased frequency of intrinsic-factor antibody in black women. N Engl J Med. 1978;298(12):647–650.
    1. Lam-Tse WK, Batstra MR, Koeleman BP, et al. The association between autoimmune thyroiditis, autoimmune gastritis and type 1 diabetes. Pediatr Endocrinol Rev. 2003;1(1):22–37.
    1. Neumann WL, Coss E, Rugge M, Genta RM. Autoimmune atrophic gastritis – pathogenesis, pathology and management. Nat Rev Gastroenterol Hepatol. 2013;10(9):529–541.
    1. Silveira PA, Wilson WE, Esteban LM, et al. Identification of the Gasa3 and Gasa4 autoimmune gastritis susceptibility genes using congenic mice and partitioned, segregative and interaction analyses. Immunogenetics. 2001;53(9):741–750.
    1. Baxter AG, Jordan MA, Silveira PA, Wilson WE, Van Driel IR. Genetic control of susceptibility to autoimmune gastritis. Int Rev Immunol. 2005;24(1–2):55–62.
    1. Ikeda T, Senoue I, Hara M, Tsutsumi Y, Harasawa S, Miwa T. Gastric pseudopolyposis: a new clinical manifestation of type A gastritis. Am J Gastroenterol. 1985;80(2):82–90.
    1. Krasinskas AM, Abraham SC, Metz DC, Furth EE. Oxyntic mucosa pseudopolyps: a presentation of atrophic autoimmune gastritis. Am J Surg Pathol. 2003;27(2):236–241.
    1. Judd LM, Gleeson PA, Toh BH, van Driel IR. Autoimmune gastritis results in disruption of gastric epithelial cell development. Am J Physiol. 1999;277(1 pt 1):G209–G218.
    1. Chlumska A, Boudova L, Benes Z, Zamecnik M. Autoimmune gastritis. A clinicopathologic study of 25 cases. Cesk Patol. 2005;41(4):137–142.
    1. Stolte M, Bethke B, Ruhl G, Ritter M. Omeprazole-induced pseudohypertrophy of gastric parietal cells. Z Gastroenterol. 1992;30(2):134–138.
    1. Solcia E, Fiocca R, Villani L, Luinetti O, Capella C. Hyperplastic, dysplastic, and neoplastic enterochromaffin-like-cell proliferations of the gastric mucosa. Classification and histogenesis. Am J Surg Pathol. 1995;19(Suppl 1):S1–S7.
    1. Li P, He C, Sun L, Dong N, Yuan Y. Pepsinogen I and II expressions in situ and their correlations with serum pesignogen levels in gastric cancer and its precancerous disease. BMC Clin Pathol. 2013;13(1):1–10.
    1. Goldenring JR, Ray GS, Coffey RJ, Jr, et al. Reversible drug-induced oxyntic atrophy in rats. Gastroenterology. 2000;118(6):1080–1093.
    1. Nomura S, Yamaguchi H, Ogawa M, Wang TC, Lee JR, Goldenring JR. Alterations in gastric mucosal lineages induced by acute oxyntic atrophy in wild-type and gastrin-deficient mice. Am J Physiol Gastrointest Liver Physiol. 2005;288(2):G362–G375.
    1. Nozaki K, Ogawa M, Williams JA, et al. A molecular signature of gastric metaplasia arising in response to acute parietal cell loss. Gastroenterology. 2008;134(2):511–522.
    1. Weis VG, Petersen CP, Mills JC, Tuma PL, Whitehead RH, Goldenring JR. Establishment of novel in vitro mouse chief cell and SPEM cultures identifies MAL2 as a marker of metaplasia in the stomach. Am J Physiol Gastrointest Liver Physiol. 2014;307(8):G777–G792.
    1. Halldorsdottir AM, Sigurdardottrir M, Jonasson JG, et al. Spasmolytic polypeptide-expressing metaplasia (SPEM) associated with gastric cancer in Iceland. Dig Dis Sci. 2003;48(3):431–441.
    1. Goldenring JR, Nam KT, Wang TC, Mills JC, Wright NA. Spasmolytic polypeptide-expressing metaplasia and intestinal metaplasia: time for reevaluation of metaplasias and the origins of gastric cancer. Gastroenterology. 2010;138(7):2207–2210. 2210.e1.
