Anti-gastric Parietal Cell Research Articles

Histological and serological features of acute liver injury after SARS-CoV-2 vaccination

Liver injury with autoimmune features after vaccination against severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) is increasingly reported. We investigated a large international cohort of individuals with acute hepatitis arising after SARS-CoV-2 vaccination, focusing on histological and serological features. Individuals without known pre-existing liver diseases and transaminase levels ≥5x the upper limit of normal within 3 months after any anti-SARS-CoV-2 vaccine, and available liver biopsy were included. Fifty-nine patients were recruited; 35 females; median age 54 years. They were exposed to various combinations of mRNA, vectorial, inactivated and protein-based vaccines. Liver histology showed predominantly lobular hepatitis in 45 (76%), predominantly portal hepatitis in 10 (17%), and other patterns in four (7%) cases; seven had fibrosis Ishak stage ≥3, associated with more severe interface hepatitis. Autoimmune serology, centrally tested in 31 cases, showed anti-antinuclear antibody in 23 (74%), anti-smooth muscle antibody in 19 (61%), anti-gastric parietal cells in eight (26%), anti-liver kidney microsomal antibody in four (13%), and anti-mitochondrial antibody in four (13%) cases. Ninety-one percent were treated with steroids ± azathioprine. Serum transaminase levels improved in all cases and were normal in 24/58 (41%) after 3 months, and in 30/46 (65%) after 6 months. One patient required liver transplantation. Of 15 patients re-exposed to SARS-CoV-2 vaccines, three relapsed. Acute liver injury arising after SARS-CoV-2 vaccination is frequently associated with lobular hepatitis and positive autoantibodies. Whether there is a causal relationship between liver damage and SARS-CoV-2 vaccines remains to be established. A close follow-up is warranted to assess the long-term outcomes of this condition. Cases of liver injury after vaccination against severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) have been published. We investigated a large international cohort of individuals with acute hepatitis after SARS-CoV-2 vaccination, focusing on liver biopsy findings and autoantibodies: liver biopsy frequently shows inflammation of the lobule, which is typical of recent injury, and autoantibodies are frequently positive. Whether there is a causal relationship between liver damage and SARS-CoV-2 vaccines remains to be established. Close follow-up is warranted to assess the long-term outcome of this condition.

Antigastric parietal cell antibody as a screening test for Autoimmune gastritis in Egyptian children and adolescents with juvenile autoimmune thyroid disease and those with type 1 diabetes, single center experience

Purpose: The diagnosis of pediatric autoimmune gastritis (AIG) is critical due to the poor outcome and risk of malignancy. Therefore, we evaluated the prevalence of autoimmune gastritis in children with autoimmune thyroid disease (ATD) and type 1 diabetes mellitus (T1D), using parietal cell antibody (PCA) to identify its use as a screening test. Methods: PCA was measured in 90 patients; 45 patients with ATD (Hashimoto Thyroiditis and Graves' Disease) and 45 patients with T1D. Their ages ranged from 5 to 18 years. Hemoglobin, ferritin, and HbA1c (in diabetic patients) were measured. Results: PCA demonstrated a statistically significant difference between the two groups of patients with a p-value (0.024). The mean value of PCA in patients with T1D was 196.45, while it reached 148.58 in patients with ATD, with a p-value (0.003). Thirty-one (68.9%) and twelve (26.7%) of patients with T1D had high (30-200) and extremely high (> 200) values of PCA, respectively, compared to twenty-six (57.8%) and eight (17.8%) of patients with ATD who had high (30-200) and extremely high (> 200) values of PCA, respectively. Seven (87.5%) of patients with ATD with extremely high PCA( above 200) also had normocytic anemia.

The profile of autoimmunity in Type 1 diabetes patients.

