Reply to Ligato et al.

We thank Ligato et al. for their comments on our article [1]. Regarding the role of intestinal metaplasia (IM), we believe it should be contextualized within the primary aim of our study, the diagnosis of autoimmune gastritis (AIG). In our study, AIG diagnosis was established using internationally recognized criteria [2] [3], requiring clinical, serological, and histopathological confirmation (defined by the presence of any grade of atrophy of the oxyntic mucosa with antrum sparing and no active Helicobacter pylori infection). As oxyntic mucosal inflammation and its atrophic progression are hallmark features of AIG, they remain absolutely necessary for a confirmed diagnosis. Of note, very little is known about the exact prevalence of IM in patients with AIG at different stages [2]. We agree that the occurrence of IM with atrophy in the oxyntic mucosa may serve as auxiliary evidence for AIG. However, IM cannot replace atrophy as the fundamental histopathological criterion for AIG diagnosis, even though histopathological agreement on atrophy may be lower compared with IM, partly due to the lack of a detailed definition of atrophy [4]. Addressing this challenge requires further investigation through multicenter studies with standardized histopathological consensus. Additionally, we would also like to clarify that IM was not an exclusion criterion in our work, and whether AIG could progress to gastric cancer remains a controversial topic that necessitates future exploration [5].

As for the uncommon cases mentioned by Ligato et al., involving H. pylori-exposed gastritis with antral healing that mimics AIG, these were not included in our study. This exclusion was ensured by the application of both serological and histopathological confirmation criteria. Besides, we concur with the suggestion that integrating clinical/laboratory data and electronic chromoendoscopy with artificial intelligence systems holds great potential for enhancing the endoscopic evaluation of AIG. Further studies evaluating this approach are expected in the future.

Publication History

Article published online:
22 April 2025

• References

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