    1. Correa P, Piazuelo MB, Wilson KT. Pathology of gastric intestinal metaplasia: clinical implications. Am J Gastroenterol. 2010;105(3):493–498.
    1. Abraham SC, Singh VK, Yardley JH, Wu TT. Hyperplastic polyps of the stomach: associations with histologic patterns of gastritis and gastric atrophy. Am J Surg Pathol. 2001;25(4):500–507.
    1. Veijola LI, Oksanen AM, Sipponen PI, Rautelin HIK. Association of autoimmune type atrophic corpus gastritis with Helicobacter pylori infection. World J Gastroenterol. 2010;16(1):83–88.
    1. Negrini R, Savio A, Poiesi C, et al. Antigenic mimicry between Helicobacter pylori and gastric mucosa in the pathogenesis of body atrophic gastritis. Gastroenterology. 1996;111(3):655–665.
    1. Faller G, Steininger H, Eck M, Hensen J, Hann EG, Kirchner T. Anti-gastric autoantibodies in Helicobacter pylori gastritis: prevalence, in-situ binding sites and clues for clinical relevance. Virchows Arch. 1996;427(5):483–486.
    1. Genta RM. Helicobacter pylori, inflammation, mucosal damage, and apoptosis: pathogenesis and definition of gastric atrophy. Gastroenterology. 1997;113(6 suppl):S51–S55.
    1. Torbenson M, Abraham SC, Boitnott J, Yardley JH, Wu TT. Autoimmune gastritis: distinct histological and immunohistochemical findings before complete loss of oxyntic glands. Mod Pathol. 2002;15(2):102–109.
    1. De Re V, Orzes E, Canzonieri V, et al. Pepsinogens to distinguish patients with gastric intestinal metaplasia and Helicobacter pylori infection among populations at risk for gastric cancer. Clin Transl Gastroenterol. 2016;7(7):e183.
    1. Castoro C, Le Moli R, Arpi ML, et al. Association of autoimmune thyroid diseases, chronic atrophic gastritis and gastric carcinoid: experience from a single institution. J Endocrinol Invest. 2016;39(7):779–784.
    1. Centanni M, Marignani M, Gargano L, et al. Atrophic body gastritis in patients with autoimmune thyroid disease: an under diagnosed association. Arch Intern Med. 1999;159(15):1726–1730.
    1. De Block CE, De Leeuw IH, Van Gaal LF. Autoimmune gastritis in type 1 diabetes: a clinically oriented review. J Clin Endocrinol Metab. 2008;93(2):363–371.
    1. Ness-Abramof R, Nabriski DA, Braverman LE, et al. Prevalence and evaluation of B12 deficiency in patients with autoimmune thyroid disease. Am J Med Sci. 2006;332(3):119–122.
    1. Amerio P, Tracanna M, De Remigis P, et al. Vitiligo associated with other autoimmune diseases: polyglandular autoimmune syndrome types 3B+C and 4. Clin Exp Dermatol. 2006;31(5):746–749.
    1. Zelissen PM, Bast EJ, Croughs RJ. Associated autoimmunity in Addison’s disease. J Autoimmun. 1995;8(1):121–130.
    1. Chang KH, Lyu RK, Ro LS, Wu YR, Chen CM. Coexistence of pernicious anemia and myasthenia gravis – a rare combination of autoimmune diseases in Taiwan. J Formos Med Assoc. 2006;105(11):946–949.
    1. Delva PL, MacDonell JE, MacIntosh OC. Megaloblastic anemia occurring simultaneously in white female monozygotic twins. Can Med Assoc J. 1965;92(21):1129–1131.
    1. Banka S, Ryan K, Thomson W, Newman WG. Pernicious anemia – genetic insights. Autoimmun Rev. 2011;10(8):455–459.
    1. Bonafoux B, Henry L, Delfour C, et al. Association of familial pernicious anaemia and hereditary haemochromatosis. Acta Haematol. 2008;119(1):12–14.
    1. Rusak E, Chobot A, Krzywicka A, Wenzlau J. Anti-parietal cell antibodies – diagnostic significance. Adv Med Sci. 2016;61(2):175–179.
    1. Khan S, Del-Duca C, Fenton E, et al. Limited value of testing for intrinsic factor antibodies with negative gastric parietal cell antibodies in pernicious anaemia. J Clin Pathol. 2009;62(5):439–441.
