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Granot M, Beinvogl BC, Schvimer M, Goldsmith JD, Matar M, Ben Tov A, Feler AY, Nachum N, Morgenstern S, Mayer C, Shamir R, Weiss B, Shouval DS. Clinical characteristics and outcomes of pediatric patients with autoimmune gastritis. J Pediatr Gastroenterol Nutr 2024. [PMID: 39010761 DOI: 10.1002/jpn3.12318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 06/23/2024] [Accepted: 07/02/2024] [Indexed: 07/17/2024]
Abstract
OBJECTIVES Autoimmune gastritis (AIG) is a rare chronic inflammatory disorder with potential long-term sequelae including gastric neoplasia. There is limited data on the natural history of pediatric AIG. We aimed to characterize the clinical course and outcomes of children with AIG. METHODS This was a multicenter retrospective study that included pediatric patients diagnosed with AIG between January 1, 2000 and December 31, 2021. Diagnosis of AIG was based on the demonstration of histological corpus-predominant atrophic gastritis, with or without positive antiparietal cell (APCA) or anti-intrinsic factor (IF) antibodies. Demographic, clinical, laboratory, endoscopic, and histologic data were retrieved, along with follow-up data. RESULTS Thirty-three patients, (23 females, [69.7%], median age 12.0 [interquartile range 7.0-15.0] years at diagnosis) were identified. Twenty-two patients (66.7%) had positive APCA and/or anti-IF serology. The most common presenting manifestation was iron deficiency anemia (75%), and accompanying autoimmune disorders were significantly more common in patients with positive serology (62% vs. 18%, p < 0.05). Pseudo-pyloric or intestinal-type metaplasia was present at diagnosis in eight patients (24%), and 11 additional patients (33%) developed metaplasia during a median follow-up time of 27 (17.5-48.3) months. One patient developed a type 1 gastric neuroendocrine tumor. Helicobacter pylori was identified in only one patient, while two patients had prior eradication. Endoscopic and histologic improvements weren't identified in any patients. CONCLUSIONS AIG should be considered in patients with autoimmunity and resistant iron-deficiency anemia. H. pylori infection may not be associated with pediatric AIG. The development of neuroendocrine tumor in one patient, and the high rates of metaplasia, highlight the importance of surveillance.
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Affiliation(s)
- Maya Granot
- Pediatric Gastroenterology and Nutrition Unit, Edmond and Lily Safra Children's Hospital, Ramat Gan, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Beate C Beinvogl
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Michael Schvimer
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Institute of Pathology, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Jeffrey D Goldsmith
- Department of Pathology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Manar Matar
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Institute of Gastroenterology, Nutrition, and Liver Diseases, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Amir Ben Tov
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Gastroenterology Institute, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Anat Y Feler
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Gastroenterology Institute, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Nurit Nachum
- Pediatric Gastroenterology and Nutrition Unit, Edmond and Lily Safra Children's Hospital, Ramat Gan, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sara Morgenstern
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Institute of Pathology, Rabin Medical Center, Petah Tikva, Israel
| | - Chen Mayer
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Institute of Pathology, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Raanan Shamir
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Institute of Gastroenterology, Nutrition, and Liver Diseases, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Batia Weiss
- Pediatric Gastroenterology and Nutrition Unit, Edmond and Lily Safra Children's Hospital, Ramat Gan, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dror S Shouval
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Institute of Gastroenterology, Nutrition, and Liver Diseases, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
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Sánchez-López JY, Díaz-Herrera LC, Rizo-de la Torre LDC. Pepsinogen I, pepsinogen II, gastrin-17, and Helicobacter pylori serological biomarkers in the diagnosis of precursor lesions of gastric cancer. Arch Med Sci 2024; 20:1016-1021. [PMID: 39050166 PMCID: PMC11264142 DOI: 10.5114/aoms/189971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 06/12/2024] [Indexed: 07/27/2024] Open
Abstract
Introduction Atrophic gastritis and intestinal metaplasia are precursor lesions of gastric cancer. The aim of this study was to determine the usefulness of the biomarkers pepsinogen I(PgI), pepsinogen II (PgII), gastrin-17, and H. pylori antibodies in the identification of precursor lesions. Methods We studied 129 patients with gastric symptoms. The biomarker status was determined using GastroPanel by means of the ELISA-technique. Results Biomarkers detected atrophy in 14% of the subjects, and 49.6% had positive antibodies for H. pylori. A PgI/PgII ratio < 3 was an important risk biomarker for precursor lesions in our population (OR = 9.171, 95% CI: 1.723-48.799, p = 0.009); however, biomarkers showed low accuracy with histopathological study. Conclusions In the Western Mexican population, precursor lesions (AG, IM) are common in adults (45%) with dyspepsia but infrequent in children (8%). H. pylori infection was detected in 41.3% of adults and 16.0% of children. Of the studied biomarkers, a PgI/PgII ratio < 3 was an important risk factor for precursor lesions such as AG or IM in our population, with an OR of 9.171 (95% CI: 1.723-48.799, p = 0.009).