Background:Type 1 diabetes mellitus (T1DM) is an autoimmune disorder caused by pancreatic β-cells destruction. Anti-pancreatic antibodies are the witness of β-cell destruction and their dosage is mainly used for etiological diagnosis. Patients with T1DM are at increased risk of developing other autoimmune reactions, which may involve other organs, resulting in organ specific autoimmune disease. The most frequently encountered are autoimmune thyroid disease, followed by celiac and gastric disease and other rare autoimmune diseases.Objectives:The purpose of this study is to investigate the prevalence of autoimmune markers in patients with T1DM.Methods:The study was conducted at the Department of Endocrinology of the Military Hospital Moulay Ismail in Meknes Morocco, from January 2016 to December 2018. All Type 1 diabetes patients consulting during the study period were included in the study. Their clinical and biochemical data were collected at their first presentation, made up of anti-pancreatic antibodies (glutamic acid decarboxylase [GAD] antibody, tyrosine phosphatase antibody, and islet cell antibody) and other organ-specific antibodies: the thyroid (antithyroid peroxidase antibody, antithyroglobulin antibody, and antithyroid-stimulating hormone receptor antibody), the intestine (IgA antitissue transglutaminase antibody), the adrenal gland (anti-21 hydroxylase antibody), and the stomach (antigastric parietal cell antibody and anti-intrinsic factor antibody).Results:Fifty-four patients were included, with an average age of 26 years. GAD, tyrosine phosphatase, and islet cell antibodies were detected in 74%, 22%, and 3.7%, respectively, of the 54 patients examined. The prevalence of extrapancreatic autoimmunity was 45% with a large preponderance among different immunities of those from thyroid and celiac diseases (CDs).Conclusion:Our results confirm that patients with Type 1 diabetes should be investigated for the presence of autoimmune diseases mainly from thyroid and CDs.

Analysis of clinical characteristics of 2243 with positive anti-gastric parietal cell antibody.

BackgroundTo facilitate the early detection of chronic diseases, we analyzed the clinical characteristics of anti‐gastric parietal cell antibody (PCA)‐positive population, revealed the early characteristics of the population.MethodsAccording to the retrospective analysis, current situation investigation and comparative analysis of the clinical characteristics and medical history of the subjects, the comparison between the groups was performed.Result(a) The positive rate of PCA detection in department of gastroenterology in our hospital was 35.80%. Among the individuals who underwent PCA, esophagogastroduodenoscopy (EGD) and pathological examination at the same time, 33.59% of the patients with PCA positive were diagnosed as atrophic gastritis by gastroscopy, which was much higher than 9.09% of the patients with PCA negative. (b) The incidence of gastroesophageal reflux, hypertension, ischemic heart disease (IHD) and cerebral ischemia in PCA‐positive population were 65.45%, 81.63%, 15.43%, and 31.61%, respectively, which were significantly higher than those in the control group. (c) The incidence rates of decreased red blood cells (RBC) and increased homocysteine (HCY) in laboratory‐related tests were 38.30% and 69.15%, respectively, which were much higher than those in control group.ConclusionPCA has predictive value for a variety of chronic diseases and timely detection is of great significance.

Anti-gastric parietal cell antibodies for autoimmune gastritis screening in juvenile autoimmune thyroid disease.

Patients with autoimmune thyroid disease (ATD) have a higher prevalence of autoimmune gastritis (AIG) compared with the general population. The association between ATD and AIG is poorly characterized in the pediatric age. We reviewed the prevalence of anti-gastric parietal cell antibodies (PCA) in young patients with ATD to evaluate its usefulness as a marker for AIG screening. We evaluated 220 children and adolescents (11.28 ± 6.37years) with ATD (186 with autoimmune thyroiditis (AT) and 34 with Graves' disease (GD). At ATD diagnosis and annually thereafter, blood counts and PCA levels were measured. In patients positive for PCA, plasma gastrin, chromogranin A, vitamin B12, iron and ferritin levels and H. pylori antigen were measured. PCA-positive patients > 18years were invited to undergo a gastroscopic exam. PCA positivity was detected in ten (4.5%) subjects (5F/5M; 12.6 ± 3.4years). The prevalence of PCA positivity was not significantly different in the comparison of GD and AT patients (p = 0.9). PCA positivity was detected after 2.7 ± 2.7years of follow-up in AT and 4.4 ± 4.0years in GD (p = 0.4). Autoantibody positivity was more prevalent in female patients, in both AT and GD (p = 0.02 and p = 0.03, respectively). At detection of PCA positivity, five out of ten PCA-positive patients had iron deficiency, four vitamin B12 deficiency, two anemia, three hypergastrinemia and two elevated chromogranin values. Two patients had H. pylori infection. Gastroscopy was performed in the five ATD patients and in all patients, AIG was confirmed. In the juvenile population, ATD and AIG may also be associated. PCA screening is useful to detect subjects at risk for this condition. Due to the longer life expectancy of the pediatric population and considering the relatively high risk of malignant transformation, early surveillance monitoring is mandatory for children and adolescents with ATD.

