Natural history of autoimmune atrophic gastritis: a prospective, single centre, long-term experience

Emanuela Miceli, Alessandro Vanoli, Marco Vincenzo Lenti, Catherine Klersy, Michele Di Stefano, Ombretta Luinetti, Costanza Caccia Dominioni, Martina Pisati, Martina Staiani, Antonella Gentile, Francesca Capuano, Giovanni Arpa, Marco Paulli, Gino Roberto Corazza, Antonio Di Sabatino

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Autoimmune atrophic gastritis (AAG) is an immune-mediated disorder characterised by destruction of gastric oxyntic mucosa. Aims: To explore gastric histopathological evolution in a cohort of AAG patients over a prolonged follow-up. Methods: Single centre prospective study enrolling consecutive patients with histologically confirmed AAG between 2000 and 2018. All AAG patients undergoing endoscopic follow-up every 1-3 years were classified as having stages 1, 2 or 3 according to atrophy severity (mild, moderate and severe). AAG patients with either glandular or neuroendocrine dysplasia/neoplasia were classified as having stage 4. Disease stage progression, and changes in serum anti-parietal cell antibody (PCA), chromogranin A and gastrin-17 were assessed. Results: In total, 282 AAG patients (mean age 60.3 years; F:M ratio 2.4:1; median follow-up 3 years, interquartile range 1-7) were enrolled. All patients with stages 1 or 2 progressed to stage 2 or 3 over time with a steady trend (P =.243) and regression from a severe to a milder stage was never noticed. Disease progression of patients with stages 1 or 2 occurred within the first 3 years. PCA positivity rate did not change over time. Stage 3 patients had higher gastrin-17 levels compared to patients with stages 1 and 2 (median 606 vs 295 pg/mL; P <.001). In stage 3, the hazard ratio for the risk of developing stage 4 was 6.6 (95% CI 1.5-29; P =.001). Conclusions: AAG is a steadily progressive disease, in which stages 1 and 2 always progress to stage 3. The risk of developing a complicated disease stage is greater in patients with more severe gastric lesions.

Original languageEnglish
JournalAlimentary Pharmacology and Therapeutics
DOIs
Publication statusAccepted/In press - Jan 1 2019

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology
  • Pharmacology (medical)

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