A case of early autoimmune gastritis with characteristic endoscopic findings

Maiko Kishino,Shinichi Nakamura,Katsutoshi Tokushige,Kenshi Yao,Hiroshi Hashimoto,Ayako Yamamoto,Kouichi Nonaka,Rie Kure,Kana Yamamoto,Hiroki Nitta

doi:10.1007/s12328-021-01351-4

Maiko Kishino, Shinichi Nakamura + Show 8 more

Open Access

https://doi.org/10.1007/s12328-021-01351-4

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Abstract

Significant atrophic gastritis in the fundic gland region is a well-known endoscopic finding observed in autoimmune gastritis (AIG). The endoscopic features of early AIG have not been reported. Iron deficiency, vitamin B12 deficiency, anemia, or neurological symptoms may not be observed in the early stages of AIG, and it may thus be difficult to diagnose early AIG based on clinical findings. We treated a 50-year-old Japanese female whose condition was suspected to be early AIG. The endoscopic findings showed normal gastric pyloric gland mucosa, and diffuse reddened and edematous gastric fundic gland mucosa. Pathologically, local infiltration of lymphocytes and decrease of parietal cells was present in a deep part of the gastric fundic gland mucosa. Blood tests showed that the titer of parietal cell antibody (PCA) was 1:320 and the gastrin level was 820 pg/ml. We determined that the patient had AIG because she also had Hashimoto’s disease, the PCA titer was high, the serum gastrin level was slightly increased, and inflammation was observed only in the gastric body on the endoscopic images. To the best of our knowledge, this is the first case report of endoscopic findings that suggest early AIG, before atrophic changes were observed.

Highlights

Endoscopic findings are important as a clue to the diagnosis of autoimmune gastritis (AIG)
Since the report on Type A gastritis by Strickland et al was published in 1973, it has been known that an autoimmune-positive result, iron deficiency anemia, pernicious anemia, and hypergastrinemia are observed in typical AIG [2]
AIG has been reported by Strickland and Mackay as a chronic inflammatory disease that yields positive test results for parietal cell antibody (PCA) or intrinsic factor antibody, gastric corpus atrophy, gastric acid hyposecretion, and hypergastrinemia [2]

Summary

Introduction

Endoscopic findings are important as a clue to the diagnosis of autoimmune gastritis (AIG). C The histopathological findings a biopsy specimen obtained from the greater curvature in the middle part of the gastric corpus did not show atrophy, intestinal metaplasia, or decreased parietal cells accompanied with a dense lymphocyte infiltration without neutrophils in the middle-to-deep part of the lamina propria mucosa (HE staining). F The finding of immunostaining for Pepsinogen I of a biopsy specimen obtained from the greater curvature in the middle part of the gastric corpus The immunostaining for both H+/K+-ATPase and Pepsinogen I was negative in the area with a dense lymphocyte infiltration (d, e, f) endoscopic findings might be characteristic of AIG at its early stage. The area of lymphocyte infiltration accompanied by parietal cell damage was predominantly present in the pale area (Fig. 4)

Discussion

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