Atrophic gastritis

Last updated
Atrophic gastritis
Other namesType A gastritis [1]
Atroficheskii gastrit.jpg
Atrophic gastritis
Specialty Gastroenterology

Atrophic gastritis is a process of chronic inflammation of the gastric mucosa of the stomach, leading to a loss of gastric glandular cells and their eventual replacement by intestinal and fibrous tissues. As a result, the stomach's secretion of essential substances such as hydrochloric acid, pepsin, and intrinsic factor is impaired, leading to digestive problems. The most common are vitamin B12 deficiency possibly leading to pernicious anemia; and malabsorption of iron, leading to iron deficiency anaemia. [2] It can be caused by persistent infection with Helicobacter pylori , or can be autoimmune in origin. Those with autoimmune atrophic gastritis (Type A gastritis) are statistically more likely to develop gastric carcinoma, Hashimoto's thyroiditis, and achlorhydria.

Contents

Type A gastritis primarily affects the fundus (body) of the stomach and is more common with pernicious anemia. [1] Type B gastritis primarily affects the antrum, and is more common with H. pylori infection. [1]

Signs and symptoms

Some people with atrophic gastritis may be asymptomatic. Symptomatic patients are mostly females and signs of atrophic gastritis are those associated with iron deficiency: fatigue, restless legs syndrome, brittle nails, hair loss, impaired immune function, and impaired wound healing. [3] And other symptoms, such as delayed gastric emptying (80%), reflux symptoms (25%), peripheral neuropathy (25% cases), autonomic abnormalities, and memory loss, are less common and occur in 1%–2% of cases. Psychiatric disorders are also reported, such as mania, depression, obsessive compulsive disorder, psychosis and cognitive impairment. [4]

Although autoimmune atrophic gastritis impairs iron and vitamin B12 absorption, iron deficiency is detected at a younger age than pernicious anemia. [3]

Associated conditions

People with atrophic gastritis are also at increased risk for the development of gastric adenocarcinoma. [5]

Causes

Recent research has shown that autoimmune metaplastic atrophic gastritis (AMAG) is a result of the immune system attacking the parietal cells. [6]

Environmental metaplastic atrophic gastritis (EMAG) is due to environmental factors, such as diet and H. pylori infection. EMAG is typically confined to the body of the stomach. Patients with EMAG are also at increased risk of gastric carcinoma. [7]

Pathophysiology

Atrophic gastritis under low power. H&E stain. Atrophic gastritis (low zoom).jpg
Atrophic gastritis under low power. H&E stain.

Autoimmune metaplastic atrophic gastritis (AMAG) is an inherited form of atrophic gastritis characterized by an immune response directed toward parietal cells and intrinsic factor. [6] The presence of serum antibodies to parietal cells and to intrinsic factor are characteristic findings. The autoimmune response subsequently leads to the destruction of parietal cells, which leads to profound Achlorhydria (and elevated gastrin levels). The inadequate production of intrinsic factor also leads to vitamin B12 malabsorption and pernicious anemia. AMAG is typically confined to the gastric body and fundus.[ citation needed ]

Achlorhydria induces G cell (gastrin-producing) hyperplasia, which leads to hypergastrinemia. Gastrin exerts a trophic effect on enterochromaffin-like cells (ECL cells are responsible for histamine secretion) and is hypothesized to be one mechanism to explain the malignant transformation of ECL cells into carcinoid tumors in AMAG. [8]

Diagnosis

Detection of APCA(Antiparietal cell antibody), anti-intrinsic factor antibody (AIFA) and Helicobacter pylori (HP) antibodies in conjunction with serum gastrin are effective for diagnostic purposes. [9]

Classification

The notion that atrophic gastritis could be classified depending on the level of progress as "closed type" or "open type" was suggested in early studies, [10] but no universally accepted classification exists as of 2017. [9]

Treatment

Supplementation of folic acid in deficient patients can improve the histopathological findings of chronic atrophic gastritis and reduce the incidence of gastric cancer. [11]

See also

Related Research Articles

<span class="mw-page-title-main">Stomach</span> Digestive organ

The stomach is a muscular, hollow organ in the gastrointestinal tract of humans and many other animals, including several invertebrates. The stomach has a dilated structure and functions as a vital organ in the digestive system. The stomach is involved in the gastric phase of digestion, following chewing. It performs a chemical breakdown by means of enzymes and hydrochloric acid.

