The prevalence and significance of circulating antibodies to gastric intrinsic factor and parietal cells in gastric carcinoma

Abstract

SUMMARYThe prevalence of circulating antibodies to gastric intrinsic factor and parietal cells was examined in 60 patients with histologically proven gastric carcinoma and was found not to differ from the prevalence of these antibodies in control subjects of similar age and sex distribution.Amongst the 60 patients with gastric carcinoma seven were thought to have actual or potential pernicious anaemia.The absence of an increased prevalence of antigastric antibodies in gastric carcinoma indicates that gastritis itself, whether autoimmune or not, is the likely common denominator underlying the predisposition to gastric carcinoma in both pernicious anaemia and chronic atrophic gastritis.The studies of Kaplan and Rigler (1945) and Mosbech and Videbaek (1950) established that pernicious anaemia is associated with an incidence of gastric carcinoma approximately three times greater than that expected for the population at large.On the basis of a study of 35 patients with gastric carcinoma Shearman, Finlayson, Wilson, and Samson (1966) suggested that the extent of this association may have been underestimated. We have investigated this possibility by estimating serum vitamin B12 levels and the prevalence of circulating antibodies to gastric intrinsic factor and parietal cells in 60 patients with histologically proven gastric carcinoma. The prevalence of antigastric antibodies is compared with that in control subjects of similar age and sex distribution. Patients and MethodsThe 60 patients with gastric carcinoma comprised 37 men and 23 women. Blood samples were requested from patients with a diagnosis on admission or subsequently of gastric carcinoma admitted to the Royal Melbourne Hospital over a period of three years. Only those in whom a gastric carcinoma was histologically proven at operation or necropsy were included in this series. The age and sex distribution of the patients is shown in Tables I and II.

Chronic Gastritis

“…In 293 cases of pernicious anemia, inci dence of gastric cancer at autopsy reached 12%, a 3-fold increase in com parison to the control series. Some authors consider that the gastric lesion in pernicious anemia is more prone to cancerization than in simple atrophic gastritis; others disagree [103,107]; as yet, no definite statement is possible.…”

“…The absolute frequency is estimated between 5 and 12% [49,66], This figure is considered by most authors to be higher than in simple atrophic gastritis, but this is not a definite statement [103,107]. On the other hand, a systematic exploration will detect pernicious anemia with an increased frequency in patients with gastric cancer.…”

“…On the other hand, a systematic exploration will detect pernicious anemia with an increased frequency in patients with gastric cancer. In a series of 60 cases [103], clinical or biological manifesta tions of a masked pernicious anemia were present in 12% of cases. Anemia [34, 39, 40, 55, 57, 76 In most cases, the gastric lesion seems to be secondary to the deficiency, rather than being its cause.…”

Chronic (Nonerosive) Gastritis: Pathogenesis and Management

“…The data overall suggest that there is only a small increased cancer risk [88, 89, 95. 96], with type A gastritis and pernicious anemia patients having a lower risk of devel oping carcinoma than type B gastritis pa tients [10,27,94], Genetic and environmental factors may be important in determining which patients with atrophic gastritis go on to develop gas tric cancer. The prevalence of atrophic gas tritis and intestinal metaplasia is increased in relatives of gastric cancer patients [97], Diet may play a role [72,73].…”

“…Familial cluster ing of cases of pernicious anemia occur; 10-20 % of relatives have overt or latent disease and relatives have an increased incidence of antibodies to gastric and thyroid tissue [25], No HLA association has been reported [26], While immunological abnormalities are common in type A gastritis, it remains un clear whether these reflect an immunological basis for the disease or are epiphenomena [26], Parietal cell antibodies occur in up to 60% of patients with type A gastritis, 90% of patients with pernicious anemia, and in ap proximately 20-30% of those with certain autoimmune diseases (Addison's disease, hypoparathyroidism, vitiligo, Graves' dis ease, Hashimoto's thyroiditis, diabetes mellitus) and the elderly [10,11], These anti bodies are not associated with other types of gastric inflammation [27]. Intrinsic factor antibodies also occur in the serum, saliva and gastric juice in pernicious anemia.…”