Am J Gastroenterol. 2024 Jul 5. doi: 10.14309/ajg.0000000000002948.
Italy의 AIG 연구 그룹인 the Autoimmune gastRitis Italian netwOrk Study grOup (ARIOSO)에서 약 1600명의 AIG 환자들의 임상적 특징을 정리하여 발표한 내용입니다. 살펴 보겠습니다.
지난 10년 간 AIG의 많은 역학적, 병태생리학적, 임상적 측면이 밝혀졌음에도 불구하고, 아직도 다각적인 임상 양상에 대해서는 많은 불확실성이 존재합니다. (Helicobacter pylori infection의 역할, anti-parietal cell antibody (PCA)-positive 및 -negative AIG의 차이, risk of developing type 1 gastric neuroendocrine neoplasms (gNENs) and gastric adenocarcinoma over time 등)
Figure 1. Kaplan Meier gastric neuroendocrine neoplasm (gNEN)-free survival estimate curves by H. pylori (HP; A) and anti-parietal cell antibody (PCA; B) status. No statistically significant differences were noticed in both cases.
Figure 2. Schematic representation of all the possible clinical scenarios of AIG presentation depending on the H. pylori and anti-parietal cell antibody (PCA) status. Our data corroborated the idea of different pathogenetic pathways, one which is unrelated to H. pylori, and the other one related to the infection. In the former case, patients display typical features of an autoimmune disorder, while in the latter case patients have different characteristics. Created with BioRender.com.
Table 1. Sociodemographic characteristics and baseline autoimmune gastritis staging of the 1598 included patients.
Table 2. Prevalence of the clinical characteristics at the time of diagnosis in patients with autoimmune gastritis (AIG).
Table 3. Comparison of the main sociodemographic, laboratory, and clinical characteristics depending on the H. pylori infection status.
Table 4. Comparison of sociodemographic, laboratory, and clinical characteristics depending on serum anti-parietal cell antibody (PCA) status.
Table 5. Cox multivariable analysis looking at the hazard ratio (HR) of neuroendocrine neoplasms after adjustment for potential confounders.
To conclude, this study shows that AIG is probably unrelated to H. pylori when presenting with clear and typically autoimmune features. In a tertiary referral setting, the risk of developing overt gastric adenocarcinoma is low, but could possibly be higher in other settings, and patients with vitamin B12 deficiency complications at onset may benefit from a more intense endoscopic follow-up for early gNEN detection. Further international, prospective, multicenter studies, also encompassing the primary care, non-specialty settings, and control groups, are needed to corroborate and to generalize our findings, with particular regard to the risk of developing gastric malignancies.
Study Highlights
WHAT IS CURRENT KNOWLEDGE
Autoimmune gastritis (AIG) is a chronic form of gastritis with uncertain pathogenesis and natural history
Data regarding the risk of developing gastric adenocarcinoma or neuroendocrine tumors in AIG, and potential differences between H. pylori-exposed and -naïve and anti-parietal cell antibody (PCA)-positive and -negative patients are lacking
WHAT IS NEW HERE
The rate of gastric adenocarcinoma and neuroendocrine neoplasms were 0.12 and 1.22 per 100 person/year, respectively
PCA-positive patients were more likely to have an associated autoimmune disease, while H. pylori-naïve patients were more likely to have a first-degree family history of AIG, type 1 diabetes mellitus, and pernicious anemia
Having an overt clinical manifestation related to vitamin B12/iron deficiency at onset was related to a 16.44 hazard ratio of developing a neuroendocrine neoplasm.
<Abstract>
Objectives: To describe the clinical features and the risk of developing gastric tumors in patients with autoimmune gastritis (AIG).
Methods: This was a retrospective, longitudinal, multicenter study conducted at eight Italian tertiary referral centers. We retrieved clinical data from all histologically proven AIG patients. Differences between H. pylori-exposed vs H. pylori-naïve, and anti-parietal cell antibody (PCA)-positive vs PCA-negative patients were investigated. The rate of gastric adenocarcinoma and type 1 gastric neuroendocrine neoplasm (gNEN) was assessed. A multivariable model for factors associated to gNEN was fitted.
Results: 1598 patients with AIG (median age 58 years, IQR 46-68; F:M ratio 2.7:1) were included. H. pylori-naïve patients were more likely to have a first-degree family history of AIG (14.7% vs 8.9%; p=0.012), type 1 diabetes mellitus (4.9% vs 2.3%; p=0.025), and pernicious anemia (30.9% vs 21.1%; p=0.003). PCA-positive patients had significantly more associated autoimmune diseases (59.0% vs 42.9%; p<0.001) and were more likely to have been diagnosed by a case-finding strategy (15.3% vs 2.6%; p<0.001). Overall, 15 cases (0.9%) of gastric adenocarcinoma and 153 cases (9.6%) of gNEN occurred, with a global rate of 0.12 (95% CI 0.07-0.20) and 1.22 (95% CI 1.03-1.42) per 100 person/year, respectively. Having a vitamin B12/iron deficiency manifestation at AIG diagnosis was associated with an 16.44 (95% CI 9.94-27.20 p<0.001) hazard ratio of gNEN.
Conclusions: The “pure” AIG pattern has typical features of an autoimmune disease and seems to be unrelated to H. pylori. In a tertiary referral setting, the risk of developing overt gastric adenocarcinoma is low, while patients with vitamin B12 deficiency complications at onset may benefit from a more intense endoscopic follow-up for early gNEN detection.
Keywords: anemia; gastric atrophy; gastric adenocarcinoma; gastric autoimmunity; Helicobacter pylori; neuroendocrine neoplasm; vitamin B12
Am J Gastroenterol. 2024 Jul 5. doi: 10.14309/ajg.0000000000002948.
