2022년 10월 Internal Medicine (Japan) 에 실린 Case report 입니다. H. pylori와 AIG의 연관성은 아직도 의문이며, 이 증례에서는 H. pylori eradication 치료이후 AIG가 빠르게 진행되어 진단되었다고 하였습니다.
Early stage의 AIG에서 H. pylori eradication에 의해 healing 이 되었다는 과거 report도 있고, H. pylori가 사라진 이후 의미있게 serum gastrin level과 auto-antibodies의 감소를 보고한 report도 있었습니다. 일본에서는 AIG는 유벼률이 낮고, chronic H. pylori gastritis가 흔한데, AIG의 많은 cases에서 H. pylori eradication 이후 발견이 되기도 하고, 어떤 경우는 eradication 이후에 reverse atrophy가 분명하게 나타난 cases들도 있습니다. 이러한 내용은 H. pylori 감염이 AIG 발생을 억제하는 것이라는 Ohara et al. 의 동물실험 연구결과와 일치합니다 (Ohana M, Okazaki K, Oshima C, et al. Inhibitory effects of Helicobacter pylori infection on murine autoimmune gastritis. Gut 52: 1102-1110, 2003).
<73세, 여성>
Figure 1. Endoscopic findings in 2008 (A-D). A, B: Atrophic changes did not extend to the upper corpus or the fornix. C: Small, round, yellowish-white nodules are observed in some parts of the greater curvature of the angular portion. D: Ulcer scarring in the anterior wall of the duodenal bulbus.
Figure 2. Endoscopic findings just before the eradication therapy in Feb. 2019 (A-D). A: Image from the posterior side of the angular portion to the antrum. The coarse and fading mucosa continuously spreads from the antrum to the angular portion. B: Image from the upper corpus to the angular portion. The atrophic border lies on the anterior wall of the corpus. Diffuse redness is observed on the greater curvature side. C: Close-up image of the lesser curvature of the lower corpus by narrow-band imaging (NBI). The areae gastricae pattern is obscured, and the original gastric pits are lost with fading change. D: Close-up image of the greater curvature of the middle corpus by NBI. The areae gastricae pattern is clear and regular with no intervening parts, and the original gastric pits are preserved in an orderly manner.
Figure 3. Temporal changes in endoscopic findings before and after the eradication therapy. Significant progression of atrophic changes was observed in the corpus, especially in the greater curvature side. Small hyperplastic polyps and lesions were observed in some areas.
Figure 4. Time course of serum markers before and after H. pylori eradication. APCA: anti-parietal cell antibody, HpAb: serum anti-H. pylori antibody, PG I: pepsinogen I
Figure 5. Histopathological findings in 2019 (A, B), 2020 (C, D), and 2021 (E, F). A, C, E: Biopsy specimens obtained from the greater curvature of the upper corpus (Hematoxylin and Eosin staining, original magnification ×200). B, D, F: The same specimens as in A, C, and E, respectively (immunohistochemical staining for chromogranin A, original magnification ×100).
Table1. Temporal Changes in the Updated Sydney Classification.
Table 2. Laboratory Blood Test Findings.
2022년 10월 Internal Medicine (Japan) 에 실린 Case report 입니다. H. pylori와 AIG의 연관성은 아직도 의문이며, 이 증례에서는 H. pylori eradication 치료이후 AIG가 빠르게 진행되어 진단되었다고 하였습니다.
Early stage의 AIG에서 H. pylori eradication에 의해 healing 이 되었다는 과거 report도 있고, H. pylori가 사라진 이후 의미있게 serum gastrin level과 auto-antibodies의 감소를 보고한 report도 있었습니다. 일본에서는 AIG는 유벼률이 낮고, chronic H. pylori gastritis가 흔한데, AIG의 많은 cases에서 H. pylori eradication 이후 발견이 되기도 하고, 어떤 경우는 eradication 이후에 reverse atrophy가 분명하게 나타난 cases들도 있습니다. 이러한 내용은 H. pylori 감염이 AIG 발생을 억제하는 것이라는 Ohara et al. 의 동물실험 연구결과와 일치합니다 (Ohana M, Okazaki K, Oshima C, et al. Inhibitory effects of Helicobacter pylori infection on murine autoimmune gastritis. Gut 52: 1102-1110, 2003).
<73세, 여성>
Figure 1. Endoscopic findings in 2008 (A-D). A, B: Atrophic changes did not extend to the upper corpus or the fornix. C: Small, round, yellowish-white nodules are observed in some parts of the greater curvature of the angular portion. D: Ulcer scarring in the anterior wall of the duodenal bulbus.
Figure 2. Endoscopic findings just before the eradication therapy in Feb. 2019 (A-D). A: Image from the posterior side of the angular portion to the antrum. The coarse and fading mucosa continuously spreads from the antrum to the angular portion. B: Image from the upper corpus to the angular portion. The atrophic border lies on the anterior wall of the corpus. Diffuse redness is observed on the greater curvature side. C: Close-up image of the lesser curvature of the lower corpus by narrow-band imaging (NBI). The areae gastricae pattern is obscured, and the original gastric pits are lost with fading change. D: Close-up image of the greater curvature of the middle corpus by NBI. The areae gastricae pattern is clear and regular with no intervening parts, and the original gastric pits are preserved in an orderly manner.
Figure 3. Temporal changes in endoscopic findings before and after the eradication therapy. Significant progression of atrophic changes was observed in the corpus, especially in the greater curvature side. Small hyperplastic polyps and lesions were observed in some areas.
Figure 4. Time course of serum markers before and after H. pylori eradication. APCA: anti-parietal cell antibody, HpAb: serum anti-H. pylori antibody, PG I: pepsinogen I
Figure 5. Histopathological findings in 2019 (A, B), 2020 (C, D), and 2021 (E, F). A, C, E: Biopsy specimens obtained from the greater curvature of the upper corpus (Hematoxylin and Eosin staining, original magnification ×200). B, D, F: The same specimens as in A, C, and E, respectively (immunohistochemical staining for chromogranin A, original magnification ×100).
Table1. Temporal Changes in the Updated Sydney Classification.
Table 2. Laboratory Blood Test Findings.