Editorial: determinants of diagnostic delay in autoimmune atrophic gastritis–a salutary lesson. Authors' reply

Lenti, Marco Vincenzo; Miceli, Emanuela; Corazza, Gino Roberto

doi:10.1111/apt.15415

Cited by 3 publications

(2 citation statements)

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“…We have already discussed in a previous study about the potential usefulness of a proactive serological screening strategy for early detection of AAG in high‐risk groups, especially in individuals suffering from autoimmune diseases and with a first‐degree family history of AAG . Our data here further support the need for this strategy, given that advanced AAG stages may be present at the time of diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Natural history of autoimmune atrophic gastritis: a prospective, single centre, long‐term experience

Miceli

Vanoli

Lenti

et al. 2019

Aliment Pharmacol Ther

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Summary Background Autoimmune atrophic gastritis (AAG) is an immune‐mediated disorder characterised by destruction of gastric oxyntic mucosa Aim To explore gastric histopathological evolution in a cohort of AAG patients over a prolonged follow‐up Methods Single centre prospective study enrolling consecutive patients with histologically confirmed AAG between 2000 and 2018. All AAG patients undergoing endoscopic follow‐up every 1‐3 years were classified as having stages 1, 2 or 3 according to atrophy severity (mild, moderate and severe). AAG patients with either glandular or neuroendocrine dysplasia/neoplasia were classified as having stage 4. Disease stage progression, and changes in serum anti‐parietal cell antibody (PCA), chromogranin A and gastrin‐17 were assessed. Results In total, 282 AAG patients (mean age 60.3 years; F:M ratio 2.4:1; median follow‐up 3 years, interquartile range 1‐7) were enrolled. All patients with stages 1 or 2 progressed to stage 2 or 3 over time with a steady trend (P = .243) and regression from a severe to a milder stage was never noticed. Disease progression of patients with stages 1 or 2 occurred within the first 3 years. PCA positivity rate did not change over time. Stage 3 patients had higher gastrin‐17 levels compared to patients with stages 1 and 2 (median 606 vs 295 pg/mL; P < .001). In stage 3, the hazard ratio for the risk of developing stage 4 was 6.6 (95% CI 1.5‐29; P = .001). Conclusions AAG is a steadily progressive disease, in which stages 1 and 2 always progress to stage 3. The risk of developing a complicated disease stage is greater in patients with more severe gastric lesions.

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Section: Discussionmentioning

confidence: 99%

Natural history of autoimmune atrophic gastritis: a prospective, single centre, long‐term experience

Miceli

Vanoli

Lenti

et al. 2019

Aliment Pharmacol Ther

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“…Cardiovascular manifestations, including thrombotic outcomes, have been reported as the main presenting symptoms in approximately 10% of patients with Addison/Biermer autoimmune atrophic gastritis. 8 However, the association of HHcy with CVD evidenced by experimental and observational population studies mismatches with the results of t-Hcy-lowering clinical trials on the prevention of CVD manifestations. These data led us to consider three main issues in the literature: Is HHcy a dose-dependent risk factor of CVD?…”

Section: Introductionmentioning

confidence: 99%

Hyperhomocysteinemia in Cardiovascular Diseases: Revisiting Observational Studies and Clinical Trials

et al. 2022

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Thromboembolic manifestations are relativement frequent in patients with intermediate/severe hyperhomocysteinemia (> 30 µmol/L) related to inherited disorders and deficiencies in vitamin B12 and folate. In contrast, moderate hyperhomocysteinemia (15- 30 µmol/L) is a modest predictor of cardiovascular risk. The recognition of homocysteine as a cardiovascular risk factor has been challenged by some but not all randomized clinical trials. We reviewed the main data of this controversy and formulated conclusions to be translated in clinical practice. Lowering homocysteine trials have been performed in cardiovascular subjects with moderate but not intermediate/severe hyperhomocysteinemia despite the dose-effect risk association. The first meta-analyses found no benefit and led cardiology societies not recommending homocysteine in the assessment of cardiovascular risk. This guideline challenged the need to diagnose and treat the nutritional and genetic causes of intermediate/major hyperhomocysteinemia and was not revised when larger meta-analyses concluded to a reduced risk of stroke. In a recent observational study, 84% of consecutive cardiovascular patients assessed for homocysteine had intermediate or major hyperhomocysteinemia, which was properly assessed in only half cases and related to B12 and/or folate deficiency and Addisson/Biermer disease in 55% of these cases. In conclusion, revisiting observational studies and clinical trials suggests that cardiovascular patients should be screened for hyperhomocysteinemia, when no other risk factor is found. Patients with intermediate/major hyperhomocysteinemia should be properly assessed and treated for vitamin B deficiencies and inherited disorders according to current guidelines. Further trials are needed to assess the lowering homocysteine effect according to hyperhomocysteinemia categories at baseline.

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Autoimmune gastritis

Lenti

Rugge

Lahner

et al. 2020

Nat Rev Dis Primers

217

165

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Editorial: determinants of diagnostic delay in autoimmune atrophic gastritis–a salutary lesson. Authors' reply

Abstract: Linked ContentThis article is linked to Lenti et al and Walker papers. To view these articles, visit https://doi.org/10.1111/apt.15317 and https://doi.org/10.1111/apt.15394.

Cited by 3 publications

References 10 publications

Natural history of autoimmune atrophic gastritis: a prospective, single centre, long‐term experience

Natural history of autoimmune atrophic gastritis: a prospective, single centre, long‐term experience

Hyperhomocysteinemia in Cardiovascular Diseases: Revisiting Observational Studies and Clinical Trials

Autoimmune gastritis

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