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Affiliation(s)
- Josefina Yoaly Sánchez-López
- División de Genética, Centro de Investigación Biomédica de Occidente, Instituto Mexicano del Seguro Social, Mexico
| | - Luis Carlos Díaz-Herrera
- Servicio de Gastroenterología, Hospital de Especialidades, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Mexico
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Diagnostic dilemma in infantile refractory diarrhea: a rare case of IPEX syndrome. Med J Armed Forces India 2023. [DOI: 10.1016/j.mjafi.2022.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
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Assa A, Borrelli O, Broekaert I, Saccomani MD, Dolinsek J, Martin-de-Carpi J, Mas E, Miele E, Sila S, Thomson M, Tzivinikos C, Benninga MA. Helicobacter pylori-negative Chronic Gastritis in Children: A Systematic Review. J Pediatr Gastroenterol Nutr 2022; 74:956-967. [PMID: 35175996 DOI: 10.1097/mpg.0000000000003414] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES To systematically review the current evidence on Helicobacter pylori-negative chronic gastritis including natural history, available therapies and outcomes. METHODS Articles providing data on the prevalence, treatment or outcomes of Helicobacter pylori-negative gastritis were identified through a systematic search in the MEDLINE and EMBASE databases. All original research articles from human studies until October 31, 2021, were included. RESULTS A total of 54 studies were included consisted of eosinophilic gastritis (n = 9), autoimmune gastritis (n = 11), collagenous gastritis (n = 16), focally enhanced gastritis (n = 6), lymphocytic gastritis (n = 5) and other causes including idiopathic gastritis and chronic renal failure related (n = 7). Most of the included studies were either cross-sectional or longitudinal cohorts except for collagenous gastritis, which mainly included case reports and case series. The prevalence of paediatric eosinophilic gastritis ranges between 5 and 7/100,000 and patients have generally favourable outcome with 50% to 70% clinical and histological response to either corticosteroids or elimination diets. Autoimmune gastritis and collagenous gastritis are extremely rare entities, commonly present with refractory iron deficiency anaemia, while lymphocytic gastritis is relatively common (10%-45%) in children with coeliac disease. Data on treatments and outcomes of autoimmune, collagenous, and focally enhanced gastritis are lacking with limited data implying poor response to therapy in the former 2 diagnoses. CONCLUSIONS Helicobacter pylori-negative gastritis is uncommonly reported, mainly in small cohorts, mixed adult-paediatric cohorts or as sporadic case reports. As common symptoms are not specific, thus not always result in an endoscopic evaluation, the true prevalence of these distinct disorders may be underestimated, and thus under reported.
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Affiliation(s)
- Amit Assa
- The Juliet Keidan institute of Pediatric Gastroenterology and Nutrition, Shaare Zedek Medical Center, The Hebrew University, Jerusalem, Israel
| | - Osvaldo Borrelli
- Division of Neurogastroenterology & Motility, Department of Paediatric Gastroenterology, Great Ormond Street Hospital, London, UK
| | - Ilse Broekaert
- Department of Paediatrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | | | - Jernej Dolinsek
- Department of pediatrics, University Medical Center Maribor, Ljubljanska 5, Maribor, Slovenia
| | - Javier Martin-de-Carpi
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Hospital Sant Joan de Deu, Barcelona, Spain
| | - Emmanuel Mas
- Unité de Gastroenterologie, Hepatologie, Nutrition et Maladies Héréditaires du Metabolisme, Hôpital des Enfants, and IRSD, Universite de Toulouse, INSERM, INRAE, ENVT, UPS, Toulouse, France
| | - Erasmo Miele
- Department of Translational Medical Science, Section of Pediatrics, University of Naples "Federico II", Naples, Italy
| | - Sara Sila
- Referral Centre for Pediatric Gastroenterology and Nutrition, Children's Hospital Zagreb, Zagreb, Croatia
| | - Mike Thomson
