Autoimmune liver diseases and autoimmune atrophic gastritis: an overlooked association?

Autoimmune atrophic gastritis (AAG) is a chronic condition characterized by the presence of atrophy in the oxyntic mucosa and a spared antrum, frequently with presence of anti-parietal cells antibodies (APCA). The prevalence of AAG has been estimated at between 0.3% and 2.7% in the general population. AAG can be associated with other autoimmune disorders such as type I diabetes, thyroid disease, vitiligo and alopecia. In literature there are only a few case reports showing the association between AAG and autoimmune liver diseases (primary biliary cholangitis=PBC, primary sclerosant cholangitis=PSC, and autoimmune hepatitis=AIE) The aim of this study was to evaluate the prevalence of AAG in patients affected by autoimmune liver diseases (PBC, PSC and AIE). We conducted a prospective study in a cohort of 46 patients with a diagnosis of either PBC (26/46, 56.5%), PSC (1/46, 2.1%), AIE (11/46, 23.9%), or an overlap PBC/AIE (8/46, 17.3%) who underwent, according to our prescription, gastroscopy (EGDS) for different reasons (dyspepsia, anemia, diarrhea, reflux symptoms or search for esophageal varices). Biopsies during EGDS were taken following the updated Sydney System protocol. 45/46 (97.8%) patients were female, while only 1 patient (2.1%) was male. Nine (19.5%) out of 46 patients were diagnosed with AAG, with histological evidence of atrophy in the oxyntic mucosa only. Moreover, 7 of these patients had positive APCA, while in the other 2 patients APCA were not tested. Six of these 9 patients were affected by PBC, 2 had AIE and 1 had an overlap syndrome (PBC/AIE). In addition, 23/46 (50%) patients had other autoimmune disorders. Our study showed a strong association between AAG and autoimmune liver diseases raising the question of the need of gastroscopy with adequate biopsy sampling and/or serological assay of APCA in patients diagnosed with liver autoimmune diseases to screen for AAG. [ABSTRACT FROM AUTHOR]