Autoimmune Metaplastic Atrophic Gastritis
Chitchai Rattananukrom1, Narasak Changraksa2
Affiliation : ¹ Division of Gastroenterology and Hepatology, Department of Internal Medicine, Srinagarind Hospital, Khon Kaen University, Khon Kaen, Thailand, ² Department of Internal Medicine,The 50th Anniversary Mahavajiralongkorn Hospital, Ubon Ratchathani, Thailand
Autoimmune metaplastic atrophic gastritis (AMAG) is a chronic progressive inflammatory condition caused by autoimmune destruction of the oxyntic mucosa in the corpus and fundus of stomach, sparing of antrum. The gastric mucosa is replaced by atrophic and metaplastic mucosa leading to progressive mucosal atrophy. Resulting in reduce or absent of acid production and loss of intrinsic factor may progress to a severe form of vitamin B12 deficiency anemia and iron deficiency anemia. Moreover, patients with AMAG have higher risks for gastric dysplasia, gastric adenoma, gastric adenocarcinoma, and gastric neuroendocrine tumor. The etiology of the development of AMAG is unclear.
The clinical presentations are usually non-specific signs or symptoms unless the degree of atrophy impairs the absorption of vitamin B12 and other substances, including folate and iron. Patients might have vague symptoms for many years before all reserves are depleted. Common clinical presentations are iron deficiency anemia and pernicious anemia.
The diagnosis of AMAG might be challenging and usually requires the combination of clinical and diagnostic tests such as laboratory tests, endoscopy, and histopathology. The management strategies are focused on the prevention of vitamin B12, folate and iron deficiencies. Rapid replenishment of vitamin B12 followed by lifelong maintenance on vitamin B12 is necessary when pernicious anemia is present. Patients should receive endoscopic follow-up every 3 to 5 years for surveillance of gastric cancer and neuroendocrine tumor.
DOI:10.35755/jmedassocthai.2023.S01.13811
Keywords : Autoimmune metaplastic atrophic gastritis; Diffuse corporal atrophic gastritis
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