Italy의 AIG 연구 그룹인 the Autoimmune gastRitis Italian netwOrk Study grOup (ARIOSO)에서 약 1600명의 AIG 환자들의 임상적 특징을 정리하여 발표한 내용입니다. 살펴 보겠습니다.
지난 10년 간 AIG의 많은 역학적, 병태생리학적, 임상적 측면이 밝혀졌음에도 불구하고, 아직도 다각적인 임상 양상에 대해서는 많은 불확실성이 존재합니다. (Helicobacter pylori infection의 역할, anti-parietal cell antibody (PCA)-positive 및 -negative AIG의 차이, risk of developing type 1 gastric neuroendocrine neoplasms (gNENs) and gastric adenocarcinoma over time 등)
Figure 1. Kaplan Meier gastric neuroendocrine neoplasm (gNEN)-free survival estimate curves by H. pylori (HP; A) and anti-parietal cell antibody (PCA; B) status. No statistically significant differences were noticed in both cases.
Figure 2. Schematic representation of all the possible clinical scenarios of AIG presentation depending on the H. pylori and anti-parietal cell antibody (PCA) status. Our data corroborated the idea of different pathogenetic pathways, one which is unrelated to H. pylori, and the other one related to the infection. In the former case, patients display typical features of an autoimmune disorder, while in the latter case patients have different characteristics. Created with BioRender.com.
Table 1. Sociodemographic characteristics and baseline autoimmune gastritis staging of the 1598 included patients.
Table 2. Prevalence of the clinical characteristics at the time of diagnosis in patients with autoimmune gastritis (AIG).
Table 3. Comparison of the main sociodemographic, laboratory, and clinical characteristics depending on the H. pylori infection status.
Table 4. Comparison of sociodemographic, laboratory, and clinical characteristics depending on serum anti-parietal cell antibody (PCA) status.
Table 5. Cox multivariable analysis looking at the hazard ratio (HR) of neuroendocrine neoplasms after adjustment for potential confounders.
To conclude, this study shows that AIG is probably unrelated to H. pylori when presenting with clear and typically autoimmune features. In a tertiary referral setting, the risk of developing overt gastric adenocarcinoma is low, but could possibly be higher in other settings, and patients with vitamin B12 deficiency complications at onset may benefit from a more intense endoscopic follow-up for early gNEN detection. Further international, prospective, multicenter studies, also encompassing the primary care, non-specialty settings, and control groups, are needed to corroborate and to generalize our findings, with particular regard to the risk of developing gastric malignancies.
Study Highlights
WHAT IS CURRENT KNOWLEDGE
Autoimmune gastritis (AIG) is a chronic form of gastritis with uncertain pathogenesis and natural history
Data regarding the risk of developing gastric adenocarcinoma or neuroendocrine tumors in AIG, and potential differences between H. pylori-exposed and -naïve and anti-parietal cell antibody (PCA)-positive and -negative patients are lacking
WHAT IS NEW HERE
The rate of gastric adenocarcinoma and neuroendocrine neoplasms were 0.12 and 1.22 per 100 person/year, respectively
PCA-positive patients were more likely to have an associated autoimmune disease, while H. pylori-naïve patients were more likely to have a first-degree family history of AIG, type 1 diabetes mellitus, and pernicious anemia
Having an overt clinical manifestation related to vitamin B12/iron deficiency at onset was related to a 16.44 hazard ratio of developing a neuroendocrine neoplasm.
<Abstract>
Objectives: To describe the clinical features and the risk of developing gastric tumors in patients with autoimmune gastritis (AIG).
Methods: This was a retrospective, longitudinal, multicenter study conducted at eight Italian tertiary referral centers. We retrieved clinical data from all histologically proven AIG patients. Differences between H. pylori-exposed vs H. pylori-naïve, and anti-parietal cell antibody (PCA)-positive vs PCA-negative patients were investigated. The rate of gastric adenocarcinoma and type 1 gastric neuroendocrine neoplasm (gNEN) was assessed. A multivariable model for factors associated to gNEN was fitted.
Results: 1598 patients with AIG (median age 58 years, IQR 46-68; F:M ratio 2.7:1) were included. H. pylori-naïve patients were more likely to have a first-degree family history of AIG (14.7% vs 8.9%; p=0.012), type 1 diabetes mellitus (4.9% vs 2.3%; p=0.025), and pernicious anemia (30.9% vs 21.1%; p=0.003). PCA-positive patients had significantly more associated autoimmune diseases (59.0% vs 42.9%; p<0.001) and were more likely to have been diagnosed by a case-finding strategy (15.3% vs 2.6%; p<0.001). Overall, 15 cases (0.9%) of gastric adenocarcinoma and 153 cases (9.6%) of gNEN occurred, with a global rate of 0.12 (95% CI 0.07-0.20) and 1.22 (95% CI 1.03-1.42) per 100 person/year, respectively. Having a vitamin B12/iron deficiency manifestation at AIG diagnosis was associated with an 16.44 (95% CI 9.94-27.20 p<0.001) hazard ratio of gNEN.
Conclusions: The “pure” AIG pattern has typical features of an autoimmune disease and seems to be unrelated to H. pylori. In a tertiary referral setting, the risk of developing overt gastric adenocarcinoma is low, while patients with vitamin B12 deficiency complications at onset may benefit from a more intense endoscopic follow-up for early gNEN detection.
Keywords: anemia; gastric atrophy; gastric adenocarcinoma; gastric autoimmunity; Helicobacter pylori; neuroendocrine neoplasm; vitamin B12