Vitiligo and autoantibodies: a systematic review and meta-analysis.

Many studies have reported the prevalence of autoantibodies in patients with vitiligo; however, results were inconsistent for some autoantibodies. This study aimed to conduct a systematic review and meta-analysis of the prevalence of autoantibodies in vitiligo patients. A systematic review and meta-analysis of the literature published from inception to Dec 31, 2016 was conducted. Case-control studies with vitiligo patients and a control group were included. The prevalence of anti-thyroperoxidase (ATPO) antibodies, anti-thyroglobulin (ATG) antibodies, antinuclear antibodies (ANA), anti-gastric parietal cell antibodies (AGPCA), anti-smooth muscle antibodies (ASMA), anti-mitochondrial antibodies (AMA), and anti-adrenal antibodies in vitiligo patients were 15.1%, 9.7%, 12.5%, 11.7%, 12.6%, 0.2%, and 2.5%, respectively. The prevalence of ATPO antibodies (odds ratio [OR]: 3.975; 95%; confidence interval [CI]: 3.085-5.122), ATG antibodies (OR: 3.759; 95% CI: 2.554-5.531), ANA (OR: 1.797, 95% CI: 1.182-2.731), AGPCA (OR: 2.503; 95% CI: 1.497-2.896), and anti-adrenal antibodies (OR: 9.808, 95% CI: 1.809-53.159) (Figure 2a-e) were significantly higher in vitiligo patients than in the control group. The routine screening of anti-thyroid antibodies should be performed in vitiligo patients to identify those at high risk of developing autoimmune thyroid disease.

Hematinic deficiencies and anemia statuses in anti-gastric parietal cell antibody-positive or all autoantibodies-negative erosive oral lichen planus patients.

Approximately 27% of erosive oral lichen planus (EOLP) patients have serum anti-gastric parietal cell antibody (GPCA) positivity. This study assessed whether serum GPCA or EOLP itself was a significant factor that caused hematinic deficiencies and anemia statuses in GPCA-positive or autoantibodies-negative EOLP patients (GPCA+/EOLP and Abs-/EOLP patients). The mean corpuscular volume (MCV) and mean blood hemoglobin (Hb), iron, vitamin B12, and folic acid levels were measured and compared between any two of three groups of 41 GPCA+/EOLP patients, 198 Abs-/EOLP patients, and 184 healthy control subjects. GPCA+/EOLP patients had significantly lower mean Hb, iron (for women only), and vitamin B12 level as well as significantly greater frequencies of Hb, iron, and vitamin B12 deficiencies than healthy control subjects. Moreover, GPCA+/EOLP patients had significantly lower serum vitamin B12 level and significantly higher MCV as well as a significantly greater frequency of vitamin B12 deficiency than Abs-/EOLP patients. Furthermore, Abs-/EOLP patients did have significantly lower mean Hb, MCV, iron (for women only), vitamin B12, and folic acid levels as well as significantly greater frequencies of Hb and iron deficiencies than healthy control subjects. We conclude that serum GPCA is the major factor that causes vitamin B12 deficiency, macrocytosis and pernicious anemia in GPCA+/EOLP patients. Approximately 29-32% GPCA-positive EOLP patients have vitamin B12 deficiency or macrocytosis and about 23-25% vitamin B12 deficiency or macrocytosis EOLP patients have pernicious anemia. ELOP itself does play a significant role in causing anemia and hematinic deficiencies in Abs-/EOLP patients.

Seronegative Myasthenia Gravis and a Biermer’s Anemia: A Rare Association

We report a rare association of seronegative myasthenia gravis and a Biermer’s anemia (or pernicious anemia). A Senegalese patient of 31 years has been followed for a vitamin B12 deficiency anemia, 12 months before his hospitalization in our department. She has been admitted for an intense and invalidating fatigability in spite of the correction of anemia, associated to a right ptosis. This clinical picture has electively been improved to the prostigmine test. The electromyography had revealed a compatible decrement with a diagnosis of myasthenia. The positivity of the antibodies anti gastric parietal cells and the twice negativity of the antibody against acetylcholine receptor (AChR) and muscle-specific kinase (MuSK) had permitted to deduct a diagnosis of seronegative myasthenia and Biermer’s anemia. The evolution was favorable under substitutive B12 vitamin therapy associated to corticotherapy and azathioprine. We insist on the research and the early treatment of a myasthenia, in a context of Biermer’s anemia, before suggestive clinical signs in spite of the negativity of the anti-Rach antibodies and anti-Musk.

