2023년 1월, 일본에서 AIG의 진단에 대한 cirteria를 J Gastroenterol에 발표하였습니다. 내용은 최근까지 발표된 내용들을 정리한 것으로 간단하게 정리하자면, serologic autoantibody test (APCA or AIFA)를 바탕으로 내시경과 조직학적 소견 등을 종합하여 진단을 해야 하며, 특히 early stage AIG 진단을 위한 autoantibody 검사가 꼭 필요하다는 것입니다. 내용을 살펴 보도록 하겠습니다.
Table 1. Differences in diagnostic criteria for autoimmune gastritis between Japan and some other countries
Table 2. Diagnostic criteria for autoimmune gastritis
Table 3. Histological stage classification and histological features of autoimmune gastritis
Figure 1. Endoscopic findings of advanced AIG (primary findings). Absent or mild antral atrophy, severe atrophy predominantly in the corpus (uniform mucosal blood vessels are visible), and no atrophic border. (a) Antral area. (b) Greater curvature of the corpus
Figure 2. Endoscopic findings of advanced AIG (secondary findings). Sticky adherent dense mucus and residual fundic gland mucosa may be found in the corpus. (a) Sticky adherent dense mucus. (b) Remnant oxyntic mucosa (pseudopolyp-like)
Figure 3. Mucosal findings of AIG (secondary findings) in the antral area. (a) Patchy redness. (b) Red streaks. (c) Circular wrinkle-like pattern
Figure 4. Endoscopic findings of early-stage AIG. Reddened and mildly edematous gastric pits are diffusely observed in the corporal mucosa without RAC despite the absence of H. pylori infection. The folds of the greater curvature of the corpus are preserved. (a) Greater curvature of the antral area. (b) Gastric body (observation looking upward). (c) Gastric body (observation looking downward)
Figure 5. Histological features of early stage (greater curvature of the corpus). (a) The fundic gland mucosal structure that is almost similar to normal is preserved, although there is the elongation of the gastric pit (ratio of the gastric pit length to the gastric gland length: 1.0:1.8), and there is moderate chronic inflammatory cell infiltration between the fundic glands (stronger in the glandular area than in the gastric pit area). Numerous residual parietal cells exhibit pseudohypertrophy (degenerative swelling and cell protrusion). (HE staining). (b) Intraglandular hyperplasia of the ECL cells is observed (chromogranin A staining)
Figure 6. Histological features of advanced florid stage (greater curvature of the corpus). (a) The normal fundic gland mucosa structure has disappeared, the lengths of the gastric pit and glandular are 0.39 and 0.29 mm, respectively, (ratio: 1.0:0.7), and there is the elongation of the gastric pit and shortening of the gastric gland. The dashed line indicates the boundary between the gastric pit and gastric gland (HE staining). (b) Intraglandular linear hyperplasia of the ECL cells is observed (chromogranin A staining)
Figure 7. Histological features of advanced end stage (greater curvature of the corpus). (a) The normal fundic gland mucosa structure has disappeared, intestinal metaplasia has become severe, and a small amount of the pyloric gland mucosa remains at the center of this photo. The gastric pit length/the gastric gland duct length ratio is 0.34/ 0.08 mm (ratio: 4.2:1.0). (HE staining). (b) Intraglandular ECL cell hyperplasia has become clear. (chromogranin A staining)
Conclusions
AIG diagnosis is significant for classifying patients into high-risk groups for gastric tumors, such as gastric cancer and NETs, and pernicious anemia, as well as for conducting regular surveillance. Our study group’s newly proposed diagnostic criteria in this article are expected to decrease the rate of underdiagnosis of AIG and promote the detection of early-stage AIG. Furthermore, the criteria can act as a framework for determining appropriate medical care. Urgent issues requiring resolution include establishing the endoscopic findings of early-stage AIG obtaining national health insurance coverage in Japan for gastric autoantibody tests.
Abstract
The Japanese diagnostic criteria for autoimmune gastritis (AIG) were established by the ‘‘Study Group on the establishment of diagnostic criteria for type A gastritis,’’ which is related to a workshop associated with the Japan Gastroenterological Endoscopy Society (JGES) and the Committee of AIG Research Group (CARP). The criteria were set as follows: the cases of confirmed diagnosis are patients in whom either the endoscopic or histological findings, or both, meet the requirements for AIG and who are confirmed to be positive for gastric autoantibodies (either anti-parietal cell or anti-intrinsic factor antibodies, or both). The presentation of endoscopic findings of early stage AIG in the diagnostic criteria was withheld owing to the need for further accumulation and characterization of endoscopic clinical data. Therefore, diagnosis of early-stage AIG only requires histological confirmation and gastric autoantibody positivity. Suspected cases are patients in whom either the endoscopic or histological findings, or both, meet only the requirements for AIG. Histological findings only meet the requirements for early-stage. AIG has been underdiagnosed in the past, but our study group’s newly proposed diagnostic criteria will enable a more accurate and early diagnosis of AIG. The criteria can be used to stratify patients into various high risk groups for gastric tumors and pernicious anemia. They would allow the establishment of an appropriate surveillance system in the coming years. Nevertheless, issues such as establishing the endoscopic findings of early-stage AIG and obtaining Japanese insurance coverage for gastric autoantibody tests require attention.
