2022년 12월 1~3일 열릴, KDDW 2022에 E-poster 제출을 했습니다.
제출한 내용은 2021년 7월부터 2022년 6월까지 1년 동안 저희 clinic에서 진단 된 총 15명의 AIG 환자의 임상적 소견을 정리한 내용입니다.
Background
Autoimmune gastritis (AIG) is a host-related atrophic gastritis which is characterized by chronic autoimmune-mediated inflammation in the oxyntic mucosa of the gastric body. We are reported to the clinical and histological characteristics of patients with AIG diagnosed in a single clinic for 1 year.
Method
From July 2021 to June 2022, among patients who visited the hospital for upper gastrointestinal (GI) endoscopy, we enrolled patients with positive of anti-parietal cell antibody, endoscopically corpus dominant atrophy of the stomach and histologically diagnosed with AIG. According to the retrospective analysis, comparative analysis of the clinical characteristics, medical history, histologic state, and comparison with autoimmune thyroid disease (ATD) was performed.
Result
In total 15 AIG patients were enrolled, with the prevalence of the period was 0.98. All were female (median age 63.1 years) with serological atrophy (median pepsinogen I was 12.5 ng/mL and pepsinogen I/II ratio was 0.8), and 98% of patients elevated serum gastrin (median value was 518.6 pg/mL). Seven out of 15 patients (46.7%) had ATD (6 had Hashimoto’s thyroiditis and 1 had Grave’s disease), five had iron deficiency anemia (33.3%), and nine had vitamin D deficiency (60%). Twelve (80%) were unrelated to Helicobacter pylori (Hp), two were current infection (all had autoimmune thyroid disease), and one was in the past. In all patients, the degree of inflammation (1.67±0.49 vs. 0.93±0.26, p<0.001) and neutrophil (1.20±0.56 vs. 0.40±0.51, p<0.001) of the body was statistically worse than that of the antrum in the biopsy results. Compared to the presence of ATD, there were no significantly differences for pepsinogen I, I/II ratio, gastrin, Hemoglobin, vitamin B12, Anti Hp IgG, and pathologic scores.
Table 1. Basic characteristics of autoimmune gastritis and comparison with accompanying autoimmune thyroid disease (ATD).
| Total patients | Without ATD | With ATD* | p value† |
Female, N (%) | 15 (100) | 8 (53.3) | 7 (46.7) |
|
Age, years | 63.1±13 | 63.9±14.5 | 62.1±12.2 | 0.808 |
Pepsinogen I, ng/mL | 12.5±8.8 | 9.7±3.4 | 15.8±9.1 | 0.185 |
Pepsinogen II, ng/mL | 15.5±6.2 | 11.9±3.4 | 19.5±6.4 | 0.011 |
Pepsinogen I/II | 0.77±0.46 | 0.79±0.59 | 0.76±0.33 | 0.905 |
Gastrin, pg/mL | 518.6±299.5 | 464.3±357 | 582±231.2 | 0.905 |
Anti H. pylori IgG titer, U/mL | 1.41±2.0 | 0.64±0.15 | 2.18±2.6 | 0.185 |
H. pylori, N (%) | 3 (20) | 1 (33.3) | 2 (66.7) | 0.438 |
Hemoglobin, g/dL | 12.2±2.7 | 12.1±3.2 | 12.4±2.4 | 0.814 |
Ferritin, ng/mL | 73.9±76.1 | 55.9±60.5 | 92.0±92.4 | 0.486 |
MCV, Fl | 92.0±8.6 | 95.1±7.9 | 89.0±8.9 | 0.289 |
Vitamin B12, pg/mL | 368.5±117.0 | 345.8±103.5 | 387.5±133.7 | 0.584 |
Iron deficiency anemia, N (%) | 5 (33.3) | 3 (60%) | 2 (40%) | 0.573 |
Vitamin D, ng/mL | 37.6±20.9 | 25.7±7.5 | 23.6±37.6 | 0.019 |
Vitamin D deficiency‡, N (%) | 9/13 (69.2) | 7 (77.8) | 2 (33,3) | 0.021 |
Osteoporosis, N (%) | 3/8 (37.5) | 3 (100) | 0 (0) | 0.071 |
Gastric neoplasm, N (%) | 4 (26.7) | 2 (50) | 2 (50) | 0.662 |
Gastric adenoma | 3 (75%) | 1 (33.3%) | 2 (66.7%) |
|
Subepithelial tumor | 1 (25%) | 1 (100%) | 0 |
|
Values are expressed as the number of subjects and mean±SD. *Accompanied by Hashimoto’s thyroiditis (6, 85.7%) or Graves’ disease (1, 14.3%). †p value: Paired t-test and Fisher’s exact test; without ATD vs. with ATD. ‡Patients diagnosed in the past and taking supplements were included.
