Autoimmune gastritis: histology phenotype and OLGA staging

Alimentary Pharmacology and Therapeutics, 05/14/2012

In autoimmune gastritis, the cancer risk is restricted to high–risk gastritis stages (III–IV), and is associated mainly with concomitant H. pylori infection. OLGA staging consistently depicts the time–dependent organic progression of the autoimmune disease and provides key information for secondary gastric cancer prevention strategies.

Methods

  • A single–institutional series (spanning the years 2003–2011) of 562 consecutive patients (M:F ratio: 1:3.7; mean age = 57.6 ± 14.4 years) with serologically confirmed autoimmune gastritis underwent histology review and OLGA staging.

Results

  • Helicobacter pylori infection was ascertained histologically in 44/562 cases (7.8%).
  • Forty six biopsy sets (8.2%) featured OLGA stages III–IV; they included all four cases of incidental epithelial neoplasia (three intraepithelial and one invasive; three of these four cases had concomitant H. pylori infection).
  • There were 230 (40.9%) and 139 (24.7%) cases, respectively, of linear and micro–nodular enterochromaffin–like cell hyperplasia; 19 (3.4%) type I carcinoids were detected.
  • The series included 116 patients who underwent repeated endoscopy/biopsy sampling (mean time elapsing between the two procedures = 54 months; range 24–108).
  • Paired histology showed a significant (P = 0.009) trend towards a stage progression [the stage increased in 25/116 cases (22%); it remained unchanged in 87/116 cases (75%)].

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