- Centre for Paediatric Gastroenterology, Sheffield Children's Hospital NHS Foundation Trust, Weston Bank, Sheffield, UK
| | - Christos Tzivinikos
- Paediatric Gastroenterology Department, Al Jalila Children's Specialty Hospital, Mohammed Bin Rashid University, Dubai Medical College, Dubai, United Arab Emirates
| | - Marc A Benninga
- Department ofPaediatrics, Emma Children's Hospital, Amsterdam University Medical Center, Amsterdam, The Netherlands
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Kulak O, Gurram B, Montgomery EA, Park JY. Pediatric autoimmune gastritis: clinical correlates and histologic features. Hum Pathol 2021; 116:31-38. [PMID: 34284050 DOI: 10.1016/j.humpath.2021.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/07/2021] [Accepted: 07/10/2021] [Indexed: 11/24/2022]
Abstract
Autoimmune gastritis is a well-known pathologic entity, but there are few studies that examine its clinical and histologic presentation in children. This is a single institution, retrospective study performed on patients diagnosed from 2011 through 2019. Patients were identified by their pathologic diagnosis within the laboratory information system. The electronic medical record and archived slides were reviewed. Twenty-two children (3 months to 18 years; median, 10.9 years) with autoimmune gastritis were diagnosed of a total of 14,257 nonconsultation gastric biopsies from unique patients (0.15% prevalence). Patients with autoimmune gastritis were diagnosed at an average age of 10.9 years and were mostly female (68.2% women, 31.8% men). The majority had extragastric immune disorders (13/22; 59.1%). All patients in the study had gastric body mucosa with enterochromaffin-like cell hyperplasia, atrophy, and histologic features of chronic injury. Most biopsies showed gastric body metaplasia (n = 19) or active gastric inflammation. However, antral atrophy was also observed in 12 patients, and antral metaplasia was identified in one patient; four patients had active chronic antral gastritis. All biopsies were negative for Helicobacter pylori. Pediatric autoimmune gastritis is a rare disorder that should be recognized because of its systemic effects with long-term morbidity. In addition, the possibility of tandem extragastric immune disorders should be considered when a diagnosis of pediatric autoimmune gastritis is established.
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Affiliation(s)
- Ozlem Kulak
- Department of Pathology, UT Southwestern Medical Center, Dallas, TX 75235, United States.
| | - Bhaskar Gurram
- Division of Pediatric Gastroenterology, UT Southwestern Medical Center and Children's Medical Center Dallas, Dallas, TX 75235, United States.
| | - Elizabeth A Montgomery
- Department of Pathology, University of Miami Miller School of Medicine, Miami, FL 33101, United States.
| | - Jason Y Park
- Department of Pathology, UT Southwestern Medical Center, Dallas, TX 75235, United States; Eugene McDermott Center for Human Growth and Development, UT Southwestern Medical Center, Dallas, TX 75235, United States; Department of Pathology and Laboratory Medicine, Children's Medical Center of Dallas, Dallas, TX 75235, United States.
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Autoimmune Gastritis Treated With Mycophenolate Mofetil. ACG Case Rep J 2020; 7:e00496. [PMID: 33324715 PMCID: PMC7725257 DOI: 10.14309/crj.0000000000000496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 07/24/2020] [Indexed: 12/02/2022] Open
Abstract
Autoimmune gastritis is an inflammatory condition of the gastric mucosa. We report a 64-year-old woman with chronic abdominal pain of 3-year duration. Endoscopic and histologic evaluation revealed autoimmune pangastritis. The gastritis was partially responsive to steroids but attempts to taper failed, and the patient had no relief from mercaptopurine, adalimumab, budesonide, or hydroxychloroquine. The patient was treated with mycophenolate mofetil which resulted in resolution of symptoms. Endoscopic and histologic examination after mycophenolate therapy showed near complete resolution of active inflammation. To the best of our knowledge, this is the first report of symptomatic autoimmune gastritis successfully treated by mycophenolate mofetil.
