Stomach
Gastritis
Autoimmune gastritis

Authors: Elliot Weisenberg, M.D. (see Authors page)

Revised: 22 November 2016, last major update July 2012

Copyright: (c) 2003-2016, PathologyOutlines.com, Inc.

PubMed Search: autoimmune gastritis[title]
Cite this page: Autoimmune gastritis. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/stomachautoimmunegastritis.html. Accessed December 8th, 2016.
Definition / General
  • Also called type A gastritis
  • < 10% of cases of chronic gastritis
  • Often autosomal dominant
Clinical Features
  • Associated with other autoimmune diseases (Hashimotos thyroiditis, Addisons disease) but NOT with Helicobacter pylori gastritis
  • Associated with hypochlorhydria or achlorhydria (due to severe parietal cell loss), high serum gastrin levels (related to severity of disease), but usually no symptoms
  • 90% have anti-parietal cell antibodies (to the proton pump K / hydrogen ATPase), 60% have anti-intrinsic factor antibodies
  • Use rat stomach / kidney blocks for parietal cell staining and to rule out renal tubular staining
  • Chief cells are damaged leading to decreased pepsinogen levels in gastric juice and serum
  • Decreased serum pepsinogen is a sensitive and specific marker of gastric atrophy
  • Occasionally leads to pernicious anemia (due to loss of intrinsic factor), indolent carcinoid tumors

  • Intrinsic factor:
    • Type 1 intrinsic factor antibody prevents binding of intrinsic factor to Vitamin B12
    • Type 2 antibody reacts with free or complexed Vitamin B12 to prevent its biological activity
Micro Description
  • Glandular atrophy predominantly in gastric body / fundus with deep or diffuse lymphoplasmacytic infiltrates within lamina propria and focal gland infiltration and damage
  • 85% have parietal cell pseudohypertrophy with snouting
  • Often extensive intestinal, antral or pancreatic acinar metaplasia
  • Linear or nodular neuroendocrine (enterochromaffin cell-like / ECL) hyperplasia on chromogranin immunostains
  • No / rare H. pylori
  • In absence of other disease, antrum is usually normal
Micro Images

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Antibodies in pernicious anemia