Autoimmune gastritis

Topic Completed: 1 July 2012

Revised: 26 April 2019

Copyright: 2003-2019,, Inc.

PubMed Search: autoimmune gastritis[title]

Elliot Weisenberg, M.D.
Page views in 2018: 7,808
Page views in 2019 to date: 7,836
Cite this page: Weisenberg E. Autoimmune gastritis. website. Accessed October 21st, 2019.
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
Microscopic (histologic) 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
Microscopic (histologic) images

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Antibodies in pernicious anemia

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