Dr. Ron’s Research Review – July 17, 2013

© 2013

This week’s research review focuses on autoimmune atrophic gastritis

Autoimmune Thyroid

Juvenile patients affected with autoimmune thyroid disorders showed a 14-21% prevalence of parietal cell antibodies (PCA) reacting against the H+/K+-ATPase of the gastric parietal cells. PCA are the principal immunological markers of atrophic body gastritis (ABG). ABG is characterized by loss of oxyntic glands, achlorhydria, and hypergastrinemia. (Segni, Borrelli et al. 2004) (Centanni, Marignani et al. 1999)

H. pylori

A recent study examined 23 patients with different grades of atrophic gastritis. Of the 14 patients with severe gastric atrophy and no evidence for an ongoing H. pylori infection, eight showed H. pylori antibodies. All eight had elevated parietal cell antibodies and 4/8 also had intrinsic factor antibodies. H. pylori may have an etiological role in autoimmune gastritis. (Veijola, Oksanen et al. 2010)

Dr. Ron


Articles

Early manifestations of gastric autoimmunity in patients with juvenile autoimmune thyroid diseases

         (Segni, Borrelli et al. 2004) Download

Juvenile patients affected with autoimmune thyroid disorders showed a 14-21% prevalence of parietal cell antibodies (PCA) reacting against the H+/K+-ATPase of the gastric parietal cells. PCA are the principal immunological markers of atrophic body gastritis (ABG).ABG is characterized by loss of oxyntic glands, achlorhydria, and hypergastrinemia. The aim of this study was to determine whether PCA positivity could be associated with biochemical and histological manifestations of gastric autoimmunity in juvenile patients with autoimmune thyroid disease (AITD). We studied 129 children (96 females and 33 males) with chronic lymphocytic thyroiditis (n = 115) or Graves' disease (n = 14). Mean age at diagnosis of AITD was 9.7 +/- 3.3 yr, and mean age at sampling was 12.3 +/- 3.7 yr. We determined PCA and Helicobacter pylori antibodies, gastrin, and pepsinogen I plasma levels. Gastroscopy with multiple biopsies was carried out in a subgroup of patients with PCA positivity. We found that 30% of children had detectable PCA. Hypergastrinemia was found in 45% of the PCA-positive children (range, 40-675 pg/ml) vs. 12% of PCA-negative children (range, 35-65 pg/ml; P < 0.001). Eighteen patients with PCA positivity underwent gastroscopy; eight of these children had normogastrinemia, which showed no signs of ABG, and 10 children had hypergastrinemia, of whom five had mild to severe ABG. Our study shows that autoimmune gastritis is an early event in juvenile AITD with detectable PCA. Gastrin plasma level is a reliable marker of gastric atrophy.

Association of autoimmune type atrophic corpus gastritis with Helicobacter pylori infection

         (Veijola, Oksanen et al. 2010) Download

AIM: To study the association between Helicobacter pylori (H. pylori) infection and autoimmune type atrophic gastritis. METHODS: Twenty-three patients with different grades of atrophic gastritis were analysed using enzyme immunoassay-based serology, immunoblot-based serology, and histology to reveal a past or a present H. pylori infection. In addition, serum markers for gastric atrophy (pepsinogen I, pepsinogen I/II and gastrin) and autoimmunity [parietal cell antibodies (PCA), and intrinsic factor (IF), antibodies] were determined. RESULTS: Of the 14 patients with severe gastric atrophy, as demonstrated by histology and serum markers, and no evidence for an ongoing H. pylori infection, eight showed H. pylori antibodies by immunoblotting. All eight had elevated PCA and 4/8 also had IF antibodies. Of the six immunoblot-negative patients with severe corpus atrophy, PCA and IF antibodies were detected in four. Among the patients with low to moderate grade atrophic gastritis (all except one with an ongoing H. pylori infection), serum markers for gastric atrophy and autoimmunity were seldom detected. However, one H. pylori negative patient with mild atrophic gastritis had PCA and IF antibodies suggestive of a pre-atrophic autoimmune gastritis. CONCLUSION: Signs of H. pylori infection in autoimmune gastritis, and positive autoimmune serum markers in H. pylori gastritis suggest an etiological role for H. pylori in autoimmune gastritis.


References

Centanni, M., M. Marignani, et al. (1999). "Atrophic body gastritis in patients with autoimmune thyroid disease: an underdiagnosed association." Arch Intern Med 159(15): 1726-30 PMID: 10448775

Segni, M., O. Borrelli, et al. (2004). "Early manifestations of gastric autoimmunity in patients with juvenile autoimmune thyroid diseases." J Clin Endocrinol Metab 89(10): 4944-8 PMID: 15472189

Veijola, L. I., A. M. Oksanen, et al. (2010). "Association of autoimmune type atrophic corpus gastritis with Helicobacter pylori infection." World J Gastroenterol 16(1): 83-8 PMID: 20039453