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Demir AM, Berberoğlu Ateş B, Hızal G, Yaman A, Tuna Kırsaçlıoğlu C, Oğuz AS, Karakuş E, Yaralı N, Özbek NY. Autoimmune atrophic gastritis: The role of Helicobacter pylori infection in children. Helicobacter 2020; 25:e12716. [PMID: 32589356 DOI: 10.1111/hel.12716] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/17/2020] [Accepted: 05/26/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Autoimmune atrophic gastritis (AIG) is very rare in children. Despite a better understanding of histopathologic changes and serological markers in this disease, underlying etiopathogenic mechanisms and the effect of Helicobacter pylori (H pylori) infection are not well known. We aimed to investigate the relation between AIG and H pylori infection in children. MATERIALS AND METHODS We evaluated the presence of AIG and H pylori infection in fifty-three patients with positive antiparietal cell antibody (APCA). Demographic data, clinical symptoms, laboratory and endoscopic findings, histopathology, and presence of H pylori were recorded. RESULTS The children were aged between 5 and 18 years, and 28 (52.8%) of them were male. Mean age was 14.7 ± 2.6 years (median: 15.3; min-max: 5.2-18), and 10 (18.8%) of them had AIG confirmed by histopathology. In the AIG group, the duration of vitamin B12 deficiency was longer (P = .022), hemoglobin levels were lower (P = .018), and APCA (P = .039) and gastrin (P = .002) levels were higher than those in the non-AIG group. Endoscopic findings were similar between the two groups. Intestinal metaplasia was higher (P = .018) in the AIG group. None of the patients in the AIG group had H pylori infection (P = .004). One patient in the AIG group had enterochromaffin-like cell hyperplasia. CONCLUSIONS Our results show that, in children, H pylori infection may not play a role in AIG. AIG could be associated with vitamin B12 deficiency, iron deficiency, and APCA positivity in children. APCA and gastrin levels should be investigated for the early diagnosis of AIG and intestinal metaplasia.
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Affiliation(s)
- Arzu Meltem Demir
- Department of Pediatric Gastroenterology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Burcu Berberoğlu Ateş
- Department of Pediatric Gastroenterology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Gülin Hızal
- Department of Pediatric Gastroenterology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Aytaç Yaman
- Department of Pediatric Gastroenterology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Ceyda Tuna Kırsaçlıoğlu
- Department of Pediatric Gastroenterology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Ayşe Selcen Oğuz
- Department of Pathology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Esra Karakuş
- Department of Pathology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Neşe Yaralı
- Department of Pediatric Hematology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Namık Yaşar Özbek
- Department of Pediatric Hematology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
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Lenti MV, Rugge M, Lahner E, Miceli E, Toh BH, Genta RM, De Block C, Hershko C, Di Sabatino A. Autoimmune gastritis. Nat Rev Dis Primers 2020; 6:56. [PMID: 32647173 DOI: 10.1038/s41572-020-0187-8] [Citation(s) in RCA: 142] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/26/2020] [Indexed: 02/07/2023]
Abstract
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 B12 (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 of Helicobacter pylori infection 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.
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Affiliation(s)
- Marco Vincenzo Lenti
- Department of Internal Medicine, IRCCS San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Massimo Rugge
- Department of Medicine (DIMED), Surgical Pathology & Cytopathology Unit, University of Padua, Padua, Italy
| | - Edith Lahner
- Department of Surgical-Medical Sciences and Translational Medicine, Digestive and Liver Disease Unit, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Emanuela Miceli
- Department of Internal Medicine, IRCCS San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Ban-Hock Toh
- Centre for Inflammatory Diseases, Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Robert M Genta
- Department of Medicine, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, Texas, USA
| | - Christophe De Block
- Department of Endocrinology, Diabetology and Metabolism, Faculty of Medicine, Antwerp University Hospital and University of Antwerp, Antwerpen, Belgium
| | - Chaim Hershko
- Department of Hematology, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel.,Hematology Clinic and Central Clinical Laboratories, Clalit Health Services, Jerusalem, Israel
| | - Antonio Di Sabatino
- Department of Internal Medicine, IRCCS San Matteo Hospital Foundation, University of Pavia, Pavia, Italy.
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Su N, Chen C, Zhou X, Ma GD, Chen RL, Tian C. Early-onset refractory diarrhea due to immune dysregulation, polyendocrinopathy, enteropathy, X-linked syndrome associated with a novel mutation in the FOXP3 gene: A case report. World J Clin Cases 2020; 8:1988-1994. [PMID: 32518791 PMCID: PMC7262694 DOI: 10.12998/wjcc.v8.i10.1988] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 04/01/2020] [Accepted: 04/20/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Immune dysregulation, polyendocrinopthy, enteropathy, X-linked (IPEX) syndrome is a rare X-linked recessive disease caused by mutations in the forkhead box protein 3 (FOXP3) gene, which is a master transcriptional regulator for the development and function of CD4+CD25+ regulatory T (Treg) cells. The dysfunction of these cells leads to multiple system autoimmune diseases. We present a case of IPEX due to a mutation not reported in the literature before.
CASE SUMMARY We report a male patient with IPEX syndrome who presented with refractory diarrhea and malabsorption leading to failure to thrive, as well as with hypothyroidism and nephrotic syndrome. Laboratory investigation showed increased total IgE and Treg cells, decreased free triiodothyronine (FT3) and free thyroxine (FT4), and proteinuria. Multiple dietary and supportive treatments were introduced but did not improve the diarrhea during his hospital stay. Ultimately, whole exome sequencing revealed that the patient was hemizygous for the exon 5, c.542G>A (p.Ser181Asn) mutation of the FOXP3 gene, which has not been previously reported. The patient remains on prednisone and euthyrox while awaiting hematopoietic stem cell transplantation at the time of the compilation of this case report.
