Moreira-Silva Helena, Silva Gisela, Costa Emília, Guerra Isabel, Santos-Silva Ermelinda, Tavares Marta, Cleto Esmeralda, Lima Rosa
Pediatric Gastroenterology Unit.
Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto.
J Pediatr Gastroenterol Nutr. 2019 Jun;68(6):e99-e104. doi: 10.1097/MPG.0000000000002278.
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.
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.
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.
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.
自身免疫性胃炎（AIG）是胃黏膜的一种慢性炎症性疾病，主要见于患有恶性贫血的成年人。它是由抗体介导的壁细胞破坏所致，但确切的起始事件尚不清楚。幽门螺杆菌（H pylori）的致病性已被提出，但尚未得到证实。本研究旨在更好地描述儿科患者的AIG，并探讨H pylori感染可能发挥的作用。
描述性单中心研究，回顾性描述20例基于抗壁细胞自身抗体阳性诊断为AIG的患者，此外还有胃体黏膜萎缩的分析和/或组织学表现。
大多数患者（18/20）在难治性缺铁性贫血调查期间被诊断为AIG。1例患者有消化不良症状，其他患者均无胃肠道症状。55%（11/20）的患者H pylori检测呈阳性，但在就诊时的平均血红蛋白值（10.6±2.5 vs 9.5±1.0 g/dL，P>0.05）、胃萎缩的分析指标（胃泌素，564.4±184 vs 721.2±220.6 pg/mL，P>0.05）或胃体黏膜萎缩的存在或程度方面，均无显著差异。
我们的研究结果表明，AIG可能有年龄依赖性表现；因此，我们可以考虑一种儿科表型，与成人不同，它表现为难治性缺铁性贫血，并与壁细胞自身抗体阳性相关，但与内因子自身抗体无关。在本研究中，H pylori与AIG之间的相关性不明显，H pylori是否为AIG的触发因素仍不清楚。
