Autoimmune liver diseases and autoimmune atrophic gastritis: an overlooked association?

IF 4 3区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Digestive and Liver Disease Pub Date : 2024-09-01 DOI:10.1016/j.dld.2024.08.017

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Abstract

Introduction

Autoimmune atrophic gastritis (AAG) is a chronic condition characterized by the presence of atrophy in the oxyntic mucosa and a spared antrum, frequently with presence of anti-parietal cells antibodies (APCA). The prevalence of AAG has been estimated at between 0.3% and 2.7% in the general population. AAG can be associated with other autoimmune disorders such as type I diabetes, thyroid disease, vitiligo and alopecia. In literature there are only a few case reports showing the association between AAG and autoimmune liver diseases (primary biliary cholangitis=PBC, primary sclerosant cholangitis=PSC, and autoimmune hepatitis=AIE)

Aim

The aim of this study was to evaluate the prevalence of AAG in patients affected by autoimmune liver diseases (PBC, PSC and AIE).

Methods

We conducted a prospective study in a cohort of 46 patients with a diagnosis of either PBC (26/46, 56.5%), PSC (1/46, 2.1%), AIE (11/46, 23.9%), or an overlap PBC/AIE (8/46, 17.3%) who underwent, according to our prescription, gastroscopy (EGDS) for different reasons (dyspepsia, anemia, diarrhea, reflux symptoms or search for esophageal varices). Biopsies during EGDS were taken following the updated Sydney System protocol.

Results

45/46 (97.8%) patients were female, while only 1 patient (2.1%) was male. Nine (19.5%) out of 46 patients were diagnosed with AAG, with histological evidence of atrophy in the oxyntic mucosa only. Moreover, 7 of these patients had positive APCA, while in the other 2 patients APCA were not tested. Six of these 9 patients were affected by PBC, 2 had AIE and 1 had an overlap syndrome (PBC/AIE). In addition, 23/46 (50%) patients had other autoimmune disorders.

Conclusion

Our study showed a strong association between AAG and autoimmune liver diseases raising the question of the need of gastroscopy with adequate biopsy sampling and/or serological assay of APCA in patients diagnosed with liver autoimmune diseases to screen for AAG.

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自身免疫性肝病和自身免疫性萎缩性胃炎：被忽视的关联？

导言自身免疫性萎缩性胃炎（AAG）是一种慢性疾病，其特点是胃黏膜萎缩，胃窦缺损，常伴有抗顶叶细胞抗体（APCA）。据估计，AAG 在普通人群中的发病率在 0.3% 到 2.7% 之间。AAG可能与其他自身免疫性疾病相关，如I型糖尿病、甲状腺疾病、白癜风和脱发。本研究旨在评估 AAG 在自身免疫性肝病（原发性胆汁性胆管炎、原发性硬化性胆管炎和自身免疫性肝炎）患者中的患病率。方法我们对 46 名诊断为 PBC（26/46，56.5%）、PSC（1/46，2.1%）、AIE（11/46，23.9%）或 PBC/AIE 重叠（8/46，17.3%）的患者进行了前瞻性研究，这些患者根据我们的处方因不同原因（消化不良、贫血、腹泻、反流症状或寻找食管静脉曲张）接受了胃镜检查（EGDS）。胃镜检查过程中的活组织切片按照最新的悉尼系统方案进行。结果45/46（97.8%）名患者为女性，只有一名患者（2.1%）为男性。46 名患者中有 9 名（19.5%）被确诊为 AAG，组织学证据显示仅有口黏膜萎缩。此外，其中 7 名患者的 APCA 呈阳性，而另外 2 名患者的 APCA 未进行检测。在这 9 名患者中，有 6 人患有 PBC，2 人患有 AIE，1 人患有重叠综合征（PBC/AIE）。此外，23/46（50%）名患者患有其他自身免疫性疾病。结论：我们的研究表明，AAG 与自身免疫性肝病之间存在密切联系，这就提出了一个问题：对于确诊患有肝脏自身免疫性疾病的患者，是否有必要在进行胃镜检查的同时进行充分的活检取样和/或进行 APCA 血清学检测，以筛查 AAG。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Digestive and Liver Disease 医学-胃肠肝病学

CiteScore

6.10

自引率

2.20%

发文量

632

审稿时长

19 days

期刊介绍： Digestive and Liver Disease is an international journal of Gastroenterology and Hepatology. It is the official journal of Italian Association for the Study of the Liver (AISF); Italian Association for the Study of the Pancreas (AISP); Italian Association for Digestive Endoscopy (SIED); Italian Association for Hospital Gastroenterologists and Digestive Endoscopists (AIGO); Italian Society of Gastroenterology (SIGE); Italian Society of Pediatric Gastroenterology and Hepatology (SIGENP) and Italian Group for the Study of Inflammatory Bowel Disease (IG-IBD). Digestive and Liver Disease publishes papers on basic and clinical research in the field of gastroenterology and hepatology. Contributions consist of: Original Papers Correspondence to the Editor Editorials, Reviews and Special Articles Progress Reports Image of the Month Congress Proceedings Symposia and Mini-symposia.