Validation of diagnostic strategies of autoimmune atrophic gastritis: A case report

doi:10.12998/wjcc.v9.i31.9557

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World Journal of Clinical Cases

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Case Report

World J Clin Cases. Nov 6, 2021; 9(31): 9557-9563
Published online Nov 6, 2021. doi: 10.12998/wjcc.v9.i31.9557

Validation of diagnostic strategies of autoimmune atrophic gastritis: A case report

Wen-Jing Sun, Qiang Ma, Ren-Zheng Liang, Ya-Mei Ran, Li Zhang, Juan Xiao, Yong-Mei Peng, Bin Zhan

Wen-Jing Sun, Ren-Zheng Liang, Ya-Mei Ran, Li Zhang, Juan Xiao, Yong-Mei Peng, Bin Zhan, Department of Gastroenterology, Hepatology and Endocrinology, Thirteenth Peoples’ Hospital of Chongqing, Chongqing 400053, China

Qiang Ma, Department of Pathology, Daping Hospital, Army Medical University, Chongqing 400042, China

Author contributions: Sun WJ contributed to diagnosis, drafting the manuscript and reviewing the literature; Ma Q performed the pathological diagnosis; Liang RZ performed the endoscopy and management of the patient; Zhang L, Xiao J and Peng YM reviewed the literature; Zhan B manage the patient as the cooperation teacher and contributed to the revising the manuscript, reference list and original figure documents.

Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.

Conflict-of-interest statement: The authors declare that they have no conflict of interest.

CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).

Corresponding author: Bin Zhan, MD, Chief Physician, Department of Gastroenterology, Hepatology and Endocrinology, Thirteenth Peoples’ Hospital of Chongqing, No. 16 Tieluxincun, Jiulongpo District, Chongqing 400053, China. 406302524@qq.com

Received: June 6, 2021
Peer-review started: June 6, 2021
First decision: July 5, 2021
Revised: July 13, 2021
Accepted: September 6, 2021
Article in press: September 6, 2021
Published online: November 6, 2021
Processing time: 145 Days and 2.2 Hours

Abstract

BACKGROUND

Autoimmune atrophic gastritis (AAG) is a type of chronic gastritis that mainly affects the gastric corpus. Due to the lack of standard diagnostic criteria and overlaps with the courses of Helicobacter pylori-related atrophic gastritis, reports on the diagnostic strategy of AAG at an early stage are limited.

CASE SUMMARY

A 71-year-old woman with severe anemia was diagnosed with AAG. Endoscopic views and pathological findings showed the coexistence of normal mucosa in the gastric antrum and atrophic mucosa in the gastric fundus. Serological tests showed that anti-parietal cell antibodies and anti-intrinsic factor antibodies were both positive. Immunohistochemical results, which showed negative H⁺-K⁺ ATPase antibody staining and positive chromogranin A (CgA) staining, confirmed the mechanism of this disease. After vitamin B12 and folic acid supplementation, the patient recovered well.

CONCLUSION

Successful diagnosis of AAG includes serological tests, endoscopic characteristics, and immunohistochemistry for H⁺-K⁺ ATPase and CgA antibodies.

Keywords: Autoimmune atrophic gastritis; Endoscopy; H⁺-K⁺ ATPase; Chromogranin A; Immunohistochemical examination; Case report

Core Tip: The mechanism of autoimmune atrophic gastritis (AAG) involves H⁺-K⁺ ATPase. It is mostly identified during the late stage due to pernicious anemia. We present a case of AAG with anemia, typical endoscopic findings and immunohistochemical staining for H⁺-K⁺ ATPase and chromogranin A (CgA) antibodies. This case report demonstrates a successful diagnostic strategy for AAG that includes serological test (anti-parietal cell and anti-intrinsic factor antibodies), endoscopic characteristics and immunohistochemical results for H⁺-K⁺ ATPase and CgA antibodies.