Kamada T1*, Haruma K2, Suehiro M2, Sunago A1, Manabe N3, Inoue K4, Kawamoto H2, Monobe Y5 and Takao T1
1Department of Health Care Medicine, Kawasaki Medical School, Japan
2Department of General Internal Medicine 2, Kawasaki Medical School, Japan
3Division of Endoscopy and Ultrasonography, Department of Clinical Pathology and Laboratory Medicine,
Kawasaki Medical School, Japan
4Health Care Center, Junpukai, Japan
5Department of Pathology, Kawasaki Medical School, Japan
Objective: Recent reports indicate that the prevalence of Autoimmune Gastritis (AIG) is increasing among patients with atrophic gastritis. The aim of our study was to investigate the prevalence and clinical characteristics of AIG in patients with Severe Atrophic Gastritis (SAG). Methods: Endoscopic mucosal atrophy was evaluated using the Kimura-Takemoto classification. AIG was defined as 1) endoscopic SAG of the corpus, 2) hypergastrinemia (≥ 250 pg/mL), and 3) presence of anti-parietal cell antibody (PCA) (titer ≥ 20-fold) or intrinsic factor antibody (IFA). Anti- H. pylori IgG antibody, gastrin, and pepsinogen levels were also determined. Patients: We prospectively enrolled 30 patients (19 men, mean age 62.5 years) with endoscopic SAG who underwent gastrointestinal endoscopy. Results: AIG was diagnosed in 3 out of 30 cases (10.0%) (Kimura-Takemoto classification: O-III: 22.2% [2/9] and O-II: 4.8% [1/21]). In the 3 AIG cases, the positivity rates were 100%, 33.3%, and 33.3% for PCA, IFA expression, and H. pylori infection, respectively. The mean gastrin level was significantly higher in the AIG group than in the non-AIG group (1064.7 ± 456.6 pg/mL vs. 147.6 ± 28.9 pg/mL, p<0.0001), whereas the mean pepsinogen I/II ratio was significantly lower in the AIG group (0.87 ± 0.22 vs. 3.75 ± 0.23, p=0.0003). Conclusion: Endoscopic examiners should consider the presence of AIG in patients with SAG. The titer of PCA and serum levels of gastrin and pepsinogen I/II ratio are useful diagnostic markers of AIG. This study was registered as UMIN000032192.
Kamada T, Haruma K, Suehiro M, Manabe N, Inoue K, Kawamoto H, et al. Prevalence and Clinical Characteristics of Autoimmune Gastritis in Patients with Severe Atrophic Gastritis. Clin Surg. 2020; 5: 2913.