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Distinguishing features of autoimmune gastritis depending on previous H. pylori infection or positivity to anti-parietal cell antibodies: results from the Autoimmune gastRitis Italian netwOrk Study grOup (ARIOSO)

2024; Lippincott Williams & Wilkins; Linguagem: Inglês

10.14309/ajg.0000000000002948

1572-0241

Marco Vincenzo Lenti, Emanuela Miceli, Edith Lahner, G. Natalello, Sara Massironi, Annalisa Schiepatti, Fabiana Zingone, V. Sciola, Roberta Rossi, Renato Cannizzaro, Elena Maria De Giorgi, Virginia Gregorio, Erica Fazzino, Antonella Gentile, Clarissa Petrucci, Emanuele Dilaghi, Giulia Pivetta, Alessandro Vanoli, Ombretta Luinetti, Marco Paulli, Andrea Anderloni, M. Vecchi, Federico Biagi, Alessandro Repici, Edoardo Savarino, Shamim Joudaki, Mariangela Delliponti, Alessandra Pasini, Federica Facciotti, Fabio Farinati, Mario Milco D’Elios, Chiara Della Bella, Bruno Annibale, Catherine Klersy, Gino Roberto Corazza, Antonio Di Sabatino,

Celiac Disease Research and Management

INTRODUCTION: 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 8 Italian tertiary referral centers. We retrieved clinical data from all histologically proven patients with AIG. Differences between Helicobacter pylori -exposed vs H. pylori -naive 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 with gNEN was fitted. RESULTS: A total of 1,598 patients with AIG (median age 58 years, interquartile range 46–68; F:M ratio 2.7:1) were included. H. pylori -naive 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% confidence interval [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 a 16.44 (95% CI 9.94–27.20 P < 0.001) hazard ratio of gNEN. DISCUSSION: 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.