Autoimmune gastritis: diagnosis to effective therapy
DOI: 10.32364/2587-6821-2024-8-5-9
S.V. Shchelochenkov1,2, D.S. Bordin3–5, M.V. Chebotareva3, M.A. Lisovsky2, A.V. Gubanova2, O.N. Guskova5
1Immanuel Kant Baltic Federal University, Kaliningrad, Russian Federation
2Omsk State Medical University, Omsk, Russian Federation
3A.S. Loginov Moscow Clinical Research Center, Moscow, Russian Federation
4Russian University of Medicine, Moscow, Russian Federation
5Tver State Medical University, Tver, Russian Federation
In recent decades, there has been a tendency to decrease the Helicobacter pylori (HP) infection proportion in the structure of etiological factors concerning the chronic gastritis, which, on the one hand, was due to the success of eradication therapy, and on the other hand, due to a decrease in the number of new infections. At the same time, there is an increase in the importance of other disease causes, which were previously considered extremely rare, as well as a combined etiology, primarily with HP infection. Currently, international position papers attract the attention of clinicians to an increase in the autoimmune gastritis (AIG) prevalence in the adult population. Besides, in real clinical practice, AIG is commonly diagnosed at the stage of severe atrophy and formed macro and micro-nutrient deficiencies, requiring correction of nutritional status to prevent the development of significant neurological disorders, anemia syndrome, as well as osteopenia/osteoporosis. The presented article is aimed at drawing the practitioner's attention to possible morphological predictors of the disease and the difficulties in the diagnostic search for AIG that may arise during differential diagnosis, including if AIG is combined with HP infection, as well as when choosing effective pharmacotherapy.
Keywords: autoimmune gastritis, atrophic gastritis, Helicobacter pylori infection, gastroprotection, carcinoprevention, rebamipid.
For citation: Shchelochenkov S.V., Bordin D.S., Chebotareva M.V., Lisovsky M.A., Gubanova A.V., Guskova O.N. Autoimmune gastritis: diagnosis to effective therapy. Russian Medical Inquiry. 2024;8(5):299–306 (in Russ.). DOI: 10.32364/2587-6821-2024-8-5-9.
ABOUT THE AUTHORS:
Sergey V. Shchelochenkov — C. Sc. (Med.), Associate Professor of the Department of Therapy of the Institute of Medicine and Life Sciences, Immanuel Kant Baltic Federal University; 14, A. Nevskii str., Kaliningrad, 236016, Russian Federation; Associate Professor of the Department of Faculty Therapy and Gastroenterology, Omsk State Medical University; 12, Lenin str., Omsk, 644099, Russian Federation; ORCID iD 0000-0002-3811-2492.
Dmitry S. Bordin — Dr. Sc. (Mеd.), Head of the Department of Pathology of the Pancreas, Biliary Tract and Upper Digestive Tract, A.S. Loginov Moscow Clinical Research Center; 86, Entuziastov road, Moscow, 111123, Russian Federation; Professor of the Department of Propaedeutics of Internal Diseases and Gastroenterology, Russian University of Medicine; 20, build. 1, Delegatskaya str., Moscow, 127473, Russian Federation; Professor of the Department of General Medical Practice and Family Medicine, Tver State Medical University; 4, Sovetskaya str., Tver, 170100, Russian Federation; ORCID iD 0000-0003-2815-3992.
Margarita V. Chebotareva — specialist of the Organizational and Methodological Department of Gastroenterology Moscow Health Department, Junior Researcher at the Laboratory of Functional Diagnostics of the Esophagus and Stomach Diseases, A.S. Loginov Moscow Clinical Research Center; 86, Entuziastov road, Moscow, 111123, Russian Federation.
Maxim M. Lisovskiy — resident of the Department of Faculty Therapy and Gastroenterology, Omsk State Medical University; 12, Lenin str., Omsk, 644099, Russian Federation; ORCID iD 0000-0001-9674-0545.
Anastasia V. Gubanova — gastroenterologist, Assistant Professor of the Department of Faculty Therapy and Gastroenterology, Omsk State Medical University; 12, Lenin str., Omsk, 644099, Russian Federation.
Oksana N. Guskova — C. Sc. (Med.), Head of the Department of Pathological Anatomy, Tver State Medical University; 4, Sovetskaya str., Tver, 170100, Russian Federation; ORCID iD 0000-0003-1635-7533.
