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Lenti MV, Vanoli A, Miceli E, Arpa G, Di Stefano M, Soriano S, Capuano F, Gentile A, Aronico N, Coppola L, Pasini A, Luinetti O, Mauro A, Paulli M, Klersy C, Corazza GR, Di Sabatino A. Increase of Deep Intraepithelial Lymphocytes in the Oxyntic Mucosa of Patients With Potential and Overt Autoimmune Gastritis. Front Immunol 2022; 13:866167. [PMID: 35603187 PMCID: PMC9114815 DOI: 10.3389/fimmu.2022.866167] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 03/31/2022] [Indexed: 01/23/2023] Open
Abstract
Pathological correlates of potential autoimmune gastritis (AIG), defined by anti-parietal cell antibody (PCA) positivity in the absence of gastric atrophy, have never been described. We herein aimed to assess intraepithelial lymphocyte (IEL) infiltration in gastric corpus of AIG patients. From 2000 to 2021, among 53 potential AIG patients, we focused on nine (median age 61 years, IQR 53-82; four females) who subsequently developed overt AIG. IEL infiltration of the oxyntic mucosa was assessed before and after developing overt AIG by measuring deep and superficial CD3+ IEL. AIG patients with different degrees of corpus atrophy, healthy controls (HC), active H. pylori gastritis, celiac disease (CD), and Hashimoto’s thyroiditis patients were included as controls. Of note, deep, but not superficial, CD3+ IEL count was higher (p<0.001) in potential AIG compared to HC and H. pylori gastritis. Deep CD3+ IEL infiltration did not change before or after the evolution into atrophy (median 9.6, IQR 8.8-12.4, vs 11.3, IQR 9.4-12.9). No difference was found in deep CD3+ IEL infiltration among potential, mild, and severe AIG, and compared to Hashimoto’s thyroiditis or CD. A deep CD3+ IEL cut-off of >7/100 epithelial cells allowed discrimination of any AIG stage and severity (AUC=0.842). We conclude that an increased deep CD3+ IEL infiltration of the oxyntic mucosa could represent a marker of potential AIG. Prospective studies including a larger number of potential AIG patients are needed.
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Affiliation(s)
- Marco Vincenzo Lenti
- Department of Internal Medicine, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Alessandro Vanoli
- Department of Pathology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Emanuela Miceli
- Department of Internal Medicine, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Giovanni Arpa
- Department of Pathology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Michele Di Stefano
- Department of Internal Medicine, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Simone Soriano
- Department of Internal Medicine, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Francesca Capuano
- Department of Pathology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Antonella Gentile
- Department of Internal Medicine, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Nicola Aronico
- Department of Internal Medicine, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Luigi Coppola
- Department of Internal Medicine, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Alessandra Pasini
- Department of Internal Medicine, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Ombretta Luinetti
- Department of Pathology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Aurelio Mauro
- Department of Internal Medicine, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Marco Paulli
- Department of Pathology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Catherine Klersy
- Unit of Clinical Epidemiology and Biometry, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Gino Roberto Corazza
- Department of Internal Medicine, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Antonio Di Sabatino
- Department of Internal Medicine, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Policlinico San Matteo, University of Pavia, Pavia, Italy
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Costetti M, Schiepatti A, Fraticelli S, Costa S, Maimaris S, Lenti MV, Villani L, Bianchi PI, Di Sabatino A, Corazza GR, Vanoli A, Biagi F. Clinical and gastro-duodenal histopathological features of enteropathy due to angiotensin II receptor blockers. Dig Liver Dis 2021; 53:1262-1267. [PMID: 34330666 DOI: 10.1016/j.dld.2021.07.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/01/2021] [Accepted: 07/04/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Clinical elements differentiating enteropathy due to angiotensin II-receptor-blockers (ARBs-E) from coeliac disease (CD) are poorly defined. The histopathological features on duodenal and gastric biopsies in these patients still need to be investigated. AIMS To describe the clinical phenotype of ARBs-E in comparison to CD, and the histological findings of gastric and duodenal biopsies in ARBs-E. METHODS Clinical data of patients with ARBs-E and CD diagnosed between 2013 and 2020 were retrospectively reviewed. Baseline presenting symptoms and demographics were compared (Fisher's exact test and t-test). Gastric and duodenal histology in ARBs-E were revised by two independent pathologists. RESULTS 14 ARBs-E and 112 CD patients were enroled. Weight loss (p < 0.01), acute onset of diarrhoea (p < 0.01), hospitalization (p < 0.01), and older age at diagnosis (p < 0.01) were more common in ARBs-E. Duodenal histology in ARBs-E showed intraepithelial lymphocytosis in 71%, increased mucosal eosinophilic count in 57%, with preserved neuroendocrine, Paneth and goblet cells in all patients. Gastric histologic lesions at baseline, including lymphocytic gastritis, eosinophilic gastritis, chronic active gastritis, and metaplastic atrophic gastritis patterns were observed in 73% of patients, without Helicobacter pylori infection. CONCLUSIONS ARBs-E showed a severe clinical phenotype, often requiring hospital admission. Gastric involvement at diagnosis is very common, and this could further support this diagnosis.
