<Letter to the Editor>
Eur J Intern Med 2024 Jul 16:S0953-6205(24)00293-0.
https://doi.org/10.1016/j.ejim.2024.07.011
AIG의 prevalence는 얼마나 될까요? Letter 형식으로 발표 된 study 결과입니다. 2022년 1월부터 20023년 6월까지, 3차 기관에 refer 된 환자를 2개의 군, case finding strategy (outpatient clinic A)와 universal screening strategy (outpatient clinic B)로 random 배정하여 AIG 여부에 대한 검사를 진행하였습니다.
* Case finding groups: high-risk patients presenting with anemia (both iron- and vitamin B12-deficiency), dyspepsia, vitamin B12 deficiency with/without clinical manifestations, neurological symptoms, infertility/recurrent miscarriage, and in patients with first-degree family history of AIG, and autoimmune disorders (i.e., autoimmune thyroid disease, celiac disease, vitiligo, Addison’s disease, diabetes mellitus type 1, psoriasis/psoriatic arthritis, rheumatoid arthritis)
* Universal screenig groups: all patients had at least a gastrointestinal complaint, since the setting is that of a gastroenterology outpatient clinic.
-> 두 그룹 환자들 모두 anti-parietal cell antibodies (PCA) 검사를 시행하였고, positive로 나오면 endoscopy와 함께 sydney protocol에 따라 biopsy를 진행하였습니다.
* Overt AIG (i.e., any degree of atrophy affecting the oxyntic mucosa with antrum sparing)
* Potential AIG (i.e., PCA positivity in the absence of gastric atrophy)
-> 이 기준에 맞추기 위해서, atrophic antral gastritis (i.e., post H. pylori gastritis), atrophic pan-gastritis, active H. pylori infection (stool antigen test 양성 및 조직검사 결과 확인 된 경우)을 가진 환자는 AIG 가 아닌 것으로 하였습니다.
Table 1. Sociodemographic, clinical characteristics and prevalence of overt and potential autoimmune gastritis(AIG) in the case-finding vs universal screening groups.
* Case-finding group: 239 patients (54.3 ± 18.3 years; F:M ratio 3.3:1)
* Universal screening group: 414 patients (53.5 ± 21.1 years; F:M ratio 1.8:1)
- PCA positivity: Case-finding group (21.7%) > Universal screening group (10.6%), p<0.001
- Overt AIG: Case-finding group (15.5%) > Universal screening group (4.3%), p<0.001 [Potential AIG: equal (6.3%)]
- Case-finding group (significantly high): female sex (76.6% vs 66.1%; p=0.0049), anemia (15.5% vs 8.4%; p=0.0053), dyspepsia (66.9% vs 20.5%; p<0.001), first-degree family AIG history (3.3% vs 0.5%; p=0.0049), and vitamin B12 deficiency (6.3% vs 0%; p<0.001) [autoimmune diseases: similar (25.1%vs 19.3%;p=0.082)]
:: 위장관 증상이 있어 내원한 일반 환자에서 PCA 양성률이 10%가 넘고, overt AIG도 4% 이상입니다. 여러 동반된 증상이 있어 적극적인 검사가 필요했던 군에서는 PCA 양성률이 20% 이상, overt AIG도 15% 이상으로 통계적으로 매우 높은 유병률을 보이고 있습니다.
* Supplementary Table1 and 2 (Data 없음)
- 전체 환자 군에서 autoimmune diseases 동반 유무는 통계적 차이가 없었지만, overt AIG 중 case-finding group에서 보다 높은 autoimmune immune disease cluster 를 보였습니다. (38.8% vs. 13.5%, p=0.0034) [potential AIG에서는 차이 없음]
- overt AIG 에서 두 군의 높은 gastrin 17 level (88.8% vs 91.9%; p=0.785) 과 severe atrophy (61.1%vs67.6%;p=0.637) 여부는 통계적 차이가 없었습니다.
* 경제적 비용에 대한 비교
- PCA 검사 비용: 8.37유로 (1,488원/유로, 12,450원) / sample
- Overt AIG
: Case-finding strategy: 100명당 1명을 진단하는데 드는 비용 - 55.8유로 (83,030원)
: Universal screening strategly: 100명당 1명을 진단하는데 드는 비용 - 209.25유로 (311,364원)
In conclusion, although our study suffers from several limits (i.e., the tertiary referral setting of enrollment, the relatively small sample size which did not allow us to perform more detailed statistical analyses,the potential heterogeneity between the two clinics), it provides the first evidence of the impact of an active case-finding strategy in AIG diagnosis.
Indeed, PCA have no absolute accuracy, and studies looking at other potential markers of AIG (e.g., such as fasting17-gastrin and pepsinogens) to be used in a screening campaigns are warranted.