Peptic ulcer disease is a break in the inner lining of the stomach, the first part of the small intestine, or sometimes the lower esophagus. An ulcer in the stomach is called a gastric ulcer, while one in the first part of the intestines is a duodenal ulcer. The most common symptoms of a duodenal ulcer are waking at night with upper abdominal pain, and upper abdominal pain that improves with eating. With a gastric ulcer, the pain may worsen with eating. The pain is often described as a burning or dull ache. Other symptoms include belching, vomiting, weight loss, or poor appetite. About a third of older people with peptic ulcers have no symptoms. Complications may include bleeding, perforation, and blockage of the stomach. Bleeding occurs in as many as 15% of cases.

<span class="mw-page-title-main">Anemia</span> Reduced ability of blood to carry oxygen

Anemia or anaemia is a blood disorder in which the blood has a reduced ability to carry oxygen. This can be due to a lower than normal number of red blood cells, a reduction in the amount of hemoglobin available for oxygen transport, or abnormalities in hemoglobin that impair its function. The name is derived from Ancient Greek ἀν- (an-) 'not', and αἷμα (haima) 'blood'. When anemia comes on slowly, the symptoms are often vague, such as tiredness, weakness, shortness of breath, headaches, and a reduced ability to exercise. When anemia is acute, symptoms may include confusion, feeling like one is going to pass out, loss of consciousness, and increased thirst. Anemia must be significant before a person becomes noticeably pale. Additional symptoms may occur depending on the underlying cause. Anemia can be temporary or long term and can range from mild to severe.

<i>Helicobacter pylori</i> Species of bacteria

Helicobacter pylori, previously known as Campylobacter pylori, is a gram-negative, flagellated, helical bacterium. Mutants can have a rod or curved rod shape, and these are less effective. Its helical body is thought to have evolved in order to penetrate the mucous lining of the stomach, helped by its flagella, and thereby establish infection. The bacterium was first identified as the causal agent of gastric ulcers in 1983 by the Australian doctors Barry Marshall and Robin Warren.

<span class="mw-page-title-main">Intrinsic factor</span> Glycoprotein produced in the stomach which binds to vitamin B12

Intrinsic factor (IF), cobalamin binding intrinsic factor, also known as gastric intrinsic factor (GIF), is a glycoprotein produced by the parietal cells (in humans) or chief cells (in rodents) of the stomach. It is necessary for the absorption of vitamin B12 later on in the distal ileum of the small intestine. In humans, the gastric intrinsic factor protein is encoded by the CBLIF gene. Haptocorrin (transcobalamin I) is another glycoprotein secreted by the salivary glands which binds to vitamin B12. Vitamin B12 is acid-sensitive and in binding to haptocorrin it can safely pass through the acidic stomach to the duodenum.

<span class="mw-page-title-main">Pernicious anemia</span> Anemia caused by vitamin B12 deficiency

Pernicious anemia is a disease where not enough red blood cells are produced due to a deficiency of vitamin B12. Those affected often have a gradual onset. The most common initial symptoms are feeling tired and weak. Other symptoms may include shortness of breath, feeling faint, a smooth red tongue, pale skin, chest pain, nausea and vomiting, loss of appetite, heartburn, numbness in the hands and feet, difficulty walking, memory loss, muscle weakness, poor reflexes, blurred vision, clumsiness, depression, and confusion. Without treatment, some of these problems may become permanent.

<span class="mw-page-title-main">Gastrin</span> Mammalian protein found in Homo sapiens

Gastrin is a peptide hormone that stimulates secretion of gastric acid (HCl) by the parietal cells of the stomach and aids in gastric motility. It is released by G cells in the pyloric antrum of the stomach, duodenum, and the pancreas.

<span class="mw-page-title-main">Parietal cell</span> Epithelial cell in the stomach

Parietal cells (also known as oxyntic cells) are epithelial cells in the stomach that secrete hydrochloric acid (HCl) and intrinsic factor. These cells are located in the gastric glands found in the lining of the fundus and body regions of the stomach. They contain an extensive secretory network of canaliculi from which the HCl is secreted by active transport into the stomach. The enzyme hydrogen potassium ATPase (H+/K+ ATPase) is unique to the parietal cells and transports the H+ against a concentration gradient of about 3 million to 1, which is the steepest ion gradient formed in the human body. Parietal cells are primarily regulated via histamine, acetylcholine and gastrin signalling from both central and local modulators.

