Distinguishing Features of Autoimmune Gastritis Depending on Previous Helicobacter pylori Infection or Positivity to Anti-Parietal Cell Antibodies: Results From the Autoimmune gastRitis Italian netwOrk Study grOup (ARIOSO).
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Lenti Marco Vincenzo, Miceli Emanuela, Lahner Edith, Natalello Gabriele, Massironi Sara, Schiepatti Annalisa, Zingone Fabiana, Sciola Valentina, Rossi Roberta Elisa, Cannizzaro Renato, De Giorgi Elena Maria, Gregorio Virginia, Fazzino Erica, Gentile Antonella, Petrucci Clarissa, Dilaghi Emanuele, Pivetta Giulia, Vanoli Alessandro, Luinetti Ombretta, Paulli Marco, Anderloni Andrea, Vecchi Maurizio, Biagi Federico, Repici Alessandro, Savarino Edoardo Vincenzo, Joudaki Shamim, Delliponti Mariangela, Pasini Alessandra, Facciotti Federica, Farinati Fabio, D'Elios Mario Milco, Della Bella Chiara, Annibale Bruno, Klersy Catherine, Corazza Gino Roberto, Di Sabatino Antonio
Аннотация
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.