Lack of specific association between gastric autoimmunity hallmarks and clinical presentations of atrophic body gastritis

Abstract

Aim: To investigate the possible relationships between gastric autoimmune phenomena and clinical presentations of this disorder, in consecutive atrophic body gastritis patients.

Methods: A total of 140 atrophic body gastritis patients, diagnosed as consecutive outpatients presenting with macrocytic or iron deficiency anemia, or longstanding dyspepsia underwent gastroscopy with antral and body biopsies, assay of intrinsic factor, parietal cells and Helicobacter pylori (H pylori) antibodies. Gastritis was assessed according to Sydney System.

Results: Parietal cell antibodies were equally distributed in all clinical presentations, whereas the positivity of intrinsic factor antibodies (49/140, 35%) was significantly higher in pernicious anemia patients (49.2%) than in iron deficiency (21.1%) and dyspeptic patients (27.8%). No specific pattern of autoantibodies was related to the clinical presentations of atrophic body gastritis. A positive correlation was obtained between the body atrophy score and the intrinsic factor antibody levels (r = 0.2216, P = 0.0085). Associated autoimmune diseases were present in 25/140 (17.9%) patients, but the prevalence of autoimmune diseases was comparable, irrespective of the clinical presentations.

Conclusion: The so-called hallmarks of gastric autoimmunity, particularly in intrinsic factor antibody cannot be usefully employed in defining an autoimmune pattern in the clinical presentations of ABG.

Figure 1

Correlation between histological score of body atrophy and level of intrinsic factor antibodies (IFA) in 140 patients with atrophic body gastritis (r = 0.2216, P = 0.0085, Spearman rank correlation).

Figure 2

Intrinsic factor antibodies (IFA) in 140 patients with atrophic body gastritis. H pylori negative at histology and serology (n = 33), H pylori negative at histology and positive at serology (n = 76), H pylori positive at histology and serology (n = 31). Broken line indicates cut-off (>2 U/mL positive); bar indicates mean; ¹P = 0.01 vs group III; ²P = 0.004 vs group III; ^aP < 0.05 vs group III, Fisher’s test.

Figure 3

Distribution of clinical presentations of ABG with respect to positivity of IFA and H pylori status. H pylori negative at histology and serology (n = 33), H pylori negative at histology and positive at serology (n = 76), H pylori positive at histology and serology (n = 31). Diagonal lines = pernicious anemia; vertical lines = iron deficiency anemia; horizontal lines = dyspepsia.