Contact information: Sergey V. Shchelochenkov, e-mail: workmedbox@gmail.com.
Financial Disclosure: the authors have no financial or property interest in any material or method mentioned.
There is no conflict of interest.
Received 05.04.2024.
Revised 30.04.2024.
Accepted 28.05.2024.
2. Livzan M.A., Gaus O.V., Mozgovoi S.I., Bordin D.S. Chronic Autoimmune Gastritis: Modern Diagnostic Principles. Diagnostics (Basel). 2021;11(11):2113. DOI: 10.3390/diagnostics11112113.
3. Carabotti M., Lahner E., Esposito G. et al. Upper gastrointestinal symptoms in autoimmune gastritis: A cross-sectional study. Medicine (Baltimore). 2017;96(1):e5784. DOI: 10.1097/MD.0000000000005784.
4. Rugge M., Genta R.M., Malfertheiner P. et al. RE.GA.IN.: the Real-world Gastritis Initiative-updating the updates. Gut. 2024;73(3):407–441. DOI: 10.1136/gutjnl-2023-331164.
5. Бордин Д.С., Мозговой С.И., Ливзан М.А. и др. Междисциплинарный консенсус RE.GA.IN.: что нового? Часть 1: дефиниции, Нelicobacter pylori-ассоциированный и аутоиммунный гастрит. Эффективная фармакотерапия. 2024;20(2):54–70. DOI: 10.33978/2307-3586-2024-20-2-54-70.Bordin D.S., Mozgovoy S.I., Livzan M.A. et al. Interdisciplinary Consensus RE.GA.IN.: What is New? Part I: Definitions, Helicobacter pylori-Associated and Autoimmune Gastritis. Effektivnaya farmakoterapiya. 2024;20(2):54–70 (in Russ.). DOI: 10.33978/2307-3586-2024-20-2-54-70.
6. Rugge M., Bricca L., Guzzinati S. et al. Autoimmune gastritis: long-term natural history in naïve Helicobacter pylori-negative patients. Gut. 2023;72(1):30–38. DOI: 10.1136/gutjnl-2022-327827.
7. Kato I., Tominaga S., Ito Y. et al. A prospective study of atrophic gastritis and stomach cancer risk. Jpn J Cancer Res. 1992;83(11):1137–1142. DOI: 10.1111/j.1349-7006.1992.tb02736.x.
8. Yue H., Shan L., Bin L. The significance of OLGA and OLGIM staging systems in the risk assessment of gastric cancer: a systematic review and meta-analysis. Gastric Cancer. 2018;21(4):579–587. DOI: 10.1007/s10120-018-0812-3.
9. Rugge M., Genta R.M., Malfertheiner P., Graham D.Y. Steps forward in understanding gastric cancer risk. Gut. 2023;72(9):1802–1803. DOI: 10.1136/gutjnl-2022-328514.
10. Livzan M.A., Mozgovoi S.I., Gaus O.V et al. Histopathological Evaluation of Gastric Mucosal Atrophy for Predicting Gastric Cancer Risk: Problems and Solutions. Diagnostics (Basel). 2023;13(15):2478. DOI: 10.3390/diagnostics13152478.
11. Delle Fave G., O'Toole D., Sundin A. et al. ENETS Consensus Guidelines Update for Gastroduodenal Neuroendocrine Neoplasms. Neuroendocrinology. 2016;103(2):119–124. DOI: 10.1159/000443168.
12. Panzuto F., Campana D., Massironi S. et al. Tumour type and size are prognostic factors in gastric neuroendocrine neoplasia: A multicentre retrospective study. Dig Liver Dis. 2019;51(10):1456–1460. DOI: 10.1016/j.dld.2019.04.016.
13. Ивашкин В.Т., Маев И.В., Лапина Т.Л. и др. Клинические рекомендации Российской гастроэнтерологической ассоциации и ассоциации «Эндоскопическое общество РЭНДО» по диагностике и лечению гастрита, дуоденита. Российский журнал гастроэнтерологии, гепатологии, колопроктологии. 2021;31(4):70–99. DOI: 10.22416/1382-4376-2021-31-4-70-99.Ivashkin V.T., Maev I.V., Lapina T.L. et al. Clinical Recommendations of Russian Gastroenterological Association and RENDO Endoscopic Society on Diagnosis and Treatment of Gastritis and Duodenitis. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2021;31(4):70–99 (in Russ.). DOI: 10.22416/1382-4376-2021-31-4-70-99.