<span class="mw-page-title-main">Gastrectomy</span> Surgical removal of the stomach

A gastrectomy is a partial or total surgical removal of the stomach.

<span class="mw-page-title-main">Gastritis</span> Stomach disease that is an inflammation of the lining of the stomach

Gastritis is inflammation of the lining of the stomach. It may occur as a short episode or may be of a long duration. There may be no symptoms but, when symptoms are present, the most common is upper abdominal pain. Other possible symptoms include nausea and vomiting, bloating, loss of appetite and heartburn. Complications may include stomach bleeding, stomach ulcers, and stomach tumors. When due to autoimmune problems, low red blood cells due to not enough vitamin B12 may occur, a condition known as pernicious anemia.

<span class="mw-page-title-main">Achlorhydria</span> Medical condition

Achlorhydria and hypochlorhydria refer to states where the production of hydrochloric acid in gastric secretions of the stomach and other digestive organs is absent or low, respectively. It is associated with various other medical problems.

<span class="mw-page-title-main">G cell</span> Type of cell in the stomach and duodenum that secretes gastrin

In anatomy, the G cell or gastrin cell is a type of cell in the stomach and duodenum that secretes gastrin. It works in conjunction with gastric chief cells and parietal cells. G cells are found deep within the pyloric glands of the stomach antrum, and occasionally in the pancreas and duodenum. The vagus nerve innervates the G cells. Gastrin-releasing peptide is released by the post-ganglionic fibers of the vagus nerve onto G cells during parasympathetic stimulation. The peptide hormone bombesin also stimulates gastrin from G cells. Gastrin-releasing peptide, as well as the presence of amino acids in the stomach, stimulates the release of gastrin from the G cells. Gastrin stimulates enterochromaffin-like cells to secrete histamine. Gastrin also targets parietal cells by increasing the amount of histamine and the direct stimulation by gastrin, causing the parietal cells to increase HCl secretion in the stomach. G-cells frequently express PD-L1 during homeostasis which protects them from Helicobacter pylori-induced immune destruction

<span class="mw-page-title-main">MALT lymphoma</span> Medical condition

MALT lymphoma is a form of lymphoma involving the mucosa-associated lymphoid tissue (MALT), frequently of the stomach, but virtually any mucosal site can be affected. It is a cancer originating from B cells in the marginal zone of the MALT.

<span class="mw-page-title-main">Gastric antral vascular ectasia</span> Medical condition of the stomach

Gastric antral vascular ectasia (GAVE) is an uncommon cause of chronic gastrointestinal bleeding or iron deficiency anemia. The condition is associated with dilated small blood vessels in the pyloric antrum, which is a distal part of the stomach. The dilated vessels result in intestinal bleeding. It is also called watermelon stomach because streaky long red areas that are present in the stomach may resemble the markings on watermelon.

<span class="mw-page-title-main">Gastric glands</span> Glands in lining of the human stomach

The gastric glands are glands in the lining of the stomach that play an essential role in the process of digestion. All of the glands have mucus-secreting foveolar cells. Mucus lines the entire stomach, and protects the stomach lining from the effects of hydrochloric acid released from other cells in the glands.

Gastric hydrogen potassium ATPase, also known as H+/K+ ATPase, is an enzyme which functions to acidify the stomach. It is a member of the P-type ATPases, also known as E1-E2 ATPases due to its two states.

<span class="mw-page-title-main">Ménétrier's disease</span> Medical condition

Ménétrier disease is a rare, acquired, premalignant disease of the stomach characterized by massive gastric folds, excessive mucous production with resultant protein loss, and little or no acid production. The disorder is associated with excessive secretion of transforming growth factor alpha (TGF-α). It is named after a French physician Pierre Eugène Ménétrier, 1859–1935.

