Long-term natural history of autoimmune gastritis: results from a prospective, monocentric series
Emanuela Miceli, Marco Vincenzo Lenti, Antonella Gentile, Giulia Gambini, Clarissa Petrucci, Lavinia Pitotti, Caterina Mengoli, Michele Di Stefano, Alessandro Vanoli, Ombretta Luinetti, Natascia Brondino, Marco Paulli, Andrea Anderloni, Catherine Klersy, Gino Roberto Corazza, Antonio Di Sabatino- Gastroenterology
- Hepatology
Objectives:
The natural history of autoimmune gastritis (AIG) has been poorly described. We herein report the long-term natural history and clinical clustering of the full spectrum of AIG, from the potential to the complicated stage.
Methods:
Prospective, single-center study conducted in a tertiary referral center. AIG patients at any stage (0=potential; 1=early; 2=florid; 3=severe; 4=complicated) were enrolled (January 2000-December 2022). The histopathological evolution, the clinical presentation, and the correlates of evolution of potential AIG were assessed.
Results:
498 AIG patients (mean age 56.7±15.2, F:M ratio 2.5:1) were included, of whom 93 with potential AIG. The maximum disease duration was 27 years (median 18, IQR 14-23), while the overall median follow-up was 52 months (IQR 12-95). Age was significantly lower in stage 0 compared to the other stages. Accidental histologic evidence and hematologic findings were the most common clusters of diagnosis. The overall median rate of progression was 7.29 per 100 person/year (95% CI 6.19-8.59), while the stage-specific rates of progression were 10.85 (stage 0; 95% CI 7.75-15.18), 14.83 (stages 1-2; 95% CI 11.89-18.49), and 2.68 (stage 3; 95% CI 1.88-3.84). Newly onset neoplastic complications at follow-up occurred in 41/483 patients (8.5%; 23 neuroendocrine tumors, 18 epithelial dysplasia). No cases of adenocarcinoma were noticed. Male sex was associated with a greater likelihood of evolving from potential AIG to overt AIG.
Conclusions:
AIG is a progressive disorder, with a virtually absent risk of gastric adenocarcinoma. Potential AIG patients should be monitored as they carry a high risk of evolving into overt AIG.