14. Маев И.В., Лазебник Л.Б., Бордин Д.С. и др. Резолюция Экспертного совета «Необследованная диспепсия: краткосрочная и долгосрочная стратегии ведения пациента». Эффективная фармакотерапия. 2023;19(8):16–24. DOI: 10.33978/2307-3586-2023-19-8-16-24.Mayev I.V., Lazebnik L.B., Bordin D.S. et al. Expert Council Resolution "Unevaluated Dyspepsia: Short- and Long-Term Patient Management Strategies.” Effektivnaya farmakoterapiya. 2023;19(8):16–24 (in Russ.). DOI: 10.33978/2307-3586-2023-19-8-16-24.
15. Carabotti M., Lahner E., Esposito G. et al. Upper gastrointestinal symptoms in autoimmune gastritis: A cross-sectional study. Medicine (Baltimore). 2017;96(1):e5784. DOI: 10.1097/MD.0000000000005784.
16. Sanders K.M., Koh S.D., Ward S.M. Interstitial cells of cajal as pacemakers in the gastrointestinal tract. Annu Rev Physiol. 2006;68:307–343. DOI: 10.1146/annurev.physiol.68.040504.094718.
17. Yun H.Y., Sung R., Kim Y.C. et al. Regional Distribution of Interstitial Cells of Cajal (ICC) in Human Stomach. Korean J Physiol Pharmacol. 2010;14(5):317–324. DOI: 10.4196/kjpp.2010.14.5.317.
18. Waldron B., Cullen P.T., Kumar R. et al. Evidence for hypomotility in non-ulcer dyspepsia: a prospective multifactorial study. Gut. 1991;32(3):246–251. DOI: 10.1136/gut.32.3.246.
19. Elamami A.H., Elmehdwi N., Younis E.Z. et al. Pernicious Anemia Presented with Isolated Nominal Dysphasia in Type Ill Polyglandular Failure Female Patient. Cureus. 2018;10(9):e3306. DOI: 10.7759/cureus.3306.
20. Cavalcoli F., Zilli A., Conte D., Massironi S. Micronutrient deficiencies in patients with chronic atrophic autoimmune gastritis: A review. World J Gastroenterol. 2017;23(4):563–572. DOI: 10.3748/wjg.v23.i4.563.
21. Драпкина О.М., Авалуева Е.Б., Бакулин И.Г. и др. Ведение пациентов с железодефицитной анемией на этапе оказания первичной медико-санитарной помощи. Практическое руководство. М.: РОПНИЗ, ООО «Силицея–Полиграф»; 2022.Drapkina O.M., Avaluyeva Ye.B., Bakulin I.G. et al. Management of patients with iron deficiency anemia at the stage of primary health care. Practical guide. M.: ROPNIZ, OOO "Silitseya–Poligraf", 2022 (in Russ.).
22. Doyama H., Yoshida N., Tsuyama S. et al. The "white globe appearance" (WGA): a novel marker for a correct diagnosis of early gastric cancer by magnifying endoscopy with narrow-band imaging (M-NBI). Endosc Int Open. 2015;3(2):E120–E124. DOI: 10.1055/s-0034-1391026.
23. Yoshida N., Doyama H., Nakanishi H. et al. White globe appearance is a novel specific endoscopic marker for gastric cancer: A prospective study. Dig Endosc. 2016;28(1):59–66. DOI: 10.1111/den.12519.
24. Omura H., Yoshida N., Hayashi T. et al. Interobserver agreement in detection of "white globe appearance" and the ability of educational lectures to improve the diagnosis of gastric lesions. Gastric Cancer. 2017;20(4):620–628. DOI: 10.1007/s10120-016-0676-3.
25. Iwamuro M., Tanaka T., Sakae H. et al. Two cases of white globe appearance in non-cancerous stomach. Ecancermedicalscience. 2018;12:856. DOI: 10.3332/ecancer.2018.856.
26. Watanabe Y., Shimizu M., Itoh T., Nagashima K. Intraglandular necrotic debris in gastric biopsy and surgical specimens. Ann Diagn Pathol. 2001;5(3):141–147. DOI: 10.1053/adpa.2001.25405.