    1. Ottesen M, Feldt-Rasmussen UF, Andersen J, Hippe E, Schouboe A. Pernicious anemia. A study of initial forms of the disease and diagnostic significance of determination of the intrinsic factor antibody and parietal cell antibody. Ugeskr Laeger. 1992;154(52):3758–3762.
    1. Antico A, Tampoia M, Villalta D, Tonutti E, Tozzoli R, Bizzaro N. Clinical usefulness of the serological gastric biopsy for the diagnosis of chronic autoimmune gastritis. Clin Dev Immunol. 2012;2012:520970.
    1. Shah P, Singh MH, Yang YX, Metz DC. Hypochlorhydria and achlorhydria are associated with false-positive secretin stimulation testing for Zollinger-Ellison syndrome. Pancreas. 2013;42(6):932.
    1. Phan J, Benhammou JN, Pisegna JR. Gastric hypersecretory states: investigation and management. Curr Treat Options Gastroenterol. 2015;13(4):386–397.
    1. Carmel R. Pepsinogens and other serum markers in pernicious anemia. Am J Clin Pathol. 1988;90(4):442–445.
    1. Wainwright P, Narayanan S, Cook P. False-normal vitamin B12 results in a patient with pernicious anaemia. Clin Biochem. 2015;48(18):1366–1367.
    1. Solomon LR. Cobalamin-responsive disorders in the ambulatory care setting: unreliability of cobalamin, methylmalonic acid, and homocysteine testing. Blood. 2005;105(3):978–985.
    1. Wu PB, Deng YZ, Shu YX, Tan SY, Li M, Fang G. Increased plasma CgA levels associated with nonalcoholic fatty liver disease. Turk J Gastroenterol. 2015;26(5):404–407.
    1. Peracchi M, Gebbia C, Basilisco G, et al. Plasma chromogranin A in patients with autoimmune chronic atrophic gastritis, enterochromaffin-like cell lesions and gastric carcinoids. Eur J Endocrinol. 2005;152(3):443–448.
    1. Massironi S, Fraquelli M, Paggi S, et al. Chromogranin A levels in chronic liver disease and hepatocellular carcinoma. Dig Liver Dis. 2009;41(1):31–35.
    1. Park YH, Kim N. Review of atrophic gastritis and intestinal metaplasia as a premalignant lesion of gastric cancer. J Cancer Prev. 2015;20(1):25–40.
    1. Dai Y-C, Tang Z-P, Zhang Y-L. How to assess the severity of atrophic gastritis. World J Gastroenterol. 2011;17(13):1690–1693.
    1. Anagnostopoulos GK, Ragunath K, Shonde A, Hawkey CJ, Yao K. Diagnosis of autoimmune gastritis by high resolution magnification endoscopy. World J Gastroenterol. 2006;12(28):4586–4587.
    1. Nomura S, Ida K, Terao S, et al. Endoscopic diagnosis of gastric mucosal atrophy: multicenter prospective study. Dig Endosc. 2014;26(6):709–719.
    1. Dixon MF, Genta RM, Yardley JH, Correa P. Classification and grading of gastritis. The updated Sydney System. International workshop on the histopathology of gastritis, Houston 1994. Am J Surg Pathol. 1996;20(10):1161–1181.
    1. Wong HH, Chu P. Immunohistochemical features of the gastrointestinal tract tumors. J Gastrointest Oncol. 2012;3(3):262–284.
    1. Sepulveda AR, Patil M. Practical approach to the pathologic diagnosis of gastritis. Arch Pathol Lab Med. 2008;132(10):1586–1593.
    1. Smith ADM. Megaloblastic madness. Br Med J. 1960;2(5216):1840–1845.
    1. Hershko C, Hoffbrand A, Keret D, et al. Role of autoimmune gastritis, Helicobacter pylori and celiac disease in refractory or unexplained iron deficiency anemia. Haematologica. 2005;90(5):585–595.
    1. Gonçalves C, Oliveira ME, Palha AM, Ferrão A, Morais A, Lopes AI. Autoimmune gastritis presenting as iron deficiency anemia in childhood. World J Gastroenterol. 2014;20(42):15780–15786.
    1. Miguel N, Costa E, Santalha M, Jr, et al. Refractory iron-deficiency anemia and autoimmune atrophic gastritis in pediatric age group: analysis of 8 clinical cases. J Pediatr Hematol Oncol. 2014;36(2):134–139.
