Ulcers and gastritis

Abstract

It is increasingly recognized that parietal cell antibodies (PCA), previously assumed to be exclusive to autoimmune gastritis, are associated with Helicobacter pylori infection. Veijola et al. reported association of autoimmune-type atrophic corpus gastritis with H. pylori infection [1]. In the study they investigated the signs of previous H. pylori infection in patients with different grades of atrophic gastritis in order to assess the proportion of gastric atrophy not associated with H. pylori infection. In total, 23 patients with different grades of atrophic gastritis were analyzed using enzyme immunoassay-based serology, immunoblot-based serology, and histology to reveal a past or a present H. pylori infection. In addition, serum markers for gastric atrophy (pepsinogen I, pepsinogen I/II, and gastrin) and autoimmunity (PCA and intrinsic factor, antibodies) were determined. Of the 14 patients with severe gastric atrophy, as demonstrated by histology and serum markers, and no evidence for an ongoing H. pylori infection, eight showed H. pylori antibodies by immunoblotting. All eight had elevated PCA, four of whom also had intrinsic factor antibodies. Of the six immunoblot-negative patients with severe corpus atrophy, PCA and intrinsic factor antibodies were detected in four patients. Among the patients with low-to-moderate grade atrophic gastritis (all except one with an ongoing H. pylori infection), serum markers for gastric atrophy and autoimmunity were seldom detected. However, only one H. pylori-negative patient with mild atrophic gastritis had PCA and intrinsic factor antibodies suggestive of a pre-atrophic autoimmune gastritis. They concluded that atrophic corpus gastritis, including autoimmune-type severe atrophy with vitamin B12-malabsorption, is associated with a long-standing H. pylori infection in most cases.