Anemia and hematinic deficiencies in anti-gastric parietal cell antibody-positive and -negative recurrent aphthous stomatitis patients with anti-thyroid antibody positivity.

Serum anti-gastric parietal cell (GPCA), anti-thyroglobulin (TGA), and anti-thyroid microsomal antibodies (TMA) can be found in some recurrent aphthous stomatitis (RAS) patients. This study mainly assessed whether serum GPCA, TGA, TMA and RAS itself played significant roles in causing anemia and hematinic deficiencies in TGA/TMA-positive RAS patients with GPCA positivity (GPCA+/TGA/TMA/RAS patients) or negativity (GPCA-/TGA/TMA/RAS patients). The mean corpuscular volume (MCV) and mean blood hemoglobin (Hb), iron, vitamin B12, and folic acid levels were measured and compared between any two of the four groups of 15 GPCA+/TGA/TMA/RAS patients, 69 GPCA-/TGA/TMA/RAS patients, 240 all autoantibodies-negative RAS patients (Abs-/RAS patients), and 342 healthy control subjects. GPCA+/TGA/TMA/RAS patients had significantly lower mean Hb (for men only) and vitamin B12 levels as well as significantly greater frequencies of Hb, iron, and vitamin B12 deficiencies than healthy control subjects. GPCA+/TGA/TMA/RAS patients had lower serum vitamin B12 level and higher MCV as well as a significantly greater frequency of vitamin B12 deficiency than GPCA-/TGA/TMA/RAS patients. Furthermore, both GPCA-/TGA/TMA/RAS and Abs-/RAS patients did have significantly lower mean Hb, MCV, and iron levels as well as significantly greater frequencies of Hb, iron and vitamin B12 deficiencies than healthy control subjects. There were no significant differences in blood data between GPCA-/TGA/TMA/RAS and Abs-/RAS patients CONCLUSION: Both serum GPCA positivity and RAS itself are the contributing factors causing anemia and hematinic deficiencies in GPCA+/TGA/TMA/RAS patients. RAS itself but not TGA/TMA positivity plays a significant role in causing anemia and hematinic deficiencies in GPCA-/TGA/TMA/RAS patients.

Anemia and hematinic deficiencies in anti-gastric parietal cell antibody-positive or all autoantibodies-negative recurrent aphthous stomatitis patients.

Approximately 13% of recurrent aphthous stomatitis (RAS) patients have serum anti-gastric parietal cell antibody (GPCA) positivity. This study assessed whether serum GPCA or RAS itself was a significant factor causing hematinic deficiencies and anemia statuses in GPCA-positive RAS (GPCA+/RAS) and all autoantibodies-negative RAS (Abs-/RAS) patients. The mean corpuscular volume (MCV) and mean blood hemoglobin (Hb), iron, vitamin B12, and folic acid levels were measured and compared between any two of three groups of 31 GPCA+/RAS patients, 240 Abs-/RAS patients, and 342 healthy control subjects. GPCA+/RAS patients had significantly lower mean Hb and serum iron level (for women only) as well as significantly greater frequencies of Hb, iron, and vitamin B12 deficiencies than healthy control subjects. Moreover, GPCA+/RAS patients had a significantly higher MCV and a significantly greater frequency of vitamin B12 deficiency than Abs-/RAS patients. Furthermore, Abs-/RAS patients did have significantly lower mean Hb, MCV, iron, and folic acid levels and significantly greater frequencies of Hb, iron, vitamin B12, and folic acid deficiencies than healthy control subjects. Of 31 GPCA+/RAS patients, 3 (9.7%) had PA, 6 (19.4%) had vitamin B12 deficiency, and 3 (9.7%) had macrocytosis. Moreover, normocytic anemia (54.0%) and iron deficiency anemia (26.4%) are the two more common types of anemia in our RAS patients. We conclude that serum GPCA plays a significant role in causing vitamin B12 deficiency and high MCV in GPCA+/RAS patients. RAS itself does play a significant role in causing anemia and hematinic deficiencies in both GPCA+/RAS and Abs-/RAS patients.

Antigastric parietal cell and antithyroid autoantibodies in patients with recurrent aphthous stomatitis.