    1. Stabler SP. Clinical practice. Vitamin B12 deficiency. N Engl J Med. 2013;368(2):149–160.
    1. Tefferi A, Pruthi RK. The biochemical basis of cobalamin deficiency. Mayo Clin Proceed. 1994;69(2):181–186.
    1. Asimacopoulos PJ, Groves MD, Fischer DK, et al. Pernicious anemia manifesting as angina pectoris. South Med J. 1994;87(6):671–672.
    1. Tadakamalla AK, Talluri SK, Besur S. Pseudo-thrombotic thrombocytopenic purpura: a rare presentation of pernicious anemia. N Am J Med Sci. 2011;3(10):472–474.
    1. Melhem A, Desai A, Hofmann MA. Acute myocardial infarction and pulmonary embolism in a young man with pernicious anemia-induced severe hyperhomocysteinemia. Thromb J. 2009;7(1):1–5.
    1. Shamkani WA, Jafar NS, Narayanan SR, Rajappan AK. Acute myocardial infarction in a young lady due to vitamin B12 deficiency induced hyperhomocysteinemia. Heart Views. 2015;16(1):25–29.
    1. Metz J. Cobalamin deficiency and the pathogenesis of nervous system disease. Annu Rev Nutr. 1992;12:59–79.
    1. Francis G, Hohol K, Jawad Z, Ayer A, Toth C. Methylmalonic acid accumulation and the development of peripheral neuropathy (IN1-1.010) Neurology. 2012;78(1 suppl):IN1–IN1.
    1. Ralapanawa DM, Jayawickreme KP, Ekanayake EM, Jayalath WA. B(12) deficiency with neurological manifestations in the absence of anaemia. BMC Res Notes. 2015;8:458.
    1. Lindenbaum J, Healton EB, Savage DG, et al. Neuropsychiatric disorders caused by cobalamin deficiency in the absence of anemia or macrocytosis. N Engl J Med. 1988;318(26):1720–1728.
    1. Hemmer B, Glocker FX, Schumacher M, Deuschl G, Lücking CH. Subacute combined degeneration: clinical, electrophysiological, and magnetic resonance imaging findings. J Neurol Neurosurg Psychiatry. 1998;65(6):822–827.
    1. Vasconcelos OM, Poehm EH, McCarter RJ, Campbell WW, Quezado ZMN. Potential outcome factors in subacute combined degeneration: review of observational studies. J Gen Intern Med. 2006;21(10):1063–1068.
    1. Saperstein DS, Barohn RJ. Peripheral neuropathy due to cobalamin deficiency. Curr Treat Options Neurol. 2002;4(3):197–201.
    1. Chu C, Scanlon P. Vitamin B12 deficiency optic neuropathy detected by asymptomatic screening. BMJ Case Rep. 2011;2011 bcr0220113823.
    1. Metzler D, Miller WH, Stephen Edwards C. Psychiatric manifestation of vitamin B-12 deficiency: an update. Jefferson J Psychiatry. 1991;9(2)
    1. Douaud G, Refsum H, de Jager CA, et al. Preventing Alzheimer’s disease-related gray matter atrophy by B-vitamin treatment. Proc Natl Acad Sci U S A. 2013;110(23):9523–9528.
    1. Lahner E, Annibale B. Pernicious anemia: new insights from a gastroenterological point of view. World J Gastroenterol. 2009;15(41):5121–5128.
    1. Zhu JC, Wang YF, Sheng J, Chen FX, Tang GY. Atrophic glossitis is attributed to cobalamin deficiency. Shanghai J Stomatol. 2013;22(1):58–62.
    1. Vannella L, Lahner E, Osborn J, Annibale B. Systematic review: gastric cancer incidence in pernicious anaemia. Aliment Pharmacol Ther. 2013;37(4):375–382.
    1. Vannella L, Sbrozzi-Vanni A, Lahner E, et al. Development of type I gastric carcinoid in patients with chronic atrophic gastritis. Aliment Pharmacol Ther. 2011;33(12):1361–1369.
    1. Lahner E, Esposito G, Galli G, Annibale B. Atrophic gastritis and pre-malignant gastric lesions. Transl Gastrointest Cancer. 2015;4(4):272–281.