CONCLUSION We report a novel FOXP3 gene mutation involved in IPEX. A high level of suspicion should be maintained in an early-onset refractory diarrhea patient.
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Affiliation(s)
- Na Su
- Department of Pediatrics, Shunde Women and Children's Hospital, Guangdong Medical University, Foshan 528300, Guangdong Province, China
- Department of Pediatrics, Guangdong Medical University, Zhanjiang 524000, Guangdong Province, China
| | - Cheng Chen
- Department of Pediatric Internal Medicine, Shunde Women and Children's Hospital, Guangdong Medical University, Foshan 528300, Guangdong Province, China
| | - Xia Zhou
- Department of Neurology, Guangdong Medical University, Zhanjiang 524000, Guangdong Province, China
| | - Guo-Da Ma
- Maternal and Child Research Institute, Shunde Women and Children's Hospital, Guangdong Medical University, Foshan 528300, Guangdong Province, China
| | - Ri-Ling Chen
- Department of Pediatric Internal Medicine, Shunde Women and Children's Hospital, Guangdong Medical University, Foshan 528300, Guangdong Province, China
| | - Chuan Tian
- Department of Pediatric Hematology, Affiliated Hospital of Guangdong Medical University, Zhanjiang 524000, Guangdong Province, China
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Abstract
OBJECTIVES To bring heightened awareness to a condition, autoimmune gastritis (AIG), which is a well-established entity in adults; however, rarely described in pediatrics. Currently, the literature describes AIG in pediatric patients who also suffer from other autoimmune disorders, which precedes the diagnosis of AIG, and often presents with unexplained anemia. Additionally, there have been case reports describing patients with immunodeficiencies and AIG, which progress to gastric adenocarcinoma. AIG is a histopathologic diagnosis, demonstrating chronic inflammatory process with loss of parietal cells with or without intestinal metaplasia and enterochromaffin-like cell hyperplasia. Management of these patients includes nutritional replacement as well as routine surveillance endoscopy with biopsy in search of metaplastic and dysplastic changes. METHODS We queried the pathology database at Children's Hospital Los Angeles (CHLA) for cases with a final diagnosis of AIG and for those with a differential diagnosis that includes AIG in the diagnostic comment. All cases that were identified were selected as long as they did not only meet the histopathologic criteria, but also the biochemical criteria for this condition. RESULTS Of the 3 patients, 2 were referred to gastroenterology for the evaluation of iron-deficiency anemia in the context of diabetes mellitus and Addison's disease; and diabetes mellitus and Hashimoto's thyroiditis. AIG was confirmed on the biopsies, which showed a reduction in parietal cell mass, pseudopyloric metaplasia and enterochromafin-like cell hyperplasia. Both patients were treated with iron replacement therapy. The third patient presented with symptomatic anemia and diagnosed with pernicious anemia without other autoimmune disorders. She was successfully treated with oral vitamin supplementation. In this case, serial gastric biopsies demonstrated stable intestinal metaplasia without evidence of dysplasia. CONCLUSION Although AIG is rare in children, pediatric gastroenterologists and pathologists should have a heightened suspicion for this entity in those patients with a history of autoimmune disorders and/or pernicious anemia.
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Cui J, Cui H, Yang M, Du S, Li J, Li Y, Liu L, Zhang X, Li S. Tongue coating microbiome as a potential biomarker for gastritis including precancerous cascade. Protein Cell 2019; 10:496-509. [PMID: 30478535 PMCID: PMC6588651 DOI: 10.1007/s13238-018-0596-6] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 10/23/2018] [Indexed: 02/06/2023] Open
Abstract
The development of gastritis is associated with an increased risk of gastric cancer. Current invasive gastritis diagnostic methods are not suitable for monitoring progress. In this work based on 78 gastritis patients and 50 healthy individuals, we observed that the variation of tongue-coating microbiota was associated with the occurrence and development of gastritis. Twenty-one microbial species were identified for differentiating tongue-coating microbiomes of gastritis and healthy individuals. Pathways such as microbial metabolism in diverse environments, biosynthesis of antibiotics and bacterial chemotaxis were up-regulated in gastritis patients. The abundance of Campylobacter concisus was found associated with the gastric precancerous cascade. Furthermore, Campylobacter concisus could be detected in tongue coating and gastric fluid in a validation cohort containing 38 gastritis patients. These observations provided biological evidence of tongue diagnosis in traditional Chinese medicine, and indicated that tongue-coating microbiome could be a potential non-invasive biomarker, which might be suitable for long-term monitoring of gastritis.
