Autoimmune Gastritis: A Clinicopathologic Review with Updates Regarding Diagnosis, Surveillance, and Artificial Intelligence

Autoimmune gastritis (AIG) is a chronic disorder involving an immune response that leads to the destruction of the oxyntic glands, which leads to gastric atrophy, intestinal metaplasia, and nutritional deficiencies. It increases the risk of type 1 gastric neuroendocrine tumors and, although the extent of this association is still disputed, also carries a risk of gastric adenocarcinoma. The present review covers the current understanding of AIG from clinical and pathologic points of view, addressing its pathogenesis, clinical and endoscopic manifestations, histopathological characteristics, diagnosis, management, and surveillance. We also point out recent findings regarding the variability in pathology reporting, clinicians’ interpretation of pathology reports, and the emerging uses of artificial intelligence in the diagnosis and surveillance of AIG, as well as what obstacles still exist before these tools can be used in a clinical setting. Improved recognition of the condition and the establishment of a common diagnostic standard would enable earlier diagnosis, more reliable risk stratification, and a form of surveillance that corresponds to the actual neoplasia risk.