27. Iwamuro M., Tanaka T., Kanzaki H. et al. Two Cases of White Globe Appearance in Autoimmune Atrophic Gastritis. Case Rep Gastrointest Med. 2018;2018:7091520. DOI: 10.1155/2018/7091520.
28. Kishino M., Nonaka K. Endoscopic Features of Autoimmune Gastritis: Focus on Typical Images and Early Images. J Clin Med. 2022;11(12):3523. DOI: 10.3390/jcm11123523.
29. Waldum H., Fossmark R. Gastritis, Gastric Polyps and Gastric Cancer. Int J Mol Sci. 2021;22(12):6548. DOI: 10.3390/ijms22126548.
30. Hong K.S., Kim B.J., Lee J.Y. et al. Rationale and design of the PreventIon of CArdiovascular events in iSchemic Stroke patients with high risk of cerebral hemOrrhage (PICASSO) study: A randomized controlled trial. Int J Stroke. 2015;10(7):1153–1158. DOI: 10.1111/ijs.12519.
31. Stolte M., Baumann K., Bethke B. et al. Active autoimmune gastritis without total atrophy of the glands. Z Gastroenterol. 1992;30(10):729–735. PMID: 1441676.
32. Itsuno M., Watanabe H., Iwafuchi M. et al. Multiple carcinoids and endocrine cell micronests in type A gastritis. Their morphology, histogenesis, and natural history. Cancer. 1989;63(5):881–890. DOI: 10.1002/1097-0142(19890301)63:5<881::aid-cncr2820630515>3.0.co;2-k.
33. Rugge M., Fassan M., Pizzi M. et al. Autoimmune gastritis: histology phenotype and OLGA staging. Aliment Pharmacol Ther. 2012;35(12):1460–1466. DOI: 10.1111/j.1365-2036.2012.05101.x.
34. McNicholl A.G., Forné M., Barrio J. et al. Accuracy of GastroPanel for the diagnosis of atrophic gastritis. Eur J Gastroenterol Hepatol. 2014;26(9):941–948. DOI: 10.1097/MEG.0000000000000132.
35. Lijinsky W. N-Nitroso compounds in the diet. Mutat Res. 1999;443(1-2):129–138. DOI: 10.1016/s1383-5742(99)00015-0.
36. Poplawski T., Chojnacki C., Czubatka A. et al. Helicobacter pylori infection and antioxidants can modulate the genotoxic effects of heterocyclic amines in gastric mucosa cells. Mol Biol Rep. 2013;40(8):5205–5212. DOI: 10.1007/s11033-013-2622-3.
37. Ohgaki H., Takayama S., Sugimura T. Carcinogenicities of heterocyclic amines in cooked food. Mutat Res. 1991;259(3-4):399–410. DOI: 10.1016/0165-1218(91)90130-e.
38. Tsugane S. Salt, salted food intake, and risk of gastric cancer: epidemiologic evidence. Cancer Sci. 2005;96(1):1–6. DOI: 10.1111/j.1349-7006.2005.00006.x.
39. Poorolajal J., Moradi L., Mohammadi Y. et al. Risk factors for stomach cancer: a systematic review and meta-analysis. Epidemiol Health. 2020;42:e2020004. DOI: 10.4178/epih.e2020004.
40. Ливзан М.А., Гаус О.В., Мозговой С.И. Хронический атрофический гастрит: тактика курации пациента. РМЖ. Медицинское обозрение. 2021;5(6):427–432. DOI: 10.32364/2587-6821-2021-5-6-427-432.Livzan M.A., Gaus O.V., Mozgovoi S.I. Chronic atrophic gastritis: patient management. Russian Medical Inquiry. 2021;5(6):427–432 (in Russ.). DOI: 10.32364/2587-6821-2021-5-6-427-432.