2023년 1월, 일본에서 AIG의 진단에 대한 cirteria를 J Gastroenterol에 발표하였습니다. 내용은 최근까지 발표된 내용들을 정리한 것으로 간단하게 정리하자면, serologic autoantibody test (APCA or AIFA)를 바탕으로 내시경과 조직학적 소견 등을 종합하여 진단을 해야 하며, 특히 early stage AIG 진단을 위한 autoantibody 검사가 꼭 필요하다는 것입니다. 내용을 살펴 보도록 하겠습니다.
Table 1. Differences in diagnostic criteria for autoimmune gastritis between Japan and some other countries
Table 2. Diagnostic criteria for autoimmune gastritis
Table 3. Histological stage classification and histological features of autoimmune gastritis
Figure 1. Endoscopic findings of advanced AIG (primary findings). Absent or mild antral atrophy, severe atrophy predominantly in the corpus (uniform mucosal blood vessels are visible), and no atrophic border. (a) Antral area. (b) Greater curvature of the corpus
Figure 2. Endoscopic findings of advanced AIG (secondary findings). Sticky adherent dense mucus and residual fundic gland mucosa may be found in the corpus. (a) Sticky adherent dense mucus. (b) Remnant oxyntic mucosa (pseudopolyp-like)
Figure 3. Mucosal findings of AIG (secondary findings) in the antral area. (a) Patchy redness. (b) Red streaks. (c) Circular wrinkle-like pattern
Figure 4. Endoscopic findings of early-stage AIG. Reddened and mildly edematous gastric pits are diffusely observed in the corporal mucosa without RAC despite the absence of H. pylori infection. The folds of the greater curvature of the corpus are preserved. (a) Greater curvature of the antral area. (b) Gastric body (observation looking upward). (c) Gastric body (observation looking downward)
Figure 5. Histological features of early stage (greater curvature of the corpus). (a) The fundic gland mucosal structure that is almost similar to normal is preserved, although there is the elongation of the gastric pit (ratio of the gastric pit length to the gastric gland length: 1.0:1.8), and there is moderate chronic inflammatory cell infiltration between the fundic glands (stronger in the glandular area than in the gastric pit area). Numerous residual parietal cells exhibit pseudohypertrophy (degenerative swelling and cell protrusion). (HE staining). (b) Intraglandular hyperplasia of the ECL cells is observed (chromogranin A staining)
Figure 6. Histological features of advanced florid stage (greater curvature of the corpus). (a) The normal fundic gland mucosa structure has disappeared, the lengths of the gastric pit and glandular are 0.39 and 0.29 mm, respectively, (ratio: 1.0:0.7), and there is the elongation of the gastric pit and shortening of the gastric gland. The dashed line indicates the boundary between the gastric pit and gastric gland (HE staining). (b) Intraglandular linear hyperplasia of the ECL cells is observed (chromogranin A staining)
Figure 7. Histological features of advanced end stage (greater curvature of the corpus). (a) The normal fundic gland mucosa structure has disappeared, intestinal metaplasia has become severe, and a small amount of the pyloric gland mucosa remains at the center of this photo. The gastric pit length/the gastric gland duct length ratio is 0.34/ 0.08 mm (ratio: 4.2:1.0). (HE staining). (b) Intraglandular ECL cell hyperplasia has become clear. (chromogranin A staining)
Conclusions
AIG diagnosis is significant for classifying patients into high-risk groups for gastric tumors, such as gastric cancer and NETs, and pernicious anemia, as well as for conducting regular surveillance. Our study group’s newly proposed diagnostic criteria in this article are expected to decrease the rate of underdiagnosis of AIG and promote the detection of early-stage AIG. Furthermore, the criteria can act as a framework for determining appropriate medical care. Urgent issues requiring resolution include establishing the endoscopic findings of early-stage AIG obtaining national health insurance coverage in Japan for gastric autoantibody tests.
Abstract
The Japanese diagnostic criteria for autoimmune gastritis (AIG) were established by the ‘‘Study Group on the establishment of diagnostic criteria for type A gastritis,’’ which is related to a workshop associated with the Japan Gastroenterological Endoscopy Society (JGES) and the Committee of AIG Research Group (CARP). The criteria were set as follows: the cases of confirmed diagnosis are patients in whom either the endoscopic or histological findings, or both, meet the requirements for AIG and who are confirmed to be positive for gastric autoantibodies (either anti-parietal cell or anti-intrinsic factor antibodies, or both). The presentation of endoscopic findings of early stage AIG in the diagnostic criteria was withheld owing to the need for further accumulation and characterization of endoscopic clinical data. Therefore, diagnosis of early-stage AIG only requires histological confirmation and gastric autoantibody positivity. Suspected cases are patients in whom either the endoscopic or histological findings, or both, meet only the requirements for AIG. Histological findings only meet the requirements for early-stage. AIG has been underdiagnosed in the past, but our study group’s newly proposed diagnostic criteria will enable a more accurate and early diagnosis of AIG. The criteria can be used to stratify patients into various high risk groups for gastric tumors and pernicious anemia. They would allow the establishment of an appropriate surveillance system in the coming years. Nevertheless, issues such as establishing the endoscopic findings of early-stage AIG and obtaining Japanese insurance coverage for gastric autoantibody tests require attention.