Defective spleen function in autoimmune gastrointestinal disorders

  • Paolo Giuffrida
  • Nicola Aronico
  • Matteo Rosselli
  • Marco Vincenzo Lenti
  • Sara Cococcia
  • Davide Roccarina
  • Francesca Saffioti
  • Mariangela Delliponti
  • Douglas Thorburn
  • Emanuela Miceli
  • Gino Roberto Corazza
  • Massimo Pinzani
  • Antonio Di SabatinoEmail author


Defective spleen function increases susceptibility to bacterial infections which can be prevented by vaccine prophylaxis. Splenic hypofunction can be found in a number of autoimmune disorders; however, no data are available regarding autoimmune atrophic gastritis (AAG), autoimmune enteropathy (AIE) and autoimmune liver disease (AILD). Peripheral blood samples from patients with AAG (n = 40), AIE (n = 3) and AILD (n = 40) were collected. Patients affected by autoimmune disorders already known to be associated with splenic hypofunction, i.e. coeliac disease (CD) and ulcerative colitis (UC), were included as disease controls, while splenectomised patients and healthy subjects were evaluated as positive and negative controls, respectively. Counting of erythrocytes with membrane abnormalities, i.e. pitted red cells, was used as an indicator of spleen function (normal upper limit 4%). Defective splenic function was observed in 22 of the 40 patients with AAG (55.0%), in two of the three patients with AIE (66.6%) and in 35 of the 40 patients with AILD (87.5%). As expected, in untreated CD, refractory CD and UC there was a high prevalence of hyposplenism (43.7%, 88.2% and 54.4%, respectively). Due to the high prevalence of splenic hypofunction, patients with AAG, AILD and AIE should undergo pitted red cell evaluation and, if hyposplenic, they should be candidate to vaccine prophylaxis against encapsulated bacteria.


Autoimmune atrophic gastritis Autoimmune enteropathy Autoimmune liver disease Coeliac disease Pitted red cell Ulcerative colitis 



Autoimmune atrophic gastritis


Autoimmune enteropathy


Autoimmune hepatitis


Autoimmune liver disease


Coeliac disease


Primary biliary cholangitis


Primary sclerosing cholangitis


Refractory coeliac disease


Ulcerative colitis



The authors would like to thank all the subjects who agreed to give blood samples, without whom this study would not have been possible.

Author contributions

All authors participated in the drafting of the manuscript or critical revision of the manuscript for important intellectual content and provided approval of the final submitted version. Individual contributions are as follows. ADS: study concept and design, analysis and interpretation of data, manuscript preparation, principal investigator, and guarantor. PG, MVL: study concept and design, acquisition of data, technical and material support, manuscript preparation. NA: acquisition of data, technical and material support, manuscript preparation. SC and MD: acquisition of data, technical and material support. MR, DR, FS, DT and EM: clinical management of patients. GRC, MP, and ADS: study supervision.



Compliance with ethical standards

Conflicts of interest

None to declare.

Statement of human and animal rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Each patient provided informed consent to the study.


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Copyright information

© Società Italiana di Medicina Interna (SIMI) 2019

Authors and Affiliations

  • Paolo Giuffrida
    • 1
  • Nicola Aronico
    • 1
  • Matteo Rosselli
    • 2
  • Marco Vincenzo Lenti
    • 1
  • Sara Cococcia
    • 1
  • Davide Roccarina
    • 2
  • Francesca Saffioti
    • 2
  • Mariangela Delliponti
    • 1
  • Douglas Thorburn
    • 2
  • Emanuela Miceli
    • 1
  • Gino Roberto Corazza
    • 1
  • Massimo Pinzani
    • 2
  • Antonio Di Sabatino
    • 1
    Email author
  1. 1.First Department of Internal MedicineSan Matteo Hospital Foundation, University of PaviaPaviaItaly
  2. 2.Institute for Liver and Digestive HealthRoyal Free Hospital, University College LondonLondonUK

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