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Affiliation(s)
- Jiaxing Cui
- MOE Key Laboratory of Bioinformatics and TCM-X center/Bioinformatics Division, BNRist/Department of Automation, Tsinghua University, Beijing, 100084, China
| | - Hongfei Cui
- MOE Key Laboratory of Bioinformatics and TCM-X center/Bioinformatics Division, BNRist/Department of Automation, Tsinghua University, Beijing, 100084, China
- Institute for Artificial Intelligence and Department of Computer Science and Technology, Tsinghua University, Beijing, 100084, China
| | - Mingran Yang
- MOE Key Laboratory of Bioinformatics and TCM-X center/Bioinformatics Division, BNRist/Department of Automation, Tsinghua University, Beijing, 100084, China
| | - Shiyu Du
- China-Japan Friendship Hospital, Beijing, 100029, China
| | - Junfeng Li
- MOE Key Laboratory of Bioinformatics and TCM-X center/Bioinformatics Division, BNRist/Department of Automation, Tsinghua University, Beijing, 100084, China
| | - Yingxue Li
- MOE Key Laboratory of Bioinformatics and TCM-X center/Bioinformatics Division, BNRist/Department of Automation, Tsinghua University, Beijing, 100084, China
| | - Liyang Liu
- MOE Key Laboratory of Bioinformatics and TCM-X center/Bioinformatics Division, BNRist/Department of Automation, Tsinghua University, Beijing, 100084, China
| | - Xuegong Zhang
- MOE Key Laboratory of Bioinformatics and TCM-X center/Bioinformatics Division, BNRist/Department of Automation, Tsinghua University, Beijing, 100084, China.
- School of Life Sciences and Center for Synthetic and Systems Biology, Tsinghua University, Beijing, 100084, China.
| | - Shao Li
- MOE Key Laboratory of Bioinformatics and TCM-X center/Bioinformatics Division, BNRist/Department of Automation, Tsinghua University, Beijing, 100084, China.
- School of Life Sciences and Center for Synthetic and Systems Biology, Tsinghua University, Beijing, 100084, China.
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Insights Into Pediatric Autoimmune Gastritis: Is There a Role for Helicobacter pylori Infection? J Pediatr Gastroenterol Nutr 2019; 68:e99-e104. [PMID: 30664567 DOI: 10.1097/mpg.0000000000002278] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Autoimmune gastritis (AIG) is a chronic inflammatory condition of the gastric mucosa, mainly described in adults presenting with pernicious anemia. It results from antibody-mediated destruction of parietal cells, but the precise initiating event is unknown. The pathogenicity of Helicobacter pylori (H pylori) has been suggested but not established. This study aimed to better characterize AIG in pediatric patients and to address the possible role of H pylori infection. METHODS Descriptive single-center study, retrospectively describing 20 patients with a diagnosis of AIG based on positivity for anti-parietal cell autoantibodies, in addition to analytical and/or histological findings of oxyntic mucosa atrophy. RESULTS In the majority (18/20), AIG diagnosis was suggested during investigation of refractory iron-deficient anemia. One patient had dyspepsia and none of the others had gastrointestinal symptoms. Fifty-five percent (11/20) were H pylori positive, but there were no significant differences regarding mean hemoglobin values at presentation (10.6 ± 2.5 vs 9.5 ± 1.0 g/dL, P > 0.05), analytical indicators of gastric atrophy (gastrin, 564.4 ± 184 vs 721.2 ± 220.6 pg/mL, P > 0.05), or in the presence or the grade of oxyntic mucosa atrophy. CONCLUSIONS Our findings highlight that AIG may have an age-dependent presentation; thus, we can consider a pediatric phenotype that in contrast to adults, is manifested by refractory iron-deficient anemia and associated with parietal cell autoantibody positivity, but not intrinsic factor autoantibodies. A correlation between H pylori and AIG was not evident in the current study and it is still unclear whether H pylori is a trigger for AIG.
