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Autoimmune gastritis
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DOI：10.1038/s41572-020-0187-8.png)
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Autoimmune gastritis (AIG) is a chronic, autoimmune disease characterized by atrophy of the oxyntic glands of the stomach. In this Primer, Di Sabatino and colleagues discuss the epidemiology, novel insights in AIG pathogenesis, diagnostic challenges and current therapeutic options. Autoimmune gastritis (AIG) is an increasingly prevalent, organ-specific, immune-mediated disorder characterized by the destruction of gastric parietal cells, leading to the loss of intrinsic factor and reduced acid output. These alterations result in malabsorption of iron, vitamin B-12(pernicious anaemia) and potentially other micronutrients. For several years, most studies have focused on pernicious anaemia only, generating confusion between the two entities. In AIG, the gastric proton pump, H+/K(+)ATPase, is the major autoantigen recognized by autoreactive T cells. The T cell-dependent activation of B cells stimulates the production of anti-parietal cell antibodies, the serological hallmark of AIG. The role ofHelicobacter pyloriinfection in activating or favouring the autoimmune process is still uncertain. Early histopathological alterations allowing a more precise and prompt recognition have recently been described. AIG is burdened by a substantial diagnostic delay as it can present with varied clinical signs including, among others, gastrointestinal symptoms and neuropsychiatric manifestations. In advanced stages, AIG might progress to neuroendocrine tumours and gastric adenocarcinoma. Management includes early detection through a proactive case-finding strategy, micronutrient supplementation and endoscopic surveillance. This Primer comprehensively describes the most important insights regarding the epidemiology, pathophysiology, diagnosis and management of AIG, focusing on the most controversial, outstanding issues and future directions.
Keyword:
HELICOBACTER-PYLORI INFECTION
PARIETAL-CELL ANTIBODIES
ATROPHIC BODY GASTRITIS
IRON-DEFICIENCY ANEMIA
THYMIC STROMAL LYMPHOPOIETIN
PERNICIOUS-ANEMIA
INTRINSIC-FACTOR
CANCER-RISK
FOLLOW-UP
INTESTINAL METAPLASIA
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60.6
论文数:
652
被引数:
3.8W
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