Endoscopic and histological evolution of newly diagnosed autoimmune gastritis

Aims To determine the rate of patients with autoimmune gastritis who experienced endoscopic and histological worsening at follow-up gastroscopy.

Methods A single center observational and retrospective study was conducted. Patients with positive parietal cell autoantibodies (PCA) (≤ 1/160) with at least two endoscopic evaluations between 2013 and 2023 were considered for inclusion. Patients without biopsies according to Sydney’s protocol or Helicobacter infection were excluded. Four different histological stages were defined; stage 0 (potential AIG) without any feature of chronic gastritis neither atrophy, stage I or chronic gastritis, stage II or atrophic gastritis and stage III (complicated) whenever dysplasia, neuroendocrine tumour or gastric adenocarcinoma were detected. Stage II or III was considered as advanced AIG. The index gastroscope was considered for diagnosis and first subsequent gastroscope as follow-up gastroscope.

Results 164 patients were included, 129 were female (79.1%) with a median age of 51.8 years (IQR 44.3-64.1). At baseline 31 patients (18.9%) presented a PCA with 1/160 titles, 71 patients (43.3%) 1/320, 36 patients (21.6%) 1/640 and 26 patients (15.9%) 1/1280.

At the index gastroscopy, 73 patients (46.5%) showed no endoscopic evidence of atrophy, 8 patients (5.1%) with exclusive antral atrophy, 14 patients (8.9%) with antral and corporal atrophy (8.9%), 23 patients with corporal and fundic atrophy (14.6%), 29 patients with exclusive corporal atrophy and 10 patients with atrophy of both antrum and gastric body. 44 patients (26.8%) were categorized as stage 0, 32 patients (19.5%) as stage I, 84 patients as stage II (51.2%) and 4 patients (2.4%) as stage III. After a median of 32,5 months (IQR 21,5-45.7) the follow-up gastroscope was performed. 21 patients were classified as stage 0 (12.8%), 36 patients as stage I (21.6%), 102 patients as stage II (62.2%) and 5 patients as stage III (3.1%). At the index gastroscopy 53.5% presented advanced GAI with significant increase to 65.2% at the follow-up gastroscopy (difference 12.1% 95% CI 1.4%-22.6%; p=0.03). Also, a significant decrease of potential GAI into more advanced stages was observed at the follow-up gastroscope (26.8% vs 12.8; difference 14% 95% CI 5.5%-22.5%; p<0.001).

Conclusions Histological evolution into worse stages may occur in a considerable percentage of AIG patients; in fact, over 50% of patients who had potential AIG at baseline may have stage transitions into worse stages.

Publikationsverlauf

Artikel online veröffentlicht:
27. März 2025