Abstract
Background: Autoimmune atrophic gastritis (AAG) leads to iron and/or vitamin B12 malabsorption, with subsequent haematological alterations which could represent the sole clinical manifestation. We aimed to assess patterns of anaemia and micronutrient deficiencies in patients with AAG at the time of diagnosis. Methods: Observational, multicentre, cross-sectional study including consecutive adult patients diagnosed with AAG within the last ten years. Cell blood count, red cell distribution width, serum vitamin B12, and ferritin were collected. Multivariate analysis for predictive factors of anaemia was computed. Results: 654 AAG patients (mean age 59.2 ± 13.8 years, female (F): male (M) ratio = 2.3:1) were included. Anaemia was present in 316 patients (48.3%; mean age 60.1 ± 15.8 years, F:M ratio = 2.3:1). Pernicious anaemia (132/316 cases, 41.7%) was more common in males (27.1% versus 12.4%; p = 0.001) and in older patients (63.0 ± 14.6 versus 58.9 ± 14.9 years; p = 0.014), while iron deficiency anaemia (112/316 cases, 35.4%) was more common in females (16.9% versus 10.0%; p = 0.039) and in younger patients (56.8 ± 16.6 versus 60.2 ± 14.6 years; p = 0.043). The prevalence of iron deficiency was equally distributed between anaemic and non-anaemic patients (p = 0.9). Anisocytosis (odds ratio: 10.65, 95% confidence interval: 6.13–18.50, p < 0.0001) was independently associated with anaemia. Conclusions: Anaemia is a common manifestation in AAG patients, mostly due to micronutrient deficiencies. Scant haematologic alterations and micronutrient deficiencies may precede overt anaemia.
Highlights
Autoimmune atrophic gastritis (AAG) is an organ-specific, immune-mediated disorder that affects the corpus and fundus of the stomach, causing atrophy of the oxyntic mucosa, impaired gastric acid secretion, and intrinsic factor deficiency [1,2]
Iron deficiency anaemia was defined as the presence of anaemia and low iron and ferritin levels, while pernicious anaemia was defined as the presence of macrocytic anaemia and vitamin B12 and/or folate deficiency
Other variables were not available for all patients, statistical analyses were preformed after exclusion of patients with missing data, as detailed in the tables
Summary
Autoimmune atrophic gastritis (AAG) is an organ-specific, immune-mediated disorder that affects the corpus and fundus of the stomach, causing atrophy of the oxyntic mucosa, impaired gastric acid secretion, and intrinsic factor deficiency [1,2]. In the natural history of AAG, malabsorption of micronutrients, especially vitamin B12 and iron, occurs over time [6,7]. Micronutrient deficiencies lead to various manifestations, in particular, red blood cell alterations, which may represent the sole clinical presentation of AAG [4,5,6,7,8]. According to a previous study of ours [4], a considerable proportion of AAG patients have scant and subtle haematological alterations, including isolated mean corpuscular volume (MCV) changes and isolated increase of red cell distribution width (RDW). Autoimmune atrophic gastritis (AAG) leads to iron and/or vitamin B12 malabsorption, with subsequent haematological alterations which could represent the sole clinical manifestation. Results: 654 AAG patients (mean age 59.2 ± 13.8 years, female (F): male (M) ratio = 2.3:1) were included. Scant haematologic alterations and micronutrient deficiencies may precede overt anaemia
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