Anti-gastric parietal cell antibody (GPCA), anti-thyroglobulin antibody (TGA), and anti-thyroid microsomal antibody (TMA) have not yet been reported in patients with recurrent aphthous stomatitis (RAS). This study mainly assessed the frequencies of the presence of serum GPCA, TGA, and TMA in different types of RAS patients. Serum GPCA, TGA, and TMA levels were measured in 355 RAS patients of different subtypes and in 355 age- and sex-matched healthy control individuals. We found that 13.0%, 19.4%, and 19.7% of 355 RAS patients, 16.7%, 23.3%, and 21.7% of 60 major-typed RAS patients, 12.2%, 18.6%, and 19.3% of 295 minor-typed RAS patients, 18.1%, 20.0%, and 21.9% of 160 atrophic glossitis-positive RAS (AG+/RAS) patients, and 8.7%, 19.0%, and 17.9% of 195 AG-negative RAS (AG-/RAS) patients had the presence of GPCA, TGA, and TMA in their sera, respectively. RAS, major-typed RAS, minor-typed RAS, AG+/RAS, and AG-/RAS patients all had a significantly higher frequency of GPCA, TGA, or TMA positivity than healthy control individuals (all p<0.001). Of 65 TGA/TMA-positive RAS patients whose serum thyroid-stimulating hormone (TSH) levels were measured, 76.9%, 12.3%, and 10.8% of these TGA/TMA-positive RAS patients had normal, lower, and higher serum TSH levels, respectively. We conclude that approximately one-third RAS patients may have GPCA/TGA/TMA positivity in their sera. Because some GPCA-positive patients may develop pernicious anemia, autoimmune atrophic gastritis, and gastric carcinoma, and some TGA/TMA-positive patients may have thyroid dysfunction such as hyperthyroidism and hypothyroidism, these patients should be referred to doctors for further management.

Antigastric parietal cell and antithyroid autoantibodies in patients with desquamative gingivitis.

Desquamative gingivitis (DG) is principally associated with erosive oral lichen planus (EOLP), mucous membrane pemphigoid (MMP), and pemphigus vulgaris (PV). Serum autoantibodies including antigastric parietal cell antibody (GPCA), antithyroglobulin antibody (TGA), and antithyroid microsomal antibody (TMA) were measured in 500 patients with DG, 287 EOLP without DG (EOLP/DG- ) patients, and 100 healthy control subjects. The 500 patients with DG were diagnosed as having EOLP in 455 (91%), PV in 40 (8%), and MMP in five (1%) patients. We found that 37.0%, 43.6%, and 42.6% of 500 patients with DG, 39.6%, 46.4%, and 45.1% of 455 EOLP with DG (EOLP/DG) patients, and 18.5%, 27.5%, and 30.3% of 287 EOLP/DG- patients had the presence of GPCA, TGA, and TMA in their sera, respectively. DG, EOLP/DG, and EOLP/DG- patients all had a significantly higher frequency of GPCA, TGA, or TMA positivity than healthy control subjects (all P-values < 0.001). Moreover, 455 EOLP/DG patients had a significantly higher frequency of GPCA, TGA, or TMA positivity than 287 EOLP/DG- patients (all P-values < 0.001). Of 210 TGA/TMA-positive patients with DG whose serum thyroid-stimulating hormone (TSH) levels were measured, 84.3%, 6.7%, and 9.0% patients had normal, lower, and higher serum TSH levels, respectively. We conclude that 73.4% DG, 77.1% EOLP/DG, and 47.4% EOLP/DG- patients may have GPCA/TGA/TMA positivity in their sera. Because part of GPCA-positive patients may develop pernicious anemia, autoimmune atrophic gastritis, and gastric carcinoma, and part of TGA/TMA-positive patients may have thyroid dysfunction, these patients should be referred to medical department for further management.

Hematinic deficiencies and anemia statuses in antigastric parietal cell antibody-positive erosive oral lichen planus patients with desquamative gingivitis.

