Komplikace

Hypochlorhydria

Nádory

• Hypochlorhydric state may induce enterochromaffin-like (ECL) cell hyperplasia
• With a major risk of developing type 1 gastric neuroendocrine tumors over time
• Percentages varying from 0.4% to 7%
• Gastric adenocarcinoma
• Incidence ranging between 0% and 1.8% per year
• Crucial role of parietal cell secretion in maintaining an acidic intragastric milieu
• Strictly regulated by both endocrinal and neuronal stimulation via the vagus nerve
• Hydrochloric acid secretion stimulated by
• Gastrin
• Secreted by gastrin-producing cells in the antrum
• histamine
• Produced by ECL cells in the corpus or fundus glands
• Oxyntic mucosa atrophy, hypochlorhydria
• Leads to persistently increased levels of gastrin
• Risk factor for ECL cell hyperplasia, dysplasia, and type 1 gastric neuroendocrine tumors

• Higher risk of gastric cancer in corpus atrophic gastritis
• Hp, considered the first trigger of a multistep carcinogenic process
• Carcinogenic mechanisms associated with AIG are still under debate
• Inflammation, dysregulation of the host immune system
• Increase in nitrate and nitrose-producing bacteria
• Leading to a non-acidic intragastric milieu, as occurs in AIG
• May play a role in gastric carcinogenesis

• European guidelines on the management of epithelial precancerous conditions and lesions
• AIG is considered a precancerous condition
• Patients should be stratified according to risk groups
• (OLGA/OLGIM system, family history of gastric cancer, or presence of incomplete intestinal metaplasia)
• Monitored by gastroscopy with biopsies, according to the updated Sydney system protocol
• At an interval of 3–5 years

Anemie z nedostatku železa

• The most frequent long-term complication associated with the hypochlorhydric state
• Onset of hematological alterations due to iron or vitamin B12 malabsorption
• Iron absorption
• Strictly dependent on normal gastric hydrochloric acid secretion
• Essential for the reduction of ferric dietary iron to ferrous iron, a major absorbable iron form
• May be managed by oral iron supplementation
• Suggested to switch to intravenous iron delivery and blood transfusion
• Only in case of severe anemia or exceptional situations

Vitamin B12 deficiency

• Intramuscular administration
• Particularly in patients who complained of neurological symptoms
• Also not always reversible
• Cochrane review did not find any superiority of oral or intramuscular vitamin B12 treatment in normalizing serum vitamin B12 levels
• Showing cost-effectiveness in favor of oral treatment
• But the trials reviewed included patients irrespective of the cause of vitamin B12 deficiency and therefore also patients without AIG or PA
• Takže injekčně na jistotu...
• www.mdpi.com/2076-2607/8/11/1827

Co-occurring autoimmune conditions may include

• Rheumatoid arthritis: an autoimmune attack on joints and connective tissue
• Crohn’s disease: an autoimmune attack on the gastrointestinal tract
• Celiac Disease: an autoimmune attack on the small intestine triggered by gluten
• Hashimoto’s thyroiditis: an autoimmune lymphocytic infiltration and destruction of the thyroid
• Other autoimmune thyroid diseases: most often Grave’s disease
• Type 1 diabetes: an autoimmune attack on the pancreas
• Vitiligo: an autoimmune attack on melanocytes, the cells in your skin that create pigment
• Addison’s disease: an autoimmune attack on the adrenal glands
• drruscio.com/autoimmune-atrophic-gastritis/

Autoimunitní perniciózní anémie

• Je často spojena s dalšími autoimunitními poruchami, jako je například
• Autoimunitní tyreoiditida,
• Systémový lupus erythematodes,
• Revmatoidní artritida
• A další

Concomitant autoimmune diseases

• Hashimoto thyroiditis
• May contribute to increasing the suspicion of an AIG diagnosis.
• The association between gastric and thyroid disorders has been observed since the early 1960s
• Frequent co-presence of the thyroid and gastric autoantibodies (anti-thyroperoxidase, anti-thyroglobulin, PCA, IFA) in patients with thyroid disorders and PA
• Doniach B and Irvine WJ et al. : “thyrogastric syndrome”
• www.mdpi.com/2076-2607/8/11/1827

Neurological symptoms - consequences of vitamin B12 deficiency

• Paresthesia, abnormal proprioception, numbness, ataxia, cognitive impairment,
• Mood disorders, and psychosis.
• Impairment of sensory and peripheral nerve function
• Reduced production of succinyl coenzyme A
• Essential for myelin sheath structure