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Stomach

Gastritis

Autoimmune gastritis


Reviewers: Elliot Weisenberg, M.D. (see Reviewers page)
Revised: 31 July 2012, last major update July 2012
Copyright: (c) 2003-2012, PathologyOutlines.com, Inc.

General
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● Also called type A gastritis
● < 10% of cases of chronic gastritis
● Often autosomal dominant

Clinical features
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● Associated with other autoimmune diseases (Hashimoto’s thyroiditis, Addison’s 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 protein 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
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● 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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Various images


Antibodies in pernicious anemia

Additional references
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Mod Pathol 2002;15:102, Mod Pathol 2003;16:325

End of Stomach > Gastritis > Autoimmune gastritis


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