<span class="mw-page-title-main">Gastric mucosa</span> Mucous membrane layer of the stomach

The gastric mucosa is the mucous membrane layer of the stomach, which contains the glands and the gastric pits. In humans, it is about 1 mm thick, and its surface is smooth, soft, and velvety. It consists of simple columnar epithelium, lamina propria, and the muscularis mucosae.

<span class="mw-page-title-main">Stomach disease</span> Medical condition

Stomach diseases include gastritis, gastroparesis, Crohn's disease and various cancers.

Cubam, is the term used to refer to a multi-ligand receptor located in the terminal ileum, specializing in absorption of vitamin B12. Cubam is essentially composed of amnionless (AMN), and cubilin. Cubilin is essential as a cell receptor recognizing the "vitamin B12-intrinsic factor" complex, whereas amnionless is more involved in the receptor mediated endocytosis of the complex.

References

  1. 1 2 3 Blaser MJ (May 1988). "Type B gastritis, aging, and Campylobacter pylori". Arch. Intern. Med. 148 (5): 1021–2. doi:10.1001/archinte.1988.00380050027005. ISSN   0003-9926. PMID   3365072.
  2. Annibale B, Capurso G, Lahner E, Passi S, Ricci R, Maggio F, Delle Fave G (April 2003). "Concomitant alterations in intragastric pH and ascorbic acid concentration in patients with Helicobacter pylori gastritis and associated iron deficiency anaemia". Gut. 52 (4): 496–501. doi:10.1136/gut.52.4.496. ISSN   0017-5749. PMC   1773597 . PMID   12631657.
  3. 1 2 Stefanie Kulnigg-Dabsch (2016). "Autoimmune gastritis". Wien Med Wochenschr. 166 (13–14): 424–430. doi:10.1007/s10354-016-0515-5. PMC   5065578 . PMID   27671008.
  4. Sara Massironi; Alessandra Zilli; Alessandra Elvevi; Pietro Invernizzi (2019). "The changing face of chronic autoimmune atrophic gastritis: an updated comprehensive perspective". Autoimmun. Rev. 18 (3): 215–222. doi:10.1016/j.autrev.2018.08.011. PMID   30639639. S2CID   58551484.
  5. Giannakis M, Chen SL, Karam SM, Engstrand L, Gordon JI (March 2008). "Helicobacter pylori evolution during progression from chronic atrophic gastritis to gastric cancer and its impact on gastric stem cells". Proc. Natl. Acad. Sci. U.S.A. 105 (11): 4358–63. Bibcode:2008PNAS..105.4358G. doi: 10.1073/pnas.0800668105 . PMC   2393758 . PMID   18332421.
  6. 1 2 Nimish Vakil, MD, Clinical Adjunct Professor, University of Madison School of Medicine and Public Health. "Autoimmune Metaplastic Atrophic Gastritis: Gastritis and Peptic Ulcer Disease: Merck Manual Professional". MSD Manual Professional Version. Merck & Co.
  7. "Atrophic Gastritis - Cleveland Clinic".
  8. Waldum H, Mjønes P (November 2020). "Towards Understanding of Gastric Cancer Based upon Physiological Role of Gastrin and ECL Cells". Cancers (Basel). 12 (11): 3477. doi: 10.3390/cancers12113477 . PMC   7700139 . PMID   33266504.
  9. 1 2 Minalyan A, Benhammou JN, Artashesyan A, Lewis MS, Pisegna JR (2017). "Autoimmune atrophic gastritis: current perspectives". Clin Exp Gastroenterol. 10: 19–27. doi: 10.2147/CEG.S109123 . PMC   5304992 . PMID   28223833.
  10. Kimura, K.; Takemoto, T. (2008). "An Endoscopic Recognition of the Atrophic Border and its Significance in Chronic Gastritis". Endoscopy. 1 (3): 87–97. doi:10.1055/s-0028-1098086. ISSN   0013-726X. S2CID   70488969.
  11. Fang JY, Du YQ, Liu WZ, Ren JL, Li YQ, Chen XY, Lv NH, Chen YX, Lv B, Chinese Society of Gastroenterology, Chinese Medical Association (2018). "Chinese consensus on chronic gastritis (2017, Shanghai)". Journal of Digestive Diseases. 19 (4): 182–203. doi:10.1111/1751-2980.12593. PMID   29573173. S2CID   4240988.