Endoscopic and clinical characteristics of autoimmune atrophic gastritis: Retrospective study

Abstract

Background and study aims

Autoimmune atrophic gastritis (AIG) is a rare chronic autoimmune disease characterized by gastric mucosa inflammation and atrophy. Limited clinical data exist about AIG, especially in western populations. In addition, there are no western series on the magnifying endoscopic features in AIG. This study presents a cohort of 63 patients with AIG, reporting their clinical, laboratory, and endoscopic findings.

Patients and methods

A retrospective analysis was conducted on patients diagnosed with AIG at Kingston Health Sciences Centre, Canada, between January 2016 and December 2023. Data collected from medical records included age, sex, presenting symptoms, laboratory findings, endoscopic features, histopathology reports, and concomitant autoimmune diseases.

Results

The study included 63 patients with autoimmune gastritis. Positive anti-parietal cell antibodies were found in the majority of patients (84.13%), whereas positive anti-intrinsic factor antibodies were less prevalent (25.40%). Deficiencies in vitamin B12 (49.21%) and iron (76.19%) were observed, along with a high prevalence of anemia (71.43%) and concomitant autoimmune diseases (58.73%). The dominant magnification pattern of atrophy in the body was oval/slit in 57.14% of patients (n=36), followed by tubular in 30.16% (n=19) and foveolar in 12.70% (n=8). Prevalence of neoplasia in our study was 42.86% (n=27).

Conclusion

This study offers insights into the clinical, laboratory, and magnifying endoscopic features of patients with AIG. It demonstrates the three main magnifying endoscopic appearances of AIG and highlights the significant prevalence of gastric neoplasia, even in the low-risk Western population. These findings emphasize the importance of the endoscopic exam in identifying AIG and notably present the key magnifying endoscopy findings in a Western setting for the first time.

Keywords

Endoscopy Upper GI Tract - Precancerous conditions & cancerous lesions (displasia and cancer) stomach - Diagnosis and imaging (inc chromoendoscopy, NBI, iSCAN, FICE, CLE)