Table 2. Pathologic score between antrum and body with update Sydney system of autoimmune gastritis.
Category | Site | Pathologic score | p value |
Inflammation | Body | 1.67±0.49 | <0.001 |
| Antrum | 0.93±0.26 |
|
Neutrophil | Body | 1.20±0.56 | <0.001 |
| Antrum | 0.40±0.51 |
|
Atrophy | Body | 0.80±0.68 | <0.001 |
| Antrum | 0 |
|
Intestinal metaplasia | Body | 0.33±0.49 | <0.019 |
| Antrum | 0 |
|
Histologically, Helicobacter pylori was not observed.
Table 3. Pathologic score with update Sydney system of autoimmune gastritis accompanying autoimmune thyroid disease (ATD).
Category | Site | Without ATD | With ATD | p value |
Inflammation | Body | 1.75±0.46 | 1.57±0.54 | 0.427 |
| Antrum | 1.00±0 | 0.86±0.38 | 0.467 |
Neutrophil | Body | 1.38±0.52 | 1.00±0.58 | 0.379 |
| Antrum | 0.38±0.52 | 0.43±0.54 | 0.622 |
Atrophy | Body | 0.75±0.71 | 0.86±0.69 | 0.935 |
| Antrum | 0 | 0 | ‒ |
Intestinal metaplasia | Body | 0.25±0.46 | 0.43±0.54 | 0.427 |
| Antrum | 0 | 0 | ‒ |
Histologically, Helicobacter pylori was not observed.
Conclusion
AIG is not uncommon disease and serological tests are helpful for diagnosis. We would like to recommend that further studies are needed to clarify its diagnosis and management.
2022년 12월 1~3일 열릴, KDDW 2022에 E-poster 제출을 했습니다.
제출한 내용은 2021년 7월부터 2022년 6월까지 1년 동안 저희 clinic에서 진단 된 총 15명의 AIG 환자의 임상적 소견을 정리한 내용입니다.
Background
Autoimmune gastritis (AIG) is a host-related atrophic gastritis which is characterized by chronic autoimmune-mediated inflammation in the oxyntic mucosa of the gastric body. We are reported to the clinical and histological characteristics of patients with AIG diagnosed in a single clinic for 1 year.
Method
From July 2021 to June 2022, among patients who visited the hospital for upper gastrointestinal (GI) endoscopy, we enrolled patients with positive of anti-parietal cell antibody, endoscopically corpus dominant atrophy of the stomach and histologically diagnosed with AIG. According to the retrospective analysis, comparative analysis of the clinical characteristics, medical history, histologic state, and comparison with autoimmune thyroid disease (ATD) was performed.
Result
In total 15 AIG patients were enrolled, with the prevalence of the period was 0.98. All were female (median age 63.1 years) with serological atrophy (median pepsinogen I was 12.5 ng/mL and pepsinogen I/II ratio was 0.8), and 98% of patients elevated serum gastrin (median value was 518.6 pg/mL). Seven out of 15 patients (46.7%) had ATD (6 had Hashimoto’s thyroiditis and 1 had Grave’s disease), five had iron deficiency anemia (33.3%), and nine had vitamin D deficiency (60%). Twelve (80%) were unrelated to Helicobacter pylori (Hp), two were current infection (all had autoimmune thyroid disease), and one was in the past. In all patients, the degree of inflammation (1.67±0.49 vs. 0.93±0.26, p<0.001) and neutrophil (1.20±0.56 vs. 0.40±0.51, p<0.001) of the body was statistically worse than that of the antrum in the biopsy results. Compared to the presence of ATD, there were no significantly differences for pepsinogen I, I/II ratio, gastrin, Hemoglobin, vitamin B12, Anti Hp IgG, and pathologic scores.
