최신연구결과(해외)

OthersNot all that is corpus restricted is necessarily autoimmune

관리자
2023-12-05
조회수 105

Gut 2023;72:2384–2385. doi:10.1136/gutjnl-2022-328959

Edith Lahner, Emanuele Dilaghi, Ludovica Dottori, Bruno Annibale.


2023년 1월 Gut에 발표되었던 Rugge M 의 논문이 연말에도 계속 회자되고 있습니다. (Rugge M, Bricca L, Guzzinati S, et al. Autoimmune Gastritis: long-term natural history in Naïve Helicobacter Pylori -Negative patients. Gut 2023;72:30–8.)


<PostScript> 

* Long-term natural history in Helicobacter pylori (Hp)- negative patients with autoimmune gastritis (AIG)

(1) corpus-restricted inflammation, pseudopyloric (PPM) rather than intestinal metaplasia (IM), and enterochromaffin like (ECL)-cell hyperplasia and neoplasia were the main histopathological hallmarks associated with AIG

(2) patients with AIG seem not to have an increased gastric cancer (GC)-risk when previous/current Hp infection is thoroughly excluded, but surveillance for type-1 gastric neuroendocrine tumours (t1-gNETs) risk may be performed.


* AIG와 연관된 조직학적 변화: Corpus-restricted inflammation, ECL-cell hyperplasia, t1 gastric NETs, PPM

- ECL cell hyperplasia: Hp-related corpus-predominant gastric atrophy 나 PPI 장기 복용 중에서도 나타나므로 AIG의 histopathologic marker로 보기는 의문이다.

- PPM (Pseudopyloric metaplasia): a benign, regenerative adaptation to gastric mucosal injuries including autoimmune and Hp -induced gastritis 으로 나타나는 histopathologic findings이며 adaptive 과정에서 Intestinal metaplasia로 진행 되는데, incomplete transition 되면 cancerization의 preneoplatic 병변으로 간주된다. 또한, PPM은 neoplastic progression을 보호하기 위한 과정이며, neoplastic progressiond은 IM과 연관성이 있다. 이번 Rugge 연구에서는 early stage AIG가 25% 포함되어 있었고, PPM score (95%)가 IM (76%) 보다 높았다.

- Corpus-restricted atrophy: Chronic Hp gastritis may show a pyloro-cardial extension and, over time, progression of corpus atrophic lesions may be associated with antral mucosa healing, possibly ending up as severe corpus restricted atrophic gastritis resembling AIG.

* H. pylori: severe corpus atrophic gastritis에서 Hp의 histopathologic detection은 매우 어려운 일이며, non-invasive tests for diagnosis of Hp infection (urea breath test, stool antigen tests) 또한 유용하지 못하다. 

* PCA: serological hall marks of AIG 이지만, general population의 약 20%에서 양성으로 나올 수 있고, clinical suspicion of corpus atrophic gastritis 에서 specificity와 sensitivity는 88~77% 정도 이다. 


* Conclusion

(1) Clearly defined and universally shared diagnostic criteria for AIG are urgently needed, as corpus-restricted atrophy, PCA positivity, and/or Hp-negativity with the commonly available tests may be insufficient to accurately diagnose AIG.

(2) Clear-cut criteria to assess or to rule out Hp in corpus restricted atrophic gastritis should be defined (including histopathology, accurate personal history of previous eradication treatment, serology and/or other tests).


... Definition is not everything, but everything involves definition (Jan Aart Scholte) ...



0 0


대한자가면역성위염연구회

주소 : 경기도 용인시 기흥구 중부대로 579, 508-23호

대표전화 : 070-8080-0453

이메일 : autogastritis@gmail.com 


Copyright (c)대한자가면역성위염연구회. All Rights Reserved.

Design Hosting By 위멘토.


대한자가면역성위염연구회

주소 : 경기도 용인시 기흥구 중부대로 579, 508-23호 (구갈동, 강남대프라자)

대표전화 : 070-8080-0453  이메일 : autogastritis@gmail.com 


Copyright (c)대한자가면역성위염연구회. All Rights Reserved. Design Hosting By 위멘토.