Autoimmune atrophic gastritis: current perspectives

Figures & data

Figure 1 Human gastric biopsy showing gastric gland atrophy.

Figure 2 Human gastric biopsy showing lymphocytic infiltrate.

Table 1 Comparison of AMAG with H. pylori-induced atrophic gastritis

Characteristics	Type of atrophic gastritis
	Autoimmune metaplastic	H. pylori induced
Pattern of distribution	Corpus and fundus (antrum is spared)	Multifocal including
ECL cell hyperplasia	Common	Rare
Parietal cell pseudohypertrophy	Common	Usually secondary to PPI use
Oxyntic gland involvement	Common	Rare
Inflammatory changes	Lymphocytes, plasma cells	Active inflammation, band-like lesions
Depth of inflammation	Lamina propria is usually involved	Superficial layers
Gastrin-17 level	High	Low but may be elevated
Pepsinogen I level	Low	Normal
Pepsinogen II level	Normal	Varies
Antibodies	Against parietal cells and intrinsic factor	Against H. pylori
Clinical manifestations	Asymptomatic or dyspepsia; symptoms of associated autoimmune conditions	Asymptomatic or dyspepsia
Risk of gastric neoplasms	Increased risk of gastric cancer and carcinoid	Increased risk of gastric cancer and carcinoid

Abbreviations: AMAG, autoimmune metaplastic atrophic gastritis; H. pylori, Helicobacter pylori; ECL, enterochromaffin like; PPI, proton pump inhibitor.

Table 2 Comparison of different types of gastric carcinoids

Parameters	Gastric carcinoid
	Type I	Type II	Type III
Frequency	65–80%	5–6%	14–25%
Gender	More common in females	No gender differences	More common in males
Age (years)	40–60	45	50
Associated conditions	AMAG	MEN1; ZES	None
Endoscopic features	Multiple, small	Similar to type I	Solitary, large, ulcerated
Affected areas	Corpus and fundus	Similar to type I + antrum	Anywhere
Gastrin (level)	Increased	Increased	N
G-cell hyperplasia	Yes	No	No
ECL cell hyperplasia	Yes	Yes	No
Management	Surveillance, somatostatin analogs, endoscopic or surgical excision	Similar to type I	Surgical (radical)
Risk of metastases to regional lymph nodes and liver	Very low	Low	High
Prognosis	Excellent	Excellent	Variable

Abbreviations: AMAG, autoimmune metaplastic atrophic gastritis; MEN1, multiple endocrine neoplasia type 1; ZES, Zollinger-Ellison syndrome; ECL, enterochromaffin like; N, normal.