Chronic Autoimmune Gastritis: Modern Diagnostic Principles
Abstract
:1. Introduction
1.1. Risk Factors
1.2. Clinical Manifestation
1.3. Gastrointestinal Symptoms
1.4. Vitamin B12 (Cobalamin) Deficiency
1.5. Iron Deficiency
1.6. Concomitant Diseases (Comorbidity)
2. Diagnostic Approaches
2.1. Laboratory Methods
2.2. Endoscopic Examination
2.3. Morphological Examination
- Simple diffuse hyperplasia. This is characterized by a more than two-fold increase in the population of ECL cells. Diagnosis is difficult due to the lack of clear quantitative criteria. The diagnosis is poorly reproduced on biopsy material.
- Linear hyperplasia. The presence in one visual field of at least two groups of linearly located neuroendocrine cells, consisting of five or more cells. Usually, changes are diagnosed in the area of the neck glands (Figure 4).
- Micronodular hyperplasia. The presence of the cells’ cluster in contact with the basement membrane, but not exceeding the diameter of the gland, up to 150 μm in diameter, or a similar cluster located freely in the lamina propria of the mucous membrane.
- Adenomatous (adenomatoid) hyperplasia. The presence of an aggregate of five or more clusters (Figure 5).
- Neuroendocrine cells dysplasia. Merging clusters with diameters of more than 150 µm but less than 500 µm.
3. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Hematological Manifestations |
|
Gastroenterological Manifestations |
|
Psychoneurological Manifestations |
|
Micronutrient | Development Frequency | Development Mechanisms | Manifestations |
---|---|---|---|
Vitamin B12 | 37–69% | Decreased production of intrinsic Castle’s factor by parietal cells of the gastric body and decreased absorption of vitamin B12 in the ileum | Hematological, gastroenterological, neuropsychiatric disorders |
Iron | 52% | The presence of erosive lesions of the mucous membrane and possible latent blood loss, concomitant infection with H. pylori and bacteria competition for dietary iron, hypochlorhydria, and increased hepcidin synthesis against a background of a concomitant inflammatory process | Microcytic anemia |
Vitamin C | Unknown | Breakdown of ascorbic acid in the stomach due to increased pH (hypo-, achlorhydria) and concomitant bacterial overgrowth in the small intestine | Decreased antioxidant defense, immunity, and protein synthesis |
Calcium | Unknown | Dissolution, ionization, and absorption of calcium salts decrease under conditions of hypo-, achlorhydria | Osteopenia/Osteoporosis |
Vitamin D | 12.1% | Not determined | Secondary hyperparathyroidism, osteopenia/osteoporosis, decreased immunity, increased risk of autoimmune disease development |
Disease | Association Degree |
---|---|
Autoimmune thyroiditis (Hashimoto’s thyroiditis) and Graves’ disease | ++++ (multiple cohort studies, two crossover studies, and two case–control studies) |
Type 1 diabetes mellitus | +++ (one case–control study and several cohort studies) |
Vitiligo | ++ (one cohort study and several clinical observations) |
Alopecia | ++ (several cohort studies) |
Celiac disease | ++ (several cohort studies) |
Myasthenia gravis | + (single clinical observations) |
Connective tissue disease | ++ (one cohort study and several clinical observations) |
Primary biliary cholangitis | ++ (one cohort study and several clinical observations) |
Primary sclerosing cholangitis | + (single clinical observations) |
Autoimmune hepatitis | + (single clinical observations) |
Addison’s disease | + (single clinical observations) |
Primary ovarian insufficiency | + (single clinical observations) |
Primary hypoparathyroidism | + (single clinical observations) |
Lambert-Eaton syndrome | + (single clinical observations) |
Oral lichen planus | + (single clinical observations) |
Indicant | Value | Comments |
---|---|---|
Antibodies to parietal cells | ↑ | They are found in 80–90% of patients with CAG, but they can also be present in 7.8–19.5% of healthy adults, as well as in people infected with HP or with other autoimmune diseases. They may not be determined in the later stages of the disease, as atrophy of the gastric mucosa progresses. |
Antibodies to the intrinsic Castle’s factor | ↑ | Specificity—98.6%, sensitivity—30–60%. They correlate with atrophy of the gastric mucosa. |
Pepsinogen I | ↓ | It is produced by the main cells of the stomach’s body. A decrease in the indicator shows the presence of atrophy in the mucous membrane of the stomach’s body. Serum level decreases in proportion to the severity of atrophy. |
Pepsinogen II | Not changed | It is produced mainly in the stomach’s antrum and duodenum; therefore, it does not change with CAG. |
Pepsinogen I/Pepsinogen II | ↓ | They decrease linearly with increasing severity of atrophy of the stomach’s body glands. |
Gastrin-17 | ↑ | It is produced by gastrin-producing cells of the stomach’s antrum. With a decrease in acid production against the background of the stomach’s body glands atrophy, it increases by the mechanism of a negative feedback loop. |
Chromogranin A | ↑ | It correlates with the degree of ECL cell hyperplasia under conditions of hypo- and achlorhydria. Due to the low sensitivity and specificity, its widespread use in routine practice is limited. |
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Livzan, M.A.; Gaus, O.V.; Mozgovoi, S.I.; Bordin, D.S. Chronic Autoimmune Gastritis: Modern Diagnostic Principles. Diagnostics 2021, 11, 2113. https://doi.org/10.3390/diagnostics11112113
Livzan MA, Gaus OV, Mozgovoi SI, Bordin DS. Chronic Autoimmune Gastritis: Modern Diagnostic Principles. Diagnostics. 2021; 11(11):2113. https://doi.org/10.3390/diagnostics11112113
Chicago/Turabian StyleLivzan, Maria A., Olga V. Gaus, Sergei I. Mozgovoi, and Dmitry S. Bordin. 2021. "Chronic Autoimmune Gastritis: Modern Diagnostic Principles" Diagnostics 11, no. 11: 2113. https://doi.org/10.3390/diagnostics11112113
APA StyleLivzan, M. A., Gaus, O. V., Mozgovoi, S. I., & Bordin, D. S. (2021). Chronic Autoimmune Gastritis: Modern Diagnostic Principles. Diagnostics, 11(11), 2113. https://doi.org/10.3390/diagnostics11112113