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Chronic atrophic gastritis. Natural history, diagnosis and therapeutic management. A position paper by the Italian Society of Hospital Gastroenterologists and Digestive Endoscopists [AIGO], the Italian Society of Digestive Endoscopy [SIED], the Italian Society of Gastroenterology [SIGE], and the Italian Society of Internal Medicine [SIMI]
- Publication Year :
- 2019
- Publisher :
- Elsevier B.V., 2019.
-
Abstract
- Chronic atrophic gastritis (CAG) is an underdiagnosed condition characterised by translational features going beyond the strict field of gastroenterology as it may manifest itself by a variable spectrum of gastric and extra-gastric symptoms and signs. It is relatively common among older adults in different parts of the world, but large variations exist. Helicobacter pylori-related CAG [multifocal] and autoimmune CAG (corpus-restricted) are apparently two different diseases, but they display overlapping features. Patients with cobalamin and/or iron deficiency anaemia or autoimmune disorders, including autoimmune thyroiditis and type 1 diabetes mellitus, should be offered screening for CAG. Pepsinogens, gastrin-17, and anti-H. pylori antibodies serum assays seem to be reliable non-invasive screening tools for the presence of CAG, helpful to identify individuals to refer to gastroscopy with five standard gastric biopsies in order to obtain histological confirmation of diagnosis. Patients with CAG are at increased risk of developing gastric cancer, and they should be estimated with histological staging systems (OLGA or OLGIM). H. pylori eradication may be beneficial by modifying the natural history of atrophy, but not that of intestinal metaplasia. Patients with advanced stages of CAG (Stage III/IV OLGA or OLGIM) should undergo endoscopic surveillance every three years, those with autoimmune CAG every three-five years. In patients with CAG, a screening for autoimmune thyroid disease and micronutrient deficiencies, including iron and vitamin B12, should be performed. The optimal treatment for dyspeptic symptoms in patients with CAG remains to be defined. Proton pump inhibitors are not indicated in hypochlorhydric CAG patients.
- Subjects :
- Gastritis, Atrophic
congenital, hereditary, and neonatal diseases and abnormalities
medicine.medical_specialty
Atrophic gastritis
Autoimmune Gastritis
diagnosis
Biopsy
autoimmune gastritis
h. pylori
Gastroenterology
Endoscopy, Gastrointestinal
Autoimmune Diseases
Helicobacter Infections
Atrophic gastriti
Autoimmune thyroiditis
histology
03 medical and health sciences
0302 clinical medicine
Risk Factors
Internal medicine
atrophic gastritis
Humans
Medicine
Helicobacter
Vitamin B
Type 1 diabetes
Hepatology
biology
business.industry
Intestinal metaplasia
Cancer
Autoimmune gastriti
medicine.disease
biology.organism_classification
Patient Care Management
Natural history
Italy
030220 oncology & carcinogenesis
030211 gastroenterology & hepatology
vitamin b 12
Deficiency