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Autoimmune gastritis

  • Primer
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From Nature Reviews Disease Primers

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Abstract

Autoimmune gastritis (AIG) is an increasingly prevalent, organ-specific, immune-mediated disorder characterized by the destruction of gastric parietal cells, leading to the loss of intrinsic factor and reduced acid output. These alterations result in malabsorption of iron, vitamin B12 (pernicious anaemia) and potentially other micronutrients. For several years, most studies have focused on pernicious anaemia only, generating confusion between the two entities. In AIG, the gastric proton pump, H+/K+ ATPase, is the major autoantigen recognized by autoreactive T cells. The T cell-dependent activation of B cells stimulates the production of anti-parietal cell antibodies, the serological hallmark of AIG. The role of Helicobacter pylori infection in activating or favouring the autoimmune process is still uncertain. Early histopathological alterations allowing a more precise and prompt recognition have recently been described. AIG is burdened by a substantial diagnostic delay as it can present with varied clinical signs including, among others, gastrointestinal symptoms and neuropsychiatric manifestations. In advanced stages, AIG might progress to neuroendocrine tumours and gastric adenocarcinoma. Management includes early detection through a proactive case-finding strategy, micronutrient supplementation and endoscopic surveillance. This Primer comprehensively describes the most important insights regarding the epidemiology, pathophysiology, diagnosis and management of AIG, focusing on the most controversial, outstanding issues and future directions.

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Fig. 1: Anatomical localization of AIG.
Fig. 2: Summary of classifications of gastritis.
Fig. 3: Pathogenetic mechanisms of AIG.
Fig. 4: Endoscopic images of the stomach.
Fig. 5: Histopathological spectrum of AIG.

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Acknowledgements

M.V.L. thanks the University of Pavia for supporting his research projects. The authors thank A. Vanoli and F. Capuano (both at IRCCS San Matteo Hospital Foundation, University of Pavia) for providing histopathological images of the gastric neuroendocrine tumour.

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Authors and Affiliations

  1. Department of Internal Medicine, IRCCS San Matteo Hospital Foundation, University of Pavia, Pavia, Italy

    Marco Vincenzo Lenti, Emanuela Miceli & Antonio Di Sabatino

  2. Department of Medicine (DIMED), Surgical Pathology & Cytopathology Unit, University of Padua, Padua, Italy

    Massimo Rugge

  3. Department of Surgical-Medical Sciences and Translational Medicine, Digestive and Liver Disease Unit, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy

    Edith Lahner

  4. Centre for Inflammatory Diseases, Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia

    Ban-Hock Toh

  5. Department of Medicine, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, Texas, USA

    Robert M. Genta

  6. Department of Endocrinology, Diabetology and Metabolism, Faculty of Medicine, Antwerp University Hospital and University of Antwerp, Antwerpen, Belgium

    Christophe De Block

  7. Department of Hematology, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel

    Chaim Hershko

  8. Hematology Clinic and Central Clinical Laboratories, Clalit Health Services, Jerusalem, Israel

    Chaim Hershko

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  1. Marco Vincenzo Lenti
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Contributions

Introduction (M.V.L. and E.L.); Epidemiology (C.D.B. and E.L.); Mechanisms/pathophysiology (M.V.L., B.-H.T. and A.D.S.); Diagnosis, screening and prevention (M.R., R.M.G., B.-H.T., A.D.S. and M.V.L.); Management (C.H., E.L. and E.M.); Quality of life (E.M., C.D.B. and M.V.L.); Outlook (M.V.L. and A.D.S.); Overview of Primer (M.V.L. and A.D.S.). All authors participated in drafting the manuscript or critical revision of the manuscript for important intellectual content and provided approval of the final submitted version.

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Correspondence to Antonio Di Sabatino.

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Nature Reviews Disease Primers thanks C. Gasche, P. Malfertheiner, K. Sugano, M. Vieth and the other, anonymous, reviewer(s) for their contribution to the peer review of this work.

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Glossary

Metaplasia

The transformation of a specific cell type into another mature cell type.

Canaliculi

Secretory channels through which hydrochloric acid is actively transported.

Macro-ovalocytes

Abnormally large red blood cells.

Anisocytosis

The co-presence of erythrocytes of different sizes in the peripheral blood.

Hyper-segmented neutrophils

Neutrophils presenting more than three nuclear segments.

Pancytopenia

Low levels of haemoglobin, platelets and white blood cells in the peripheral blood.

Mean corpuscular volume

The mean volume of erythrocytes in the peripheral blood.

Paraesthesia

An abnormal sensation that may include a burning, tingling or prickling.

Proprioception

The sense of position and movement of the body.

Ataxia

A condition causing abnormal body movements and loss of coordination.

Hyperhomocysteinaemia

Increased serum levels of homocysteine.

Hyperplastic polyps

A type of polyp characterized by little malignant potential.

Chromoendoscopy

An endoscopic technique that uses specific stains (both electronic and dyes) for highlighting mucosal lesions.

Narrow-band imaging

An imaging technique used during endoscopic examinations in which only two wavelengths can be visualized, namely blue light and green light.

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Lenti, M.V., Rugge, M., Lahner, E. et al. Autoimmune gastritis. Nat Rev Dis Primers 6, 56 (2020). https://doi.org/10.1038/s41572-020-0187-8

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