41. Ивашкин В.Т., Лапина Т.Л., Маев И.В. и др. Клинические рекомендации Российской гастроэнтерологической ассоциации, Научного сообщества по содействию клиническому изучению микробиома человека, Российского общества профилактики неинфекционных заболеваний, Межрегиональной ассоциации по клинической микробиологии и антимикробной химиотерапии по диагностике и лечению H. pylori у взрослых. Российский журнал гастроэнтерологии, гепатологии, колопроктологии. 2022;32(6):72–93. DOI: 10.22416/1382-4376-2022-32-6-72-93.Ivashkin V.T., Lapina T.L., Maev I.V. et al. Clinical Practice Guidelines of Russian Gastroenterological Association, Scientific Society for the Clinical Study of Human Microbiome, Russian Society for the Prevention of Non-Communicable Diseases, Interregional Association for Clinical Microbiology and Antimicrobial Chemotherapy for Н. pylori Diagnostics and Treatment in Adults. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2022;32(6):72–93 (in Russ.). DOI: 10.22416/1382-4376-2022-32-6-72-93.
42. Nishizawa T., Nishizawa Y., Yahagi N. et al. Effect of supplementation with rebamipide for Helicobacter pylori eradication therapy: a systematic review and meta-analysis. J Gastroenterol Hepatol. 2014;29 Suppl 4:20–24. DOI: 10.1111/jgh.12769.
43. Андреев Д.Н., Маев И.В., Бордин Д.С. и др. Эффективность включения ребамипида в схемы эрадикационной терапии инфекции Helicobacter pylori в России: метаанализ контролируемых исследований. Consilium Medicum. 2022;24(5):333–338. DOI: 10.26442/20751753.2022.5.201863.Andreev D.N., Maev I.V., Bordin D.S. et al. Effectiveness of Rebamipide as a part of the Helicobacter pylori eradication therapy in Russia: a meta-analysis of controlled trials. Consilium Medicum. 2022;24(5):333–338 (in Russ.). DOI: 10.26442/20751753.2022.5.201863.
44. Bordin D.S., Voynovan I.N., Andreev D.N., Maev I.V. Current Helicobacter pylori Diagnostics. Diagnostics (Basel). 2021;11(8):1458. DOI: 10.3390/diagnostics11081458.
45. Hou D., Yang M., Hu Z., Yang L. Effects of rebamipide for chronic atrophic gastritis: A protocol for systematic review and meta-analysis. Medicine (Baltimore). 2020;99(25):e20620. DOI: 10.1097/MD.0000000000020620.
46. Бакулина Н.В., Тихонов С.В., Оковитый С.В. и др. Фармакокинетика и фармакодинамика ребамипида. Новые возможности терапии. Терапевтический архив. 2022;94(12):1431–1437. DOI: 10.26442/00403660.2022.12.202000.Bakulina N.V., Tikhonov S.V., Okovityi S.V. et al. Pharmacokinetics and pharmacodynamics of rebamipide. New possibilities of therapy: A review. Terapevticheskii Arkhiv. 2022;94(12):1431–1437 (in Russ.). DOI: 10.26442/00403660.2022.12.202000.
47. Seo G.H., Lee H. Chemopreventive Effect of Rebamipide against Gastric Cancer in Patients who undergo Endoscopic Resection for Early Gastric Neoplasms: A Nationwide Claims Study. Digestion. 2019;100(4):221–228. DOI: 10.1159/000495288.
48. Pimentel-Nunes P., Libânio D., Marcos-Pinto R. et al. Management of epithelial precancerous conditions and lesions in the stomach (MAPS II): European Society of Gastrointestinal Endoscopy (ESGE), European Helicobacter and Microbiota Study Group (EHMSG), European Society of Pathology (ESP), and Sociedade Portuguesa de Endoscopia Digestiva (SPED) guideline update 2019. Endoscopy. 2019;51(4):365–388. DOI: 10.1055/a-0859-1883.
49. Lenti M.V., Rugge M., Lahner E. et al. Autoimmune gastritis. Nat Rev Dis Primers. 2020;6(1):56. DOI: 10.1038/s41572-020-0187-8.
50. Ливзан М.А., Гаус О.В., Лисовский М.А. и др. Диспансерное наблюдение хронического атрофического гастрита. Экспериментальная и клиническая гастроэнтерология. 2023;3:148–155. DOI: 10.31146/1682-8658-ecg-211-3-148-155.Livzan M.A., Gaus O.V., Lisovskiy M.A. et al. Clinical supervision of chronic atrophic gastritis. Experimental and Clinical Gastroenterology. 2023;3:148–155 (in Russ.). DOI: 10.31146/1682-8658-ecg-211-3-148-155.
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