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Early autoimmune gastritis presenting with a normal endoscopic appearance

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Abstract

This report describes a patient with early-stage autoimmune gastritis (AIG) presenting with a normal endoscopic appearance. A 66-year-old man with autoimmune thyroiditis was suspected of having AIG because of a previous history of vitamin B12 deficiency when receiving steroid therapy for interstitial pneumonia 5 years earlier. At presentation, he tested positive for anti-parietal cell antibody (1:320) and anti-intrinsic factor antibody, but not for vitamin B12 deficiency. His gastrin level was elevated (338 pg/mL), but his pepsinogen (PG) I level (56.1 ng/mL) and PGI/PGII ratio (7.6) were normal. Endoscopically, neither atrophic nor inflammatory changes were observed. Histopathologic examination, however, showed mild atrophic changes with dense lymphocytic infiltration in the deep lamina propria and focal destruction of parietal cells in the greater curvature of the corpus. PGI-positive/MUC6-positive pseudo-pyloric metaplasia was observed in the area from which H+/K+-ATPase-positive parietal cells had disappeared. Chromogranin A immunostaining showed linear hyperplasia of enterochromaffin-like cells. By contrast, atrophic changes were not evident in the lesser curvature of the corpus, except for mild lymphocytic infiltration around and into the fundic glands. These serological and histopathological findings suggested that the patient had early-stage AIG with a normal endoscopic appearance.

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Acknowledgements

We are grateful to Dr. Yuji Shimura (Division of Hematology and Oncology, Kyoto Prefectural University of Medicine), Dr. Yoshiko Kaneko (Department of Pulmonary Medicine, Kyoto Prefectural University of Medicine), Dr. Kazuhiko Uchiyama (Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine), and Dr. Osamu Handa (Division of Gastroenterology, Kawasaki Medical School) for assistance in collecting clinical data. We also would like to thank Bioedit for English language editing.

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Authors and Affiliations

  1. Department of Medical Examination, Uji-Tokushukai Medical Center, Uji, Kyoto, Japan

    Tohru Kotera

  2. Department of Emergency and General Medicine, Uji-Tokushukai Medical Center, Uji, Kyoto, Japan

    Masayoshi Yamanishi

  3. Department of Pathology, Shiga University of Medical Science, Otsu, Shiga, Japan

    Ryoji Kushima

  4. Department of General Internal Medicine 2, Kawasaki Medical School General Medical Center, Okayama, Okayama, Japan

    Ken Haruma

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  1. Tohru Kotera
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  2. Masayoshi Yamanishi
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Correspondence to Tohru Kotera.

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Kotera, T., Yamanishi, M., Kushima, R. et al. Early autoimmune gastritis presenting with a normal endoscopic appearance. Clin J Gastroenterol 15, 547–552 (2022). https://doi.org/10.1007/s12328-022-01617-5

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  • DOI: https://doi.org/10.1007/s12328-022-01617-5

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