Autoimmune gastritis — ESEGH MCQ

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ModerateLuminal GIAutoimmune gastritisESEGH

A 70-year-old woman presents with fatigue, glossitis and paraesthesia. Investigations show haemoglobin 86 g/L, mean corpuscular volume 118 fL, vitamin B12 74 ng/L and positive intrinsic factor antibodies. Gastroscopy demonstrates pale mucosa in the gastric body. Biopsies show corpus-predominant glandular atrophy with intestinal metaplasia, with relative sparing of the antrum. What is the most likely diagnosis?

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Correct answer: C — Autoimmune metaplastic atrophic gastritis

The diagnosis is autoimmune metaplastic atrophic gastritis. Autoimmune destruction of oxyntic glands produces corpus-predominant atrophy, intestinal metaplasia and loss of intrinsic factor, ultimately causing vitamin B12 deficiency and pernicious anaemia. The positive intrinsic factor antibody is highly supportive, while macrocytosis, glossitis and paraesthesia demonstrate clinically significant deficiency. Helicobacter pylori-associated atrophy is usually multifocal and commonly includes the antrum rather than showing this autoimmune corpus-restricted pattern. Reactive gastropathy and lymphocytic gastritis do not explain intrinsic factor antibodies or pernicious anaemia. Zollinger–Ellison syndrome causes acid hypersecretion with hypertrophic gastric folds and peptic ulceration, not oxyntic atrophy. Autoimmune atrophic gastritis is associated with increased risks of gastric adenocarcinoma and type 1 gastric neuroendocrine tumours.

Reference: Banks M, Graham D, Jansen M, et al. British Society of Gastroenterology guidelines on the diagnosis and management of patients at risk of gastric adenocarcinoma. Gut. 2019;68:1545–1575. https://www.bsg.org.uk/getattachment/0bf7dea9-7c88-4171-8444-57e508f0f07e/7a6ac794-40ca-4a87-82a2e553bb4b78b1.pdf?lang=en-US