Massironi Sara, Dispinzieri Giulia, Rossi Alberto, Cristoferi Laura, Lenti Marco Vincenzo, Gerussi Alessio, Elvevi Alessandra, Carbone Marco, Bonfichi Alessandra, Di Sabatino Antonio, Danese Silvio, Invernizzi Pietro
Vita e Salute San Raffaele University, Medicine and Surgery, Milan, Italy.
Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
Front Immunol. 2025 Jul 25;16:1628478. doi: 10.3389/fimmu.2025.1628478. eCollection 2025.
Autoimmune gastritis (AIG) and autoimmune liver diseases (AILDs)-including autoimmune hepatitis (AIH), primary biliary cholangitis (PBC), and primary sclerosing cholangitis (PSC)-are chronic organ-specific immune-mediated disorders. While both conditions frequently co-occur with other autoimmune diseases, the prevalence, clinical overlap, and immunological associations between AIG and AILDs remain underexplored.
To investigate the prevalence of AIG in patients with AILD and characterize the clinical, serological, and histopathological features of this overlap, to improve early detection and guide integrated management strategies.
We conducted a prospective study on 104 patients with a confirmed diagnosis of AILD. All participants were screened for anti-parietal cell antibodies (APCA); those testing positive underwent upper gastrointestinal endoscopy and gastric biopsies. Histological assessment was based on the updated Sydney System, with evaluation of mucosal inflammation, glandular atrophy, and intestinal metaplasia.
APCA positivity was observed in 22.1% of AILD patients, with a female predominance (78.3%). The median age of AIG diagnosis in APCA-positive patients was 58 years. Among APCA-positive individuals, histological confirmation of AIG was achieved in 91.3%, with a high rate of intestinal metaplasia (95.7%) and variable OLGA stages of gastric atrophy. Comorbid autoimmune conditions were common, with 43.5% of APCA-positive patients also presenting with autoimmune thyroiditis. Notably, PBC was disproportionately represented in the APCA-positive subgroup (47.8%) compared to the overall cohort (39.0%).
This study highlights a clinically significant association between AIG and AILDs, particularly in patients with PBC and concurrent autoimmune conditions. Given the elevated risk of gastric mucosal atrophy and potential neoplastic transformation, targeted screening for AIG in AILD patients-especially those with APCA positivity or thyroid autoimmunity-should be considered. These findings underscore the importance of cross-specialty surveillance and open new avenues for research into shared immunopathogenic mechanisms.
This study found that a significant number of patients with autoimmune liver diseases, especially those with primary biliary cholangitis, also show signs of autoimmune gastritis. These results support the consideration of targeted screening for gastric involvement in selected patients to improve early detection and clinical management of associated complications.
自身免疫性胃炎（AIG）和自身免疫性肝病（AILDs），包括自身免疫性肝炎（AIH）、原发性胆汁性胆管炎（PBC）和原发性硬化性胆管炎（PSC），是慢性器官特异性免疫介导的疾病。虽然这两种疾病都经常与其他自身免疫性疾病同时发生，但AIG与AILDs之间的患病率、临床重叠情况及免疫关联仍未得到充分研究。
调查AILD患者中AIG的患病率，并描述这种重叠情况的临床、血清学和组织病理学特征，以改善早期检测并指导综合管理策略。
我们对104例确诊为AILD的患者进行了一项前瞻性研究。所有参与者均接受抗壁细胞抗体（APCA）筛查；检测呈阳性者接受上消化道内镜检查和胃活检。组织学评估基于更新后的悉尼系统，评估黏膜炎症、腺体萎缩和肠化生情况。
22.1%的AILD患者APCA呈阳性，女性占优势（78.3%）。APCA阳性患者中AIG诊断的中位年龄为58岁。在APCA阳性个体中，91.3%通过组织学确诊为AIG，肠化生率高（95.7%），胃萎缩的OLGA分期各异。合并自身免疫性疾病很常见，43.5%的APCA阳性患者还患有自身免疫性甲状腺炎。值得注意的是，与整个队列（39.0%）相比，APCA阳性亚组中PBC的比例过高（47.8%）。
本研究强调了AIG与AILDs之间临床上的显著关联，特别是在PBC患者和并发自身免疫性疾病的患者中。鉴于胃黏膜萎缩和潜在肿瘤转化风险升高，应考虑对AILD患者，尤其是APCA阳性或存在甲状腺自身免疫的患者进行针对性的AIG筛查。这些发现强调了跨专业监测的重要性，并为共享免疫发病机制的研究开辟了新途径。
本研究发现，大量自身免疫性肝病患者，尤其是原发性胆汁性胆管炎患者，也表现出自身免疫性胃炎的迹象。这些结果支持对特定患者进行针对性的胃部受累筛查，以改善相关并发症的早期检测和临床管理。