Publication History

Received: 26 January 2024

Accepted after revision: 19 November 2024

Accepted Manuscript online:
21 November 2024

Article published online:
07 January 2025

• References

• 1 Hall SN, Appelman HD. Autoimmune gastritis. Arch Pathol Lab Mede 2019; 143: 1327-1331
• 2 Banks M, Graham D, Jansen M. et al. British Society of Gastroenterology guidelines on the diagnosis and management of patients at risk of gastric adenocarcinoma. Gut 2019; 68: 1545-1575
• 3 Neumann WL, Coss E, Rugge M. et al. Autoimmune atrophic gastritis—pathogenesis, pathology and management. Nat Rev Gastroenterol Hepatol 2013; 10: 529-541
• 4 Kamada T, Maruyama Y, Monobe Y. et al. Endoscopic features and clinical importance of autoimmune gastritis. Digest Endosc 2022; 34: 700-713
• 5 Kimura K, Takemoto T. An endoscopic recognition of the atrophic border and its significance in chronic gastritis. Endoscopy 1969; 1: 87-97
• 6 Bansal A, Ulusarac O, Mathur S. et al. Correlation between narrow band imaging and nonneoplastic gastric pathology: a pilot feasibility trial. Gastrointest Endosc 2008; 67: 210-216
• 7 Saka A, Yagi K, Nimura S. OLGA- and OLGIM-based staging of gastritis using narrow-band imaging magnifying endoscopy: Gastritis staging using NBI-ME. Digest Endosc 2015; 27: 735-742
• 8 Miceli E, Lenti MV, Padula D. et al. Common features of patients with autoimmune atrophic gastritis. Clin Gastroenterol Hepatol 2012; 10: 812-814
• 9 Kato M, Uedo N, Toth E. et al. Differences in image-enhanced endoscopic findings between Helicobacter pylori-associated and autoimmune gastritis. Endosc Int Open 2021; 09: E22-E30
• 10 Kamada T, Watanabe H, Furuta T. et al. Diagnostic criteria and endoscopic and histological findings of autoimmune gastritis in Japan. J Gastroenterol 2023; 58: 185-195
• 11 Kulnigg-Dabsch S. Autoimmune gastritis. Wien Med Wochenschr 2016; 166: 424-430
• 12 Nakajima S, Watanabe H, Shimbo T. et al. Incisura angularis belongs to fundic or transitional gland regions in Helicobacter pylori-naïve normal stomach: Sub-analysis of the prospective multi-center study. Digest Endosc 2021; 33: 125-132
• 13 El-Zimaity HM. Gastric atrophy, diagnosing and staging. WJG 2006; 12: 5757
• 14 Coati I. Autoimmune gastritis: Pathologist’s viewpoint. WJG 2015; 21: 12179
• 15 Pimentel-Nunes P, Libânio D, Marcos-Pinto R. et al. Management of epithelial precancerous conditions and lesions in the stomach (MAPS II): European Society of Gastrointestinal Endoscopy (ESGE), European Helicobacter and Microbiota Study Group (EHMSG), European Society of Pathology (ESP), and Sociedade Portuguesa de Endoscopia Digestiva (SPED) guideline update 2019. Endoscopy 2019; 51: 365-388
• 16 Toh B-H, Chan J, Kyaw T. et al. Cutting edge issues in autoimmune gastritis. Clinic Rev Allerg Immunol 2012; 42: 269-278
• 17 Kono S. Can endoscopic atrophy predict histological atrophy? Historical study in United Kingdom and Japan. WJG 2015; 21: 13113
• 18 Notsu T, Adachi K, Mishiro T. et al. Prevalence of Autoimmune gastritis in individuals undergoing medical checkups in Japan. Intern Med 2019; 58: 1817-1823
• 19 Chiu PWY, Uedo N, Singh R. et al. An Asian consensus on standards of diagnostic upper endoscopy for neoplasia. Gut 2019; 68: 186-197
• 20 Doyama H, Yoshida N, Tsuyama S. et al. The “white globe appearance” (WGA): a novel marker for a correct diagnosis of early gastric cancer by magnifying endoscopy with narrow-band imaging (M-NBI). EIO 2015; 03: E120-E124
• 21 Terao S, Suzuki S, Yaita H. et al. Multicenter study of autoimmune gastritis in Japan: Clinical and endoscopic characteristics. Digest Endosc 2020; 32: 364-372
• 22 Rustgi SD, Bijlani P, Shah SC. Autoimmune gastritis, with or without pernicious anemia: epidemiology, risk factors, and clinical management. Therap Adv Gastroenterol 2021; 14: 175628482110387
• 23 Hershko C, Ronson A, Souroujon M. et al. Variable hematologic presentation of autoimmune gastritis: age-related progression from iron deficiency to cobalamin depletion. Blood 2006; 107: 1673-1679
• 24 Park JY, Cornish TC, Lam-Himlin D. et al. Gastric lesions in patients with autoimmune metaplastic atrophic gastritis (AMAG) in a tertiary care setting. Am J Surg Pathol 2010; 34: 1591-1598
• 25 Rugge M, Bricca L, Guzzinati S. et al. Autoimmune gastritis: long-term natural history in naïve Helicobacter pylori -negative patients. Gut 2023; 72: 30-38
• 26 Miceli E, Vanoli A, Lenti MV. et al. Natural history of autoimmune atrophic gastritis: a prospective, single centre, long-term experience. Aliment Pharmacol Ther 2019; 50: 1172-1180
• 27 Vannella L. Risk for gastric neoplasias in patients with chronic atrophic gastritis: A critical reappraisal. WJG 2012; 18: 1279
• 28 Spence AD, Cardwell CR, McMenamin ÚC. et al. Adenocarcinoma risk in gastric atrophy and intestinal metaplasia: a systematic review. BMC Gastroenterol 2017; 17: 157
• 29 Quach DT, Hiyama T. Assessment of endoscopic gastric atrophy according to the Kimura-Takemoto classification and its potential application in daily practice. Clin Endosc 2019; 52: 321-327
• 30 Varis O, Valle J, Siurala M. Is Helicobacter pylori involved in the pathogenesis of the gastritis characteristic of pernicious anaemia? Comparison between pernicious anaemia relatives and duodenal ulcer relatives. Scandinavian J Gastroenterol 1993; 28: 705-708
• 31 Annibale B, Lahner E, Bordi C. et al. Role of Helicobacter pylori infection in pernicious anaemia. Dig Liver Dis 2000; 32: 756-762
• 32 Morgan E, Arnold M, Camargo MC. et al. The current and future incidence and mortality of gastric cancer in 185 countries, 2020–40: A population-based modelling study. EClinicalMedicine 2022; 47: 101404
• 33 Shin WS, Xie F, Chen B. et al. Updated epidemiology of gastric cancer in Asia: Decreased incidence but still a big challenge. Cancers (Basel) 2023; 15: 2639