Erosive oral lichen planus (EOLP) patients with desquamative gingivitis (DG) are sometimes encountered in our oral mucosal disease clinic. This study assessed hematinic deficiencies and anemia statuses in antigastric parietal cell antibody (GPCA)-positive EOLP patients with DG (GPCA+/DG+/EOLP patients). The blood hemoglobin, iron, vitamin B12, folic acid, and homocysteine concentrations and serum GPCA levels in 92 GPCA+/DG+/EOLP patients and 184 age- and sex-matched healthy controls were measured and compared between the two groups. We found that 27 (29.3%), 16 (17.4%), and 27 (29.3%) of 92 GPCA+/DG+/EOLP patients had hemoglobin (men<13g/dL and women<12g/dL), iron (< 60μg/dL), and vitamin B12 (< 200pg/mL) deficiencies, respectively. Moreover, 37 (40.2%) of 92 GPCA+/DG+/EOLP patients had an abnormally high blood homocysteine level (> 12.1μM). GPCA+/DG+/EOLP patients had a significantly higher frequency of hemoglobin, iron, or vitamin B12 deficiency and an abnormally high blood homocysteine level than healthy control individuals (all p<0.001). Of 27 anemic GPCA+/DG+/EOLP patients, 13 (48.2%) had pernicious anemia, five (18.5%) had iron deficiency anemia, one (3.7%) had thalassemia trait, and the remaining eight (29.6%) had normocytic anemia. Moreover, of the 92 GPCA+/DG+/EOLP patients, 24 had macrocytosis, and only 13 (54.2%) of these 24 patients had pernicious anemia. We conclude that GPCA+/DG+/EOLP patients may have vitamin B12 deficiency, iron deficiency, and an abnormally high blood homocysteine level. In addition to pernicious anemia, GPCA+/DG+/EOLP patients may sometimes have normocytic anemia or iron deficiency anemia.

Effective vitamin B12 treatment can reduce serum antigastric parietal cell antibody titer in patients with oral mucosal disease.

Patients with serum antigastric parietal cell antibody (GPCA) positivity may have vitamin B12 deficiency and some oral symptoms. This study assessed the changes of serum GPCA titer in GPCA-positive patients after effective vitamin B12 treatment. Two hundred and ten GPCA-positive oral mucosal disease patients became oral symptom free (complete response) after 1.0-67.1months of treatment with regular and continuous intramuscular injection of vitamin B12 once per week. The changes of serum GPCA titers after treatment were evaluated in these 210 patients. We found a significant drop of the GPCA positive rate from 100% to 42.9% in our 210 complete response patients after effective vitamin B12 treatment (p<0.001). When 210 patients were further divided into seven subgroups according to the low to high serum GPCA titers, we noted that the higher serum GPCA titers decreased to significantly lower levels after treatment in all seven subgroups (all p<0.001). However, serum GPCA titers increased to significantly higher levels in 46 GPCA-positive control patients receiving only oral administration of two vitamin BC capsules (containing 10μg of vitamin B12) plus deficient hematinic supplements per day after a follow-up period of 2.7-27months. A maintenance vitamin B12 treatment once a month could retain the GPCA-negative status in 87% of treated-to GPCA-negative patients compared with those (10%) without further maintenance vitamin B12 treatment. Regular and continuous effective vitamin B12 treatment can reduce the relatively higher serum GPCA titers to significantly lower or undetectable levels in GPCA-positive patients.

Prevalence of Anti-Gastric Parietal Cell Antibodies and Vitamin B12 Deficiency in Rheumatoid Arthritis

Recent studies are lacking in assessing presence of both the anti-gastric parietal cell (GPC) antibody and concurrent vitamin B12 deficiency in Rheumatoid Arthritis (RA) patients in the era of more aggressive disease modifying therapy. We recruited patients to one of three arms:

Pernicious anemia: diagnosis and course in Burkina Faso

Pernicious anemia (also known as Biermer disease or anemia, Addison or Addisonian anemia, and Addison-Biermer anemia) is an autoimmune atrophic gastritis responsible for vitamin B12 malabsorption due to a deficiency of intrinsic factor. We report eight cases of pernicious anemia in Burkina Faso, collected over a 44-month period. The three criteria for diagnosis of pernicious anemia were: vitamin B12 deficiency, gastric disease (gastric histology) with presence of anti-intrinsic factor, and/or anti-gastric parietal cell antibodies in serum. All patients had anemia, with a mean hemoglobin level of 8.75 g/100mL. The average mean corpuscular volume (MCV) was 122.1 fL the average mean corpuscular hemoglobin (MCH) 39.3 pg, the mean reticulocyte count 12.069 10(9)/L reticulocytes, and the mean rate of megaloblast marrow cells 17.2%. The serum vitamin B12 level ranged from 35 to 71 pmol/L. Antibodies against intrinsic factor were found in all eight patients. All ABO blood groups were present with a predominance (4 cases) of group O. Endoscopy found a normal fundic mucosa in three patients. Histology showed gastric atrophy and intestinal metaplasia for six patients (85.7%). Under B12 vitamin therapy, the course was favorable in all patients; seven patients also had 10 days of iron therapy. We recommend a gastric biopsy even in the absence of macroscopic gastric lesions on the upper gastrointestinal endoscopy.

