Pediatric Gastroenterology and Nutrition Unit, Edmond and Lily Safra Children's Hospital, Ramat Gan, Israel.
Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
J Pediatr Gastroenterol Nutr. 2024 Sep;79(3):501-509. doi: 10.1002/jpn3.12318. Epub 2024 Jul 16.
Autoimmune gastritis (AIG) is a rare chronic inflammatory disorder with potential long-term sequelae including gastric neoplasia. There is limited data on the natural history of pediatric AIG. We aimed to characterize the clinical course and outcomes of children with AIG.
This was a multicenter retrospective study that included pediatric patients diagnosed with AIG between January 1, 2000 and December 31, 2021. Diagnosis of AIG was based on the demonstration of histological corpus-predominant atrophic gastritis, with or without positive antiparietal cell (APCA) or anti-intrinsic factor (IF) antibodies. Demographic, clinical, laboratory, endoscopic, and histologic data were retrieved, along with follow-up data.
Thirty-three patients, (23 females [69.7%], median age 12.0 [interquartile range 7.0-15.0] years at diagnosis) were identified. Twenty-two patients (66.7%) had positive APCA and/or anti-IF serology. The most common presenting manifestation was iron deficiency anemia (75%), and accompanying autoimmune disorders were significantly more common in patients with positive serology (62% vs. 18%, p < 0.05). Pseudo-pyloric or intestinal-type metaplasia was present at diagnosis in eight patients (24%), and 11 additional patients (33%) developed metaplasia during a median follow-up time of 27 (17.5-48.3) months. One patient developed a type 1 gastric neuroendocrine tumor. Helicobacter pylori was identified in only one patient, while two patients had prior eradication. Endoscopic and histologic improvements weren't identified in any patients.
AIG should be considered in patients with autoimmunity and resistant iron-deficiency anemia. H. pylori infection may not be associated with pediatric AIG. The development of neuroendocrine tumor in one patient, and the high rates of metaplasia, highlight the importance of surveillance.
自身免疫性胃炎（AIG）是一种罕见的慢性炎症性疾病，具有潜在的长期后果，包括胃肿瘤。儿科 AIG 的自然病史数据有限。我们旨在描述 AIG 患儿的临床病程和结局。
这是一项多中心回顾性研究，纳入了 2000 年 1 月 1 日至 2021 年 12 月 31 日期间诊断为 AIG 的儿科患者。AIG 的诊断基于组织学胃体为主的萎缩性胃炎的表现，伴有或不伴有抗壁细胞（APCA）或抗内因子（IF）抗体阳性。检索了人口统计学、临床、实验室、内镜和组织学数据以及随访数据。
共确定了 33 名患者（23 名女性[69.7%]，诊断时的中位年龄为 12.0 [四分位距 7.0-15.0]岁）。22 名患者（66.7%）APCA 和/或抗 IF 血清学阳性。最常见的表现为缺铁性贫血（75%），伴有自身免疫性疾病的患者血清学阳性更为常见（62%比 18%，p<0.05）。8 名患者（24%）在诊断时存在假性幽门或肠型化生，11 名患者（33%）在中位随访 27（17.5-48.3）个月期间发生化生。1 名患者发生 1 型胃神经内分泌肿瘤。仅在 1 名患者中发现幽门螺杆菌，而 2 名患者有既往根除史。在任何患者中均未发现内镜和组织学改善。
对于自身免疫性疾病和耐药性缺铁性贫血的患者，应考虑 AIG。幽门螺杆菌感染可能与儿科 AIG 无关。1 名患者发生神经内分泌肿瘤，且化生发生率较高，这突出了监测的重要性。
