Autoimmune gastritis

Autoimmune gastritis 

Updated: 02/17/2021

© Jun Wang, MD, PhD

General features
  • AKA type A gastritis
  • More common in elder patients
  • Associated with other autoimmune diseases (Hashimoto’s thyroiditis, Addison’s disease) but NOT with Helicobacter pylori gastritis
  • Presence of serum anti-parietal cell (APC) antibodies or anti-intrinsic factor (AIF) antibodies
  • Decreased serum pepsinogen: marker of gastric atrophy
  • May leads to pernicious anemia, due to loss of intrinsic factor
  • May have iron-deficiency anemia, due to achlorhydria (Parietal cell damage)
  • Higher risk for adenocarcinoma, well differentiated neuroendocrine tumors
Pathogenesis NSAID associated gastritis
  • Anti-parietal cell antibodies (to the protein pump K/hydrogen ATPase)
  • Anti-intrinsic factor antibodies
  • CD4+  T cells against parietal cell components, esp. H+,K+-ATPase
Clinical presentations
  • Nonspecific
  • Epigastric pain, etc
Key pathological features


PAS stain reveals increased number of goblet cells

 (Image credit: CoRus13 [CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0)])

  • Glandular atrophy predominantly in gastric body/fundus with deep or diffuse lymphoplasmacytic infiltrates, often with intestinal metaplasia
  • Often extensive intestinal, antral or pancreatic acinar metaplasia
  • No/rare H. pylori
  • In absence of other disease, antrum is usually normal
Key laboratory findings
  • Elevated: gastrin
  • Decreased: pepsinogen I
  • Autoantibodies: APC, AIF
  • Macrocytic anemia: Pernicious anemia
  • Microcytic anemia: Iron deficiency anemia
Treatment
  • Preventing or treating anemia
  • Endoscopic follow up due to high risk for adenocarcinoma



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