<Letter to the Editor>
Eur J Intern Med 2024 Jul 16:S0953-6205(24)00293-0.
https://doi.org/10.1016/j.ejim.2024.07.011
AIG의 prevalence는 얼마나 될까요? Letter 형식으로 발표 된 study 결과입니다. 2022년 1월부터 20023년 6월까지, 3차 기관에 refer 된 환자를 2개의 군, case finding strategy (outpatient clinic A)와 universal screening strategy (outpatient clinic B)로 random 배정하여 AIG 여부에 대한 검사를 진행하였습니다.
* Case finding groups: high-risk patients presenting with anemia (both iron- and vitamin B12-deficiency), dyspepsia, vitamin B12 deficiency with/without clinical manifestations, neurological symptoms, infertility/recurrent miscarriage, and in patients with first-degree family history of AIG, and autoimmune disorders (i.e., autoimmune thyroid disease, celiac disease, vitiligo, Addison’s disease, diabetes mellitus type 1, psoriasis/psoriatic arthritis, rheumatoid arthritis)
* Universal screenig groups: all patients had at least a gastrointestinal complaint, since the setting is that of a gastroenterology outpatient clinic.
-> 두 그룹 환자들 모두 anti-parietal cell antibodies (PCA) 검사를 시행하였고, positive로 나오면 endoscopy와 함께 sydney protocol에 따라 biopsy를 진행하였습니다.
* Overt AIG (i.e., any degree of atrophy affecting the oxyntic mucosa with antrum sparing)
* Potential AIG (i.e., PCA positivity in the absence of gastric atrophy)
-> 이 기준에 맞추기 위해서, atrophic antral gastritis (i.e., post H. pylori gastritis), atrophic pan-gastritis, active H. pylori infection (stool antigen test 양성 및 조직검사 결과 확인 된 경우)을 가진 환자는 AIG 가 아닌 것으로 하였습니다.
Table 1. Sociodemographic, clinical characteristics and prevalence of overt and potential autoimmune gastritis(AIG) in the case-finding vs universal screening groups.
* Case-finding group: 239 patients (54.3 ± 18.3 years; F:M ratio 3.3:1)
* Universal screening group: 414 patients (53.5 ± 21.1 years; F:M ratio 1.8:1)
- PCA positivity: Case-finding group (21.7%) > Universal screening group (10.6%), p<0.001
- Overt AIG: Case-finding group (15.5%) > Universal screening group (4.3%), p<0.001 [Potential AIG: equal (6.3%)]
- Case-finding group (significantly high): female sex (76.6% vs 66.1%; p=0.0049), anemia (15.5% vs 8.4%; p=0.0053), dyspepsia (66.9% vs 20.5%; p<0.001), first-degree family AIG history (3.3% vs 0.5%; p=0.0049), and vitamin B12 deficiency (6.3% vs 0%; p<0.001) [autoimmune diseases: similar (25.1%vs 19.3%;p=0.082)]
:: 위장관 증상이 있어 내원한 일반 환자에서 PCA 양성률이 10%가 넘고, overt AIG도 4% 이상입니다. 여러 동반된 증상이 있어 적극적인 검사가 필요했던 군에서는 PCA 양성률이 20% 이상, overt AIG도 15% 이상으로 통계적으로 매우 높은 유병률을 보이고 있습니다.
* Supplementary Table1 and 2 (Data 없음)
- 전체 환자 군에서 autoimmune diseases 동반 유무는 통계적 차이가 없었지만, overt AIG 중 case-finding group에서 보다 높은 autoimmune immune disease cluster 를 보였습니다. (38.8% vs. 13.5%, p=0.0034) [potential AIG에서는 차이 없음]
- overt AIG 에서 두 군의 높은 gastrin 17 level (88.8% vs 91.9%; p=0.785) 과 severe atrophy (61.1%vs67.6%;p=0.637) 여부는 통계적 차이가 없었습니다.
* 경제적 비용에 대한 비교
- PCA 검사 비용: 8.37유로 (1,488원/유로, 12,450원) / sample
- Overt AIG
: Case-finding strategy: 100명당 1명을 진단하는데 드는 비용 - 55.8유로 (83,030원)
: Universal screening strategly: 100명당 1명을 진단하는데 드는 비용 - 209.25유로 (311,364원)
In conclusion, although our study suffers from several limits (i.e., the tertiary referral setting of enrollment, the relatively small sample size which did not allow us to perform more detailed statistical analyses,the potential heterogeneity between the two clinics), it provides the first evidence of the impact of an active case-finding strategy in AIG diagnosis.
Indeed, PCA have no absolute accuracy, and studies looking at other potential markers of AIG (e.g., such as fasting17-gastrin and pepsinogens) to be used in a screening campaigns are warranted.