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Elli L, Norsa L, Zullo A, Carroccio A, Girelli C, Oliva S, Romano C, Leandro G, Bellini M, Marmo R, Soncini M, Monica F, De Francesco V, Paulon E, Cappellini MD, Motta I, Ferretti F, Orlando S, Mansueto P, Buscarini E, Manfredi G, Agostoni C, Tomba C, Cannizzaro R. Diagnosis of chronic anaemia in gastrointestinal disorders: A guideline by the Italian Association of Hospital Gastroenterologists and Endoscopists (AIGO) and the Italian Society of Paediatric Gastroenterology Hepatology and Nutrition (SIGENP). Dig Liver Dis 2019; 51:471-483. [PMID: 30850345 DOI: 10.1016/j.dld.2019.01.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 01/18/2019] [Accepted: 01/29/2019] [Indexed: 12/11/2022]
Abstract
Anaemia is a common pathologic condition, present in almost 5% of the adult population. Iron deficiency is the most common cause; other mechanisms can be involved, making anaemia a multi-factorial disorder in most cases. Anaemia being a frequent manifestation in the diseases of the gastrointestinal tract, patients are often referred to gastroenterologists. Furthermore, upper and lower endoscopy and enteroscopy are pivotal to the diagnostic roadmap of anaemia. In spite of its relevance in the daily clinical practice, there is a limited number of gastroenterological guidelines dedicated to the diagnosis of anaemia. For this reason, the Italian Association of Hospital Gastroenterologists and Endoscopists and the Italian Society of Paediatric Gastroenterology, Hepatology and Nutrition commissioned a panel of experts to prepare a specific guideline on anaemia and its diagnostic roadmap in the gastroenterological scenario. The panel also discussed about the potential involvement of gastroenterologists and endoscopists in the management of patients with anaemia, with particular attention to the correct use of investigations. The panel paid particular attention to practical issues with the aim to support gastroenterologists in their clinical practice when dealing with patients with anaemia.
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Affiliation(s)
- Luca Elli
- Gastroenterology and Endoscopy Division/Center for Prevention and Diagnosis of Coeliac Disease, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano.
| | - Lorenzo Norsa
- Division of Paediatric Gastroenterology, Hepatology and Transplantation, ASST "Pope Giovanni XXIII", Bergamo
| | - Angelo Zullo
- Gastroenterology and Digestive Endoscopy, "Nuovo Regina Margherita" Hospital, Rome
| | - Antonio Carroccio
- Internal Medicine, "Giovanni Paolo II" Hospital, Sciacca; Biomedical Department of Internal and Specialist Medicine - DiBiMIS, University of Palermo, Palermo
| | - Carlo Girelli
- Gastroenterology and Digestive Endoscopy Unit, Hospital of Busto Arsizio, Busto Arsizio
| | - Salvatore Oliva
- Paediatric Gastroenterology and Liver Unit, University "La Sapienza" of Rome, Roma
| | - Claudio Romano
- Paediatric Gastroenterology and Cystic Fibrosis Unit, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University of Messina, Messina
| | - Gioacchino Leandro
- National Institute of Gastroenterology "S. De Bellis" Research Hospital, Castellana Grotte, Italy
| | - Massimo Bellini
- Gastrointestinal Unit, Department of Translational Research and New Technology in Medicine and Surgery, University of Pisa, Pisa
| | | | - Marco Soncini
- Internal Medicine, "Alessandro Manzoni" Hospital, ASST-Lecco, Lecco
| | - Fabio Monica
- Gastroenterology and Digestive Endoscopy Unit, Cattinara Hospital, Trieste
| | | | - Emma Paulon
- Gastroenterology and Digestive Endoscopy Unit, Cattinara Hospital, Trieste
| | - Maria Domenica Cappellini
- Rare Diseases Center, Department of Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano; Department of Clinical Sciences and Community Health, University of Milan, Milano
| | - Irene Motta
- Rare Diseases Center, Department of Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano; Department of Clinical Sciences and Community Health, University of Milan, Milano
| | - Francesca Ferretti
- Gastroenterology and Endoscopy Division/Center for Prevention and Diagnosis of Coeliac Disease, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano
| | - Stefania Orlando
- Gastroenterology and Endoscopy Division/Center for Prevention and Diagnosis of Coeliac Disease, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano
| | - Pasquale Mansueto
- Biomedical Department of Internal and Specialist Medicine - DiBiMIS, University of Palermo, Palermo
| | | | - Guido Manfredi
- Gastroenterology Unit, ASST Ospedale Maggiore di Crema, Crema
| | - Carlo Agostoni
- Paediatric Intermediate Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano; Department of Clinical Sciences and Community Health, University of Milan, Milano
| | | | - Renato Cannizzaro
- Oncological Gastroenterology Division, Centro di Riferimento Oncologico (CRO) IRCCS, Aviano
