Autoimmune Gastritis Versus Severe Body Predominant H.pylori Gastritis: A Comparative Analysis of 88 Cases
Hye Seung Han, Gregory Y Lauwers. Konkuk University School of Medicine, Seoul, Republic of Korea; Massachusetts General Hospital, Harvard Medical School, Boston,, MA
Background: Autoimmune gastritis (AIG) is a body predominant inflammatory process associated with mucosal atrophy and metaplastic changes. Although the features of AIG are reported to be distinctive from the common antral H. pylori gastritis (HPG), we are not aware of comparative analysis between AIG and severe chronic HPG involving the oxyntic mucosa.
Design: 58 consecutive cases of AIG diagnosed at MGH were compared to 30 consecutive cases of severe chronic HPG involving the oxyntic body mucosa obtained from the files of KUMC. In each group, the inflammatory pattern, i.e., distribution, degree and type of inflammation, including: neutrophilic and eosinophilic infiltrate, presence of lymphoid follicles, intraepithelial lymphocyte and granuloma were evaluated. Detection of glandular destruction, apoptosis, mucosal atrophy, intestinal, pyloric and pancreatic acinar cell metaplasia and parietal cell hyperplasia were also investigated.
Results: The average age of patients with AIG was 61.4 years and the ratio of female:male was 37:18. Neoplasia was observed in 11 patients including adenocarcinomas (n=7), adenomas (n=2) and neuroendocrine tumors (n=2). Within the AIG group, lymphoid follicles (p=0.019), intraepithelial lymphocytes (p=0.004), gland destruction (p=0.000), pancreatic acinar metaplasia (p=0.001) and nodular enterochromaffin-like cell hyperplasia (p=0.011) were more common in AIG cases with associated neoplasia. In the HPG group, the average was 54.2 years and there was no sex predilection. Comparing AIG to HPG, AIG patients were older (p=0.035). Lymphoplasmacytic predominant, basal inflammation with lesser neutrophilic (all p=0.000) but with more common eosinophils (p=0.009), lymphoid follicles (p=0.042) and intraepithelial lymphocytes (p=0.047) characterized AIG. In addition, severe glandular destruction, atrophy (p=0.000), apoptosis (p=0.003), intestinal metaplasia and marked pyloric metaplasia (p=0.000) were also more common in AIG. Pancreatic acinar cell metaplasia and enterochromaffin-like cell hyperplasia were only detected in AIG. There was no difference in the rate of parietal cell hyperplasia between both groups.
Conclusions: AIG with neoplastic lesions are associated with distinctive inflammatory pattern that need to be evaluated as surveillance tool. Furthermore, several mucosal stigmata of AIG remain distinct from those of severe long standing chronic HPG involving the oxyntic mucosa even in area of with heavy bacterial load like in Korea.
Monday, March 19, 2012 1:00 PM
Poster Session II # 98, Monday Afternoon