Associated Diseases A Graves' Disease Patient Diagnosed as Autoimmune Gastritis with Helicobacter pylori Infection

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The Korean Journal of Helicobacter and Upper Gastrointestinal Research 2022;22(4):308-312.

Published online: December 2, 2022 // DOI:

<Case Report>

* 44/Female 

* Graves’ disease (Radio-active Iodine treatment) -> synthroid 0.01mg 

* For evaluation of anemia

* Serologic findings

- Hb: 7.5 g/dL (Hct: 25.1%, MCV: 73.2 fl, MCH: 21.6 pg,  MCHC: 29.5 g/dL)

     Iron 13.0 µg/dL, Ferritin 8.10 ng/mL, TIBC: 371.0 µg/dL, Vitamin B12: 403.0 pg/mL 

- Free T4: 1.32 ng/dL . T3: 1.62 ng/mL, TSH: <0.05 µIU/mL 

     TSH receptor Ab: 2.26 IU/L (0.0~1.22), Anti-TPO Ab: 10.1 IU/mL (0.0~34.0), Anti-thyroglobulin Ab: 13.9 IU/mL (0.0~115.0) 

- PG I: 28.7 ng/mL, PG II: 26.3 ng/mL, PG I/II ratio: 1.1

- Gastrin: 792.0 pg/mL, Anti-H. pylori antibodies: 4.27 U/mL (negative <0.90 U/mL, equivocal 0.90~1.09 U/mL, positive ≥1.10 U/mL) 

- Anti-parietal cell Ab (IFA): positive

* Endoscopic (UBT(+)) & Pathologic findings

 Figure 1. Endoscopic and histopathological findings. Mild atrophic changes are observed in the antral mucosa (A). Extensive atrophic changes with marked submucosal vasculature are observed in the mucosa of the fundus and gastric body (B). Focal disappearance of folds and spotty redness are observed in the greater curvature of the gastric body (C). Mild mucosal destruction accompanied by chronic inflammatory cell infiltration of the lamina propria is observed in the antrum (Hematoxylin and Eosin [H&E] stain, ×100) (D). Mucosal destruction with significant inflammatory cell infiltration of the lamina propria and focal intestinal metaplasia are observed in the gastric body (H&E stain, ×100) (E). Increased numbers of neuroendocrine cells with linear neuroendocrine cell hyperplasia are observed in the body (Chromogranin A stain, ×100) (F). 

* Autoimmune diseases (AD) combined with AIG

* Discussion

- More than 50.0% of patients with AIG may develop AD, and ATD represents the most common comorbidity in approximately >36.0% of patients. 

- AIG should be suspected and serological testing is warranted in patients with ATD accompanied by nutrient deficiencies that show varied clinical presentations, including anemia of unknown etiology. 

- Anemia, serological atrophy, and elevated serum gastrin levels are significant markers for diagnosis of AIG; APCA assays and endoscopic biopsy evaluation should be performed in such cases for definitive diagnosis. 


Autoimmune gastritis (AIG) is a type of atrophic gastritis characterized by destruction of parietal cells in the gastric fundus and body. These changes may be attributable to immune-mediated chronic inflammatory responses. AIG is characterized by extensive atrophy of the gastric body; therefore, endoscopic findings offer useful diagnostic clues. AIG is diagnosed based on serological and histopathological evaluation of endoscopic biopsy specimens; however, this condition may be accompanied by autoimmune diseases including autoimmune thyroid disease (ATD), and the opposite can be suspected. Diagnostic delays and misdiagnosis are common in patients with AIG owing to the nonspecific clinical presentation and accompanying autoimmune diseases. Additionally, confirmation of AIG based on serological atrophy or endoscopic findings is challenging in cases of active Helicobacter pylori (H. pylori) infection. We report a case of Graves’ disease (an ATD) in a patient diagnosed with AIG and concomitant H. pylori-induced gastritis based on the rapid urease and serological test results and endoscopic biopsy findings.

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