Abstract
Autoimmune atrophic gastritis is an organ-specific immune-mediated condition characterized by atrophy of the oxyntic mucosa. Autoimmune atrophic gastritis (AIG) is characterized by a progressive loss of acid-secreting parietal cells leading to hypo-achlorhydria. Due to this peculiar intra-gastric environment, gastric microbiota composition in individuals with autoimmune atrophic gastritis was first supposed and then recently reported to be different from subjects with a normal acidic healthy stomach. Recent data confirm the prominent role of Helicobacter pylori as the main bacterium responsible for gastric disease and long-term complications. However, other bacteria than Helicobacter pylori, for example, Streptococci, were found in subjects who developed gastric cancer and in subjects at risk of this fearful complication, as well as those with autoimmune gastritis. Gastric microbiota composition is challenging to study due to the acidic gastric environment, the difficulty of obtaining representative samples of the entire gastric microbiota, and the possible contamination by oral or throat microorganisms, which can potentially lead to the distortion of the original gastric microbial composition, but innovative molecular approaches based on the analysis of the hyper-variable region of the 16S rRNA gene have been developed, permitting us to obtain an overall microbial composition view of the RNA gene that is present only in prokaryotic cells.
Highlights
Autoimmune atrophic gastritis (AIG) is a relatively frequent and often undiagnosed disorder with important and potentially life-threatening consequences from a clinical point of view, ranging from micronutrient deficiencies and severe anemia to such neoplastic complications as gastric cancer and gastric type 1 neuroendocrine tumors
This review addresses different aspects of AIG, focusing on epidemiology, the clinical picture and management, the relationship between hypochlorhydria and long-term complications, and the interplay between the gastric microbiota, autoimmune gastritis and its clinical consequences, as well as the complicated and still debated role of Helicobacter pylori infection, providing an updated summary of recent scientific evidence on this intriguing topic
Recent data confirm the prominent role of Helicobacter pylori (Hp) as the main bacterium responsible for gastric disease and long-term complications
Summary
Autoimmune atrophic gastritis (AIG) is a relatively frequent and often undiagnosed disorder with important and potentially life-threatening consequences from a clinical point of view, ranging from micronutrient deficiencies and severe anemia to such neoplastic complications as gastric cancer and gastric type 1 neuroendocrine tumors. Due to its peculiar intra-gastric environment, characterized by severely impaired gastric acid secretion as a result of gastric oxyntic mucosa atrophy, the gastric microbiota composition in individuals with AIG was first supposed and recently reported to be different from subjects with a normal acidic stomach, possibly assuming a key role in the development of neoplastic complications This evidence adds new pieces to a constantly developing puzzle on the knowledge of autoimmune atrophic gastritis, a condition far from being completely investigated, and opens the door to new and intriguing perspectives on the management and possible treatment options of this important condition, which reduces the quality of life of millions of persons all over the world. This review addresses different aspects of AIG, focusing on epidemiology, the clinical picture and management, the relationship between hypochlorhydria and long-term complications, and the interplay between the gastric microbiota, autoimmune gastritis and its clinical consequences, as well as the complicated and still debated role of Helicobacter pylori infection, providing an updated summary of recent scientific evidence on this intriguing topic
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