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Affiliation(s)
- Martina Costetti
- Gastroenterology Unit of Pavia Institute, IRCCS Pavia, Istituti Clinici Scientifici Maugeri, University of Pavia, Via Salvatore Maugeri 10, Pavia 27100, Italy
| | - Annalisa Schiepatti
- Gastroenterology Unit of Pavia Institute, IRCCS Pavia, Istituti Clinici Scientifici Maugeri, University of Pavia, Via Salvatore Maugeri 10, Pavia 27100, Italy.
| | - Sara Fraticelli
- Unit of Anatomic Pathology, Department of Molecular Medicine, University of Pavia, and Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Stefania Costa
- Gastroenterology Unit of Pavia Institute, IRCCS Pavia, Istituti Clinici Scientifici Maugeri, University of Pavia, Via Salvatore Maugeri 10, Pavia 27100, Italy
| | - Stiliano Maimaris
- Gastroenterology Unit of Pavia Institute, IRCCS Pavia, Istituti Clinici Scientifici Maugeri, University of Pavia, Via Salvatore Maugeri 10, Pavia 27100, Italy
| | - Marco Vincenzo Lenti
- Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy
| | - Laura Villani
- Pathology Unit, IRCCS Pavia, Istituti Clinici Scientifici Maugeri, University of Pavia, Italy
| | | | - Antonio Di Sabatino
- Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy
| | - Gino Roberto Corazza
- Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy
| | - Alessandro Vanoli
- Unit of Anatomic Pathology, Department of Molecular Medicine, University of Pavia, and Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Federico Biagi
- Gastroenterology Unit of Pavia Institute, IRCCS Pavia, Istituti Clinici Scientifici Maugeri, University of Pavia, Via Salvatore Maugeri 10, Pavia 27100, Italy
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Choudhuri J, Hall S, Castrodad-Rodriguez CA, Westerhoff M, El Jabbour T, Jain S, Panarelli NC. Features That Aid Identification of Autoimmune Gastritis in a Background of Active Helicobacter pylori Infection. Arch Pathol Lab Med 2021; 145:1536-1543. [PMID: 33635965 DOI: 10.5858/arpa.2020-0615-oa] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2020] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Helicobacter pylori-associated and autoimmune gastritis may coexist in a subset of patients who require treatment for both disorders. OBJECTIVE.— To delineate findings that identify autoimmune gastritis in the background of H pylori infection. DESIGN.— We examined cases of (1) patients with H pylori-associated gastritis who had successful eradication therapy and subsequent biopsies diagnostic of autoimmune gastritis and (2) H pylori-associated gastritis wherein pathologists noted features of autoimmune gastritis during original interpretation. Control patients underwent H pylori eradication but lacked evidence of autoimmune gastritis or H pylori infection after 10 years of follow-up. RESULTS.— Eight subjects had H pylori-associated gastritis followed by H pylori-negative sampling that showed autoimmune gastritis. Review of original samples showed full-thickness inflammation of oxyntic mucosa in 8 of 8 and oxyntic gland loss in 7 of 8 cases. Enterochromaffin-like (ECL) cell hyperplasia, pyloric metaplasia, and intestinal metaplasia were present in 4 of 8 (80% of 5 tested cases), 4 of 8, and 3 of 8 cases, respectively. Features of autoimmune gastritis were noted at the time of their original H pylori diagnosis in 11 study subjects. Ten of 11 samples displayed full-thickness inflammation of oxyntic mucosa and/or partial loss of oxyntic glands, 8 of 11 had ECL cell hyperplasia (all tested cases), 6 of 11 showed pyloric metaplasia, and 4 of 11 harbored intestinal metaplasia. Except for full-thickness oxyntic mucosa inflammation, these features were absent in control cases. CONCLUSIONS.— Full-thickness inflammation combined with oxyntic gland loss and ECL cell hyperplasia may help to identify autoimmune gastritis in patients with concomitant H pylori infection.
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Affiliation(s)
- Jui Choudhuri
- From the Department of Pathology, Montefiore Medical Center, Bronx, New York (Choudhuri, Castrodad-Rodriguez, Panarelli)
| | - Sara Hall
- the Department of Pathology, University of Michigan, Ann Arbor (Hall, Westerhoff)
| | - Carlos A Castrodad-Rodriguez
- From the Department of Pathology, Montefiore Medical Center, Bronx, New York (Choudhuri, Castrodad-Rodriguez, Panarelli)
| | - Maria Westerhoff
- the Department of Pathology, University of Michigan, Ann Arbor (Hall, Westerhoff)
| | - Tony El Jabbour
- the Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York (El Jabbour)
| | - Shilpa Jain
- the Department of Pathology & Immunology, Baylor College of Medicine, Houston, Texas (Jain)
| | - Nicole C Panarelli
- From the Department of Pathology, Montefiore Medical Center, Bronx, New York (Choudhuri, Castrodad-Rodriguez, Panarelli).,and the Department of Pathology, Albert Einstein College of Medicine, Bronx, New York (Panarelli)
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