Table 1. Basic characteristics of autoimmune gastritis and comparison with accompanying autoimmune thyroid disease (ATD).
Total patients
Without ATD
With ATD*
p value†
Female, N (%)
15 (100)
8 (53.3)
7 (46.7)
Age, years
63.1±13
63.9±14.5
62.1±12.2
0.808
Pepsinogen I, ng/mL
12.5±8.8
9.7±3.4
15.8±9.1
0.185
Pepsinogen II, ng/mL
15.5±6.2
11.9±3.4
19.5±6.4
0.011
Pepsinogen I/II
0.77±0.46
0.79±0.59
0.76±0.33
0.905
Gastrin, pg/mL
518.6±299.5
464.3±357
582±231.2
0.905
Anti H. pylori IgG titer, U/mL
1.41±2.0
0.64±0.15
2.18±2.6
0.185
H. pylori, N (%)
3 (20)
1 (33.3)
2 (66.7)
0.438
Hemoglobin, g/dL
12.2±2.7
12.1±3.2
12.4±2.4
0.814
Ferritin, ng/mL
73.9±76.1
55.9±60.5
92.0±92.4
0.486
MCV, Fl
92.0±8.6
95.1±7.9
89.0±8.9
0.289
Vitamin B12, pg/mL
368.5±117.0
345.8±103.5
387.5±133.7
0.584
Iron deficiency anemia, N (%)
5 (33.3)
3 (60%)
2 (40%)
0.573
Vitamin D, ng/mL
37.6±20.9
25.7±7.5
23.6±37.6
0.019
Vitamin D deficiency‡, N (%)
9/13 (69.2)
7 (77.8)
2 (33,3)
0.021
Osteoporosis, N (%)
3/8 (37.5)
3 (100)
0 (0)
0.071
Gastric neoplasm, N (%)
4 (26.7)
2 (50)
2 (50)
0.662
Gastric adenoma
3 (75%)
1 (33.3%)
2 (66.7%)
Subepithelial tumor
1 (25%)
1 (100%)
0
Values are expressed as the number of subjects and mean±SD. *Accompanied by Hashimoto’s thyroiditis (6, 85.7%) or Graves’ disease (1, 14.3%). †p value: Paired t-test and Fisher’s exact test; without ATD vs. with ATD. ‡Patients diagnosed in the past and taking supplements were included.
Table 2. Pathologic score between antrum and body with update Sydney system of autoimmune gastritis.
Category
Site
Pathologic score
p value
Inflammation
Body
1.67±0.49
<0.001
Antrum
0.93±0.26
Neutrophil
Body
1.20±0.56
<0.001
Antrum
0.40±0.51
Atrophy
Body
0.80±0.68
<0.001
Antrum
0
Intestinal metaplasia
Body
0.33±0.49
<0.019
Antrum
0
Histologically, Helicobacter pylori was not observed.
Table 3. Pathologic score with update Sydney system of autoimmune gastritis accompanying autoimmune thyroid disease (ATD).
Category
Site
Without ATD
With ATD
p value
Inflammation
Body
1.75±0.46
1.57±0.54
0.427
Antrum
1.00±0
0.86±0.38
0.467
Neutrophil
Body
1.38±0.52
1.00±0.58
0.379
Antrum
0.38±0.52
0.43±0.54
0.622
Atrophy
Body
0.75±0.71
0.86±0.69
0.935
Antrum
0
0
‒
Intestinal metaplasia
Body
0.25±0.46
0.43±0.54
0.427
Antrum
0
0
‒
Histologically, Helicobacter pylori was not observed.
Conclusion
AIG is not uncommon disease and serological tests are helpful for diagnosis. We would like to recommend that further studies are needed to clarify its diagnosis and management.