Serum Parietal Cell Antibodies Research Articles

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.

Abstract 2819: Serum parietal cell antibodies, gastrin G17 concentration and risk of gastric cancer: A 15 year prospective assessment

Abstract Background: We conducted a prospective nested case-cohort analysis within a high-risk Chinese population to determine if baseline serum PCAs or gastrin was associated with an increased risk of gastric or esophageal cancer during 15 years of follow-up. Methods: The study included 200 cases of gastric cardia adenocarcinoma (GCA), 200 gastric non-cardia adenocarcinomas (GNCA), 100 esophageal squamous cell carcinomas (ESCC), and a 400 person subcohort of the Linxian General Population Nutritional Intervention Trial cohort. Serum PCA and gastrin G17 concentrations were measured using enzyme-linked immunosorbent assays. Mean sample concentrations were calculated by averaging duplicate optical density measures. Cox proportional hazards models were used to estimate crude and adjusted hazard ratios (HRs) and 95% confidence intervals (95% CIs), using case-cohort models. Models assessed high PCA (Q4 vs Q1) or low gastrin G17 (Q1 vs Q4) and cancer risk. H. pylori status and pepsinogen serology were previously determined (Kamangar et al. Br J. Ca 2007, Ren et al. Gut 2009). Results: The average time from baseline to cancer diagnosis was 8.1 years. Serum PCA concentrations were non-significantly lower in those who developed GCA than in the subcohort, and were inversely associated with GCA risk. Serum gastrin G17 concentrations were significantly lower in those who developed GNCA than in the subcohort, and were inversely associated with GNCA risk. Neither serum PCA nor gastrin G17 concentration was associated with ESCC risk. These associations were independent of gender, age, smoking, serum pepsinogen I and II concentrations, and H. pylori status. PCA concentration, median (IQR)PwilcoxonPCA Q4 vs Q1PtrendSubcohort (N= 424)0.84 (0.26-5.8)---ESCC (N=95)1.02 (0.32-6.3)0.231.28 (0.65-2.53)>0.5Cardia (N=193)0.59 (0.23-3.2)0.0700.53 (0.30-0.93)0.013Noncardia (N=193)0.85 (0.27-5.4)0.830.76 (0.42-1.35)>0.5 G17 concentration median (IQR)PwilcoxonG17 Q1 vs Q4PtrendSubcohort (N= 424)3.16 (0.78-8.33)-- ESCC (N=95)3.23 (0.57-10.39)0.731.06 (0.55-2.03)0.91Cardia (N=193)3.23 (0.87-6.89)0.681.54 (0.83-2.87)0.30Noncardia (N=193)2.20 (0.30-5.70)0.00203.72 (1.83-7.57)0.00020 Conclusion: High serum parietal cell antibodies were associated with a decreased risk of GCA, and low serum gastrin G17 levels were associated with an increased risk of GNCA in this high-risk population. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 2819.

L-Thyroxine Requirement in Patients with Autoimmune Hypothyroidism and Parietal Cell Antibodies

Hypothyroid patients on l-T(4) therapy may require replacement doses exceeding the theoretical needs to normalize serum TSH due to low patient compliance, drugs interference, and malabsorption. We examined whether autoimmune gastritis might cause increased l-T(4) requirement in patients with autoimmune thyroiditis receiving l-T(4) replacement. We studied 391 patients with clinical or subclinical hypothyroidism from autoimmune thyroiditis who had achieved normal serum TSH concentration (0.3-3.0 microU/ml) under l-T(4) for at least 6 months. Patients were screened for serum parietal cell antibodies (PCA) as a marker of autoimmune gastritis, and the PCA status was correlated with the l-T(4) dose. We also studied a group of 60 patients receiving l-T(4) replacement after total thyroidectomy. PCA-positive (155 of 391) and PCA-negative (236 of 391) patients did not differ for pretherapy serum TSH levels and thyroid volume. The l-T(4) requirement was significantly (P = 0.002) higher in PCA-positive (1.24 +/- 0.40 microg/kg x d) than in PCA-negative patients (1.06 +/- 0.36 microg/kg x d), and a significant positive correlation was found between l-T(4) requirement and serum PCA levels. Among PCA-positive patients, l-T(4) requirement was even higher in those with proven gastritis (1.52 +/- 0.40 microg/kg x d) compared with those without gastric damage (1.15 +/- 0.33 microg/kg x d) (P < 0.0001). The increased l-T(4) requirement was confirmed also in PCA-positive thyroidectomized patients (1.81 +/- 0.27 microg/kg x d) compared with PCA-negative thyroidectomized patients (1.52 +/- 0.24 microg/kg x d). Independent variables affecting l-T(4) requirement were PCA and serum TSH at diagnosis. Autoimmune gastritis is an additional factor affecting l-T(4) requirement in patients with autoimmune thyroiditis. Serum PCA measurement should be considered in patients with an unexplained high requirement of l-T(4).

Autoimmune hepatitis, autoimmune gastritis, and gastric carcinoid in a type 1 diabetic patient: A case report

The history of a 45-year-old male type 1 diabetic patient is presented. At the age of 29 years, he was diagnosed to have an autoimmune hepatitis with incipient liver cirrhosis. Five years later, a successful liver/pancreas transplantation was performed. Eighteen months later, however, pancreatic insufficiency occurred due to thrombosis of the pancreatic graft. Besides these conditions, iron deficiency, pernicious anemia, and autoimmune gastritis were also diagnosed. Serum parietal cell antibodies (PCA) and intrinsic factor antibodies (AIF) were positive. At 45, this patient was found to have a gastric carcinoid tumor. The clinical importance of PCA is discussed with regard to chronic atrophic gastritis and pernicious anemia, which both predispose toward gastric carcinoid tumors. Autoimmune type 1 diabetic patients who have a high prevalence of PCA should be screened for gastric autoimmune manifestations and tumors, as the history of this patient illustrates.

Epidemic gastritis with hypochlorhydria

Seventeen of 37 healthy volunteers participating in studies of acid secretion and 2 patient with Zollinger-Ellison syndrome became rapidly and profoundly hypochlorhydric. A mild illness with epigastric pain occurred in 9 subjects, usually several days before detection of hypochlorhydria. Gastric mucosal biopsy specimens taken from subjects during hypochlorhydria revealed severe fundal and antral gastritis; however, even when acid secretion was severely depressed, parietal cells were abundant and appeared normal histologically. During hypochlorhydria, gastric permeability to hydrogen, sodium, and lithium was normal in 4 subjects. Serum gastrin concentrations were usually normal, whereas serum pepsinogen concentrations were invariably elevated. Serum parietal cell antibodies were not present. Acid secretion returned to near baseline levels in 14 of 17 subjects after a mean of 126 days (range 53–235); severity of gastritis diminished concurrently in 7 of 10 subjects on whom biopsies were serially performed. An infectious etiology is suspected, although serologic studies and bacterial and conventional viral cultures of stool and gastric juice have not identified a candidate agent.