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Luo Y, Chen J, Fang Y, Lou J, Yu J. A case of Metaplastic atrophic gastritis in immune Dysregulation, Polyendocrinopathy, Enteropathy, X-linked (IPEX) syndrome. BMC Pediatr 2018; 18:191. [PMID: 29907148 PMCID: PMC6002972 DOI: 10.1186/s12887-018-1169-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 06/06/2018] [Indexed: 12/02/2022] Open
Abstract
Background Autoimmune metaplastic atrophic gastritis is a chronic progressive inflammatory condition. The clinical spectrum includes pernicious anemia, atrophic gastritis, antibodies to parietal cell antigens and intrinsic factor, achlorhydria, hypergastrinemia and carcinoma. It is rare in paediatric cohorts. Case presentation We present the case of a boy with metaplastic atrophic gastritis in whom immune dysregulation, polyendocrinopathy, enteropathy, X-linked(IPEX) syndrome was confirmed by FOXP3 gene mutation. The patient was referred to the hospital at the age of 3 years with recurrent emesis, diarrhoea and malnutrition. His elder brother died at 9 years of age from acute respiratory distress syndrome and renal tubular acidosis. The patient was allergic to cow milk formula and noodles. Oesophagegastroduodenoscopy revealed redness, erosion and edema throughout the stomach; whitish granules in the duodenal bulb; and edema in the second part of the duodenum. Biopsies showed extensive villous atrophy and goblet cell depletion in the duodenum. He was diagnosed with type-1 diabetes mellitus (T1DM) during the treatment of methylprednisolone. Serum antibodies against glutamic acid decarboxylase and pancreatic islets were detected. The patient’s FOXP3 gene was sequenced; this identified that the patient was hemizygous for a pathogenic variant [NM_014009.3:c.748_750del (p.Lys250del)]. Conclusion Metaplastic atrophic gastritis is rarely reported in patients with IPEX. Clinical gastroenterologists should be aware of IPEX syndrome when facing the complex syndromes of metaplastic atrophic gastritis and endocrinopathy.
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Affiliation(s)
- Youyou Luo
- Gastroenterology Department, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jie Chen
- Gastroenterology Department, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
| | - Youhong Fang
- Gastroenterology Department, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jingan Lou
- Gastroenterology Department, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jindan Yu
- Gastroenterology Department, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Saglietti C, Sciarra A, Abdelrahman K, Schneider V, Karpate A, Nydegger A, Sempoux C. Autoimmune Gastritis in the Pediatric Age: An Underestimated Condition Report of Two Cases and Review. Front Pediatr 2018; 6:123. [PMID: 29765934 PMCID: PMC5939145 DOI: 10.3389/fped.2018.00123] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 04/13/2018] [Indexed: 12/16/2022] Open
Abstract
Background: Diagnosis of pediatric autoimmune gastritis (AIG) in children is important due to poor outcome and risk of malignancy. This condition is often underestimated in the clinico-pathologic diagnostic work-up, leading to delayed time-to-diagnosis. To increase the awareness of this condition in the pediatric population, we present two cases encountered at our institution, discuss their clinical, biological, and histological presentations in relation with evidence from the literature, and propose an algorithm for diagnosis and follow-up of AIG in children. Case presentation: Two patients (12 and 17 years old) presented with iron deficiency anemia and negative family history for autoimmune disorders. In both cases, the final diagnosis of autoimmune gastritis was delayed until pathological examination of endoscopic gastric biopsies showed atrophy of oxyntic glands. Helicobacter pylori search was negative. Follow up biopsies revealed persistent disease. Literature review on this condition shows unclear etiology and poor long term outcome in some patients because of increased risk of malignancy. Conclusions: AIG should be considered in the differential diagnosis of iron deficiency anemia in the pediatric population.Standardized clinico-pathologic work-up is mandatory. Endoscopic follow-up should be performed due to the risk of malignancy.
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Affiliation(s)
- Chiara Saglietti
- Institute of Pathology, Lausanne University Hospital, Lausanne, Switzerland
| | - Amedeo Sciarra
- Institute of Pathology, Lausanne University Hospital, Lausanne, Switzerland
| | - Karim Abdelrahman
- Gastroenterology and Hepatology Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Vanessa Schneider
- Institute of Pathology, Lausanne University Hospital, Lausanne, Switzerland
| | - Arti Karpate
- Institute of Pathology, Lausanne University Hospital, Lausanne, Switzerland
| | - Andreas Nydegger
- Pediatric Gastroenterology Unit, Department of Pediatrics, Lausanne University Hospital, Lausanne, Switzerland
| | - Christine Sempoux
- Institute of Pathology, Lausanne University Hospital, Lausanne, Switzerland
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