Mucocutaneous Manifestations in Autoimmune Gastritis: A Prospective Case-Control Study

Abstract

Introduction: Autoimmune gastritis (AIG) is associated with nutritional deficiencies, autoimmune diseases, and gastric malignancies. The aims of the study were to test the hypothesis that mucocutaneous (MC) manifestations occur more often in patients with vs without AIG and to delineate patterns of MC manifestations in AIG.

Methods: A single-center, prospective 2:1 case-control study was conducted. Cases were patients with the diagnosis of AIG based on consistent serologic and histologic findings. Controls had a normal gastric biopsy. MC manifestations were independently evaluated by 3 experienced dermatologists. We conducted a multivariable logistic regression model adjusted for age, sex, Helicobacter pylori, tobacco use, and alcohol consumption to estimate the association between AIG (vs no AIG) and MC manifestations (adjusted odds ratio; 95% confidence interval).

Results: We prospectively enrolled 60 cases and 30 controls (mean age 53.5 ± 15.8 vs 53.4 ± 14.5 years; 75% vs 73.3% women). The pooled prevalence of MC immune-mediated diseases was higher in patients with vs without AIG (66.7% vs 23.3%; adjusted odds ratio 12.01 [95% confidence interval: 3.51-41.13]). In patients with AIG, seropositive vs seronegative anti-intrinsic factor antibodies more often had concomitant immunological diseases with MC manifestations (100% vs 58.5%; P = 0.016). The most common MC immune-mediated diseases in AIG were Sjögren syndrome (n = 5, 8.3%), alopecia areata (n = 5, 8.3%), and vitiligo (n = 4, 6.7%). Nutritional deficiency-related MC findings, mainly xerosis, lingual, and nail disorders, were also more common in AIG.

Discussion: This is the first comparative study specifically designed to evaluate MC manifestations in AIG. We demonstrated that AIG is more frequently associated with both immune- and nutritional deficiency-related MC manifestations, which might have both diagnostic and therapeutic clinical implications.

Figure 1.. General mucocutaneous findings:

Geographic tongue (a), hypertrophic papillae (b), fissured/hairy black tongue (c) and scrotal tongue (d).

Figure 2.. Vitiligo:

Case 1: 71-years old man. History of acrofacial (a), mucosal (b) and perianal (c) vitiligo, psoriasis vulgar, hypothyroidism, fissured tongue, nail fragility and koilonychia. Additionally, previous history of vitamin B12 deficiency and depression, anti-thyroid antibodies (+), ANA (+) 1/80 and elevated gastrin levels (138 pg/mL). Case 2: 58-years old woman. History of periocular (d) (e) and perianal (f) vitiligo, hypothyroidism, anemia due to iron deficiency and depression. Wood’s Lamp was used to highlight periocular vitiligo (e).

Figure 3.. Polyautoimmunity:

Case 3: 45-years old man. History of alopecia areata universalis (a), trachyonychia (b), periodontal disease secondary to Sjögren’s syndrome (c), vitiligo and genital lichen sclerosus (d). Additionally, previous history of vitamin B12<100 pg/mL, peripheral neuropathy, burning mouth syndrome, anti-thyroid antibodies (+), ANA (+) 1/80 and elevated gastrin levels (331 pg/mL).