    1. Schneller J, Gupta R, Mustafa J, Villanueva R, Straus EW, Raffaniello RD. Helicobacter pylori infection is associated with a high incidence of intestinal metaplasia in the gastric mucosa of patients at inner-city hospitals in New York. Dig Dis Sci. 2006;51(10):1801–1809.
    1. Wong BC, Lam SK, Wong WM, et al. China Gastric Cancer Study Group Helicobacter pylori eradication to prevent gastric cancer in a high-risk region of China: a randomized controlled trial. JAMA. 2004;291(2):187–194.
    1. Correa P, Piazuelo MB. The gastric precancerous cascade. J Dig Dis. 2012;13(1):2–9.
    1. Yong X, Tang B, Li B-S, et al. Helicobacter pylori virulence factor CagA promotes tumorigenesis of gastric cancer via multiple signaling pathways. Cell Commun Signal. 2015;13(1):1–13.
    1. Yamaoka Y. Mechanisms of disease: Helicobacter pylori virulence factors. Nat Rev Gastroenterol Hepatol. 2010;7(11):629–641.
    1. van Doorn LJ, Figueiredo C, Sanna R, et al. Clinical relevance of the cagA, vacA, and iceA status of Helicobacter pylori. Gastroenterology. 1998;115(1):58–66.
    1. Wroblewski LE, Peek RM, Wilson KT. Helicobacter pylori and gastric cancer: factors that modulate disease risk. Clin Microbiol Rev. 2010;23(4):713–739.
    1. Zhou K, Ho W. Gastric carcinoids: classification and Diagnosis. In: Pisegna RJ, editor. Management of Pancreatic Neuroendocrine Tumors. New York, NY: Springer New York; 2015. pp. 83–93.
    1. Burkitt MD, Pritchard DM. Review article: pathogenesis and management of gastric carcinoid tumours. Aliment Pharmacol Ther. 2006;24(9):1305–1320.
    1. Li T-T, Qiu F, Qian ZR, Wan J, Qi X-K, Wu B-Y. Classification, clinicopathologic features and treatment of gastric neuroendocrine tumors. World J Gastroenterol. 2014;20(1):118–125.
    1. Andres E, Fothergill H, Mecili M. Efficacy of oral cobalamin (vitamin B12) therapy. Expert Opin Pharmacother. 2010;11(2):249–256.
    1. Stolte M, Meier E, Meining A. Cure of autoimmune gastritis by Helicobacter pylori eradication in a 21-year-old male. Z Gastroenterol. 1998;36(8):641–643.
    1. Faller G, Winter M, Steininger H, et al. Decrease of antigastric autoantibodies in Helicobacter pylori gastritis after cure of infection. Pathol Res Pract. 1999;195(4):243–246.
    1. Nikou GC, Angelopoulos TP. Current concepts on gastric carcinoid tumors. Gastroenterol Res Pract. 2012;2012:287825.
    1. Dockray GJ. Clinical endocrinology and metabolism. Gastrin. Best Pract Res Clin Endocrinol Metab. 2004;18(4):555–568.
    1. Moore AR, Boyce M, Steele IA, Campbell F, Varro A, Pritchard DM. Netazepide, a gastrin receptor antagonist, normalises tumour biomarkers and causes regression of type 1 gastric neuroendocrine tumours in a nonrandomised trial of patients with chronic atrophic gastritis. PLoS One. 2013;8(10):e76462.
    1. Fossmark R, Sordal O, Jianu CS, et al. Treatment of gastric carcinoids type 1 with the gastrin receptor antagonist netazepide (YF476) results in regression of tumours and normalisation of serum chromogranin A. Aliment Pharmacol Ther. 2012;36(11–12):1067–1075.
    1. Massironi S, Zilli A, Fanetti I, Ciafardini C, Conte D, Peracchi M. Intermittent treatment of recurrent type-1 gastric carcinoids with somatostatin analogues in patients with chronic autoimmune atrophic gastritis. Dig Liver Dis. 2015;47(11):978–983.
    1. Kwekkeboom DJ, Krenning EP. Peptide receptor radionuclide therapy in the treatment of neuroendocrine tumors. Hematol Oncol Clin North Am. 2016;30(1):179–191.

Source: PubMed

Szponzorok és közreműködők

Egészségi állapot

Kábítószer-beavatkozások

3
Iratkozz fel