Autoimmune polyendocrine syndrome 3 onset with severe ketoacidosis in a 74-year-old woman.

Type 1 diabetes mellitus (T1D), autoimmune thyroid disease, and autoimmune gastritis often occur together forming the so-called autoimmune polyendocrine syndrome type 3 (APS3). We here report a clinical case of a 74-year-old woman who presented for the first time with severe hyperglycemia and ketoacidosis diagnosed as T1D. Further clinical investigations revealed concomitant severe hypothyroidism with autoimmune thyroid disease and severe cobalamin deficiency due to chronic atrophic gastritis. The diagnosis of type 1 diabetes mellitus was confirmed by the detection of autoantibodies against glutamic acid decarboxylase 65, islet cell antibodies, and anti-insulin autoantibodies. Anti-thyroperoxidase, anti-thyroglobulin, and anti-gastric parietal cell antibodies were also clearly positive. The case emphasized that new onset diabetic ketoacidosis, hypothyroidism, and cobalamin deficiency may simultaneously occur, and one disease can mask the features of the other, thereby making diagnosis difficult. It is noteworthy that an APS3 acute episode occurred in an asymptomatic elder woman for any autoimmune diseases.

Gastric cancer--epidemiologic and clinical aspects.

Gastric cancer (GC) continues to be an important health threat as the third leading cause of cancer related death in both sexes worldwide. In a recent analysis, the mortality trends for the time period from 1980 till 2011 were significantly downward in all countries, but the declines in the USA, EU and several other major countries were of low magnitude when compared with the past. Furthermore, the relative contribution of cardia cancers compared with noncardia cancers increased among countries with higher GC rates. With respect to preneoplastic changes of the gastric mucosa, a large population-based study suggests that Helicobacter pylori infection and antigastric parietal cell antibodies-mediated autoimmune response might, for the most part, be independent and follow distinct pathways rather than causally related pathways leading to chronic atrophic gastritis. A large prospective, randomized, open-label Korean trial questioned the role of H.pylori eradication for the prevention of metachronous lesions after endoscopic resection of early GC. A review of 1258 Japanese cases undergoing curative endoscopic submucosa dissection for early GC showed that scheduled follow-up endoscopy is mandatory for detecting metachronous lesions at an early stage, where they can be treated by endoscopic resection. Ramucirumab, a vascular endothelial growth factor receptor-2 antagonist, is the first biological treatment that provides survival benefits to patients with advanced GC in progress after first-line chemotherapy. The target agent rilotumumab is currently being evaluated in patients with advanced GC overexpressing the HGF/c-MET signaling pathway. In the near future, ipilimumab and nivolumab, two immunostimulatory monoclonal antibodies with antineoplastic effects, might offer new therapeutic options for patients with advanced GC.

Increased prevalence of anti-thyroid and anti-gastric parietal cell antibodies in first degree relatives of patients with type 1 diabetes

Increased prevalence of anti-thyroid and anti-gastric parietal cell antibodies in first degree relatives of patients with type 1 diabetes

Circulating Autoantibodies and Autoimmune Comorbidities in Vitiligo Patients: A Multicenter Italian Study

Background: Autoimmune comorbidities and circulating autoantibodies have been observed in vitiligo patients, but differences in rate are present according to countries in which the studies were performed, perhaps owing to ethnic diversities or different trigger factors. Objective: To estimate the prevalence of circulating autoantibodies and overt autoimmune diseases in a fairly large sample of Italian vitiligo patients. Methods: 175 outpatients affected by vitiligo and referred to nine dermatological centers were included in the study. Patients were offered routine blood test, serological testing for thyroid function and search for autoantibodies. Results: At least one circulating autoantibody was detected in 61 (41.8%) of 146 subjects who underwent laboratory tests. Anti-thyroperoxidase (25.6%), anti-thyroglobulin (23.4%), antinuclear antibodies (16.8%) and anti-gastric parietal cell antibodies (7.8%) were the most noticed autoantibodies. 74 (41.5%) autoimmune comorbidities, mainly autoimmune thyroiditis (37%), were reported. Conclusion: The prevalence of autoimmune comorbidities and circulating autoantibodies in this study was in agreement with other surveys conducted on Caucasian patients.