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Autoimmune atrophic gastritis—pathogenesis, pathology and management
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Journal Article
Autoimmune atrophic gastritis—pathogenesis, pathology and management
2013
Overview
Autoimmune gastritis is a chronic progressive inflammatory condition that results in the replacement of the parietal cell mass by atrophic and metaplastic mucosa. This Review summarizes the epidemiology, pathogenesis and pathological aspects of autoimmune atrophic gastritis. The authors also provide practical advice for the diagnosis and management of patients with this disease.
Autoimmune gastritis is a chronic progressive inflammatory condition that results in the replacement of the parietal cell mass by atrophic and metaplastic mucosa. 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 absorption of vitamin B
12
. The resulting cobalamin deficiency manifests with megaloblastic anaemia and neurological and systemic signs and symptoms collectively known as pernicious anaemia. Previously believed to be predominantly a disease of elderly women of Northern European ancestry, autoimmune gastritis has now been recognized in all populations and ethnic groups, but because of the complexity of the diagnosis no reliable prevalence data are available. For similar reasons, as well as the frequent and often unknown overlap with
Helicobacter pylori
infection, the risk of gastric cancer has not been adequately assessed in these patients. This Review summarizes the epidemiology, pathogenesis and pathological aspects of autoimmune metaplastic atrophic gastritis. We also provide practical advice for the diagnosis and management of patients with this disease.
Key Points
Atrophic gastritis can be associated with long-standing
Helicobacter pylori
infection (multifocal atrophic gastritis) and with an autoimmune process that progressively destroys the oxyntic mucosa (autoimmune atrophic gastritis)
Both types of atrophic gastritis are underdiagnosed, in part because of inadequate biopsy sampling
Autoimmune atrophic gastritis progresses from a mild chronic inflammation of the gastric corpus to an advanced stage associated with a severe form of vitamin B
12
deficiency anaemia known as pernicious anaemia
Traditionally, autoimmune atrophic gastritis has been viewed as a disease affecting predominantly elderly women of Northern European descent, but growing evidence suggests that there might be no racial specificity
The diagnosis of autoimmune gastritis rests on the demonstration of its characteristic histopathological features and the demonstration of autoantibodies against intrinsic factor and parietal cells
Management of the early stages of autoimmune atrophic gastritis is focused on the prevention of vitamin B
12
, folate and iron deficiencies
Publisher
Nature Publishing Group UK,Nature Publishing Group
