Kotera Tohru, Nishimi Yurika, Kushima Ryoji, Haruma Ken
Department of Medical Examination, Uji-Tokushukai Medical Center, Uji, Japan.
Department of Emergency and General Medicine, Uji-Tokushukai Medical Center, Uji, Japan.
Case Rep Gastroenterol. 2023 Jan 10;17(1):34-40. doi: 10.1159/000528388. eCollection 2023 Jan-Dec.
We report a case of autoimmune gastritis (AIG) in which gastric mucosal atrophy improved with eradication. Based on endoscopic findings (advanced gastric atrophy with vascular visibility and diffuse redness in remnant oxyntic mucosa), a woman in her 40s was suspected of having AIG coexisting with an active infection. This was confirmed by a positive anti-parietal cell antibody (PCA, 1:160), an elevated serum gastrin level (638 pg/mL), and positive anti- antibody ( Ab, 15.5 U/mL) and stool antigen tests. Seven months after eradication, reduced vascular visibility and disappearance of diffuse redness on endoscopy and reduced PCA (1:40) and Ab (5.1 U/mL) titers were observed, although histopathological findings (basal-predominant lymphocytic infiltration, destruction of parietal and chief cells, pseudopyloric metaplasia, and enterochromaffin-like cell hyperplasia) were consistent with AIG. Endoscopy 26 months after eradication showed further improvement in atrophic findings in the gastric corpus and histopathological recovery of parietal and chief cells in fundic glands. Serum gastrin levels returned to normal (64 pg/mL), and the PCA titer fell further (1:20).
我们报告一例自身免疫性胃炎（AIG），其胃黏膜萎缩在根除治疗后有所改善。根据内镜检查结果（重度胃萎缩，可见血管，残余泌酸黏膜弥漫性发红），一名40多岁的女性被怀疑患有AIG并伴有活动性感染。抗壁细胞抗体（PCA，1:160）阳性、血清胃泌素水平升高（638 pg/mL）、抗内因子抗体（IF Ab，15.5 U/mL）阳性以及粪便抗原检测结果证实了这一诊断。根除治疗7个月后，内镜检查发现血管可见度降低，弥漫性发红消失，PCA（1:40）和IF Ab（5.1 U/mL）滴度降低，尽管组织病理学检查结果（以基底为主的淋巴细胞浸润、壁细胞和主细胞破坏、假幽门化生以及嗜银样细胞增生）与AIG相符。根除治疗26个月后的内镜检查显示胃体萎缩性改变进一步改善，胃底腺壁细胞和主细胞的组织病理学恢复。血清胃泌素水平恢复正常（64 pg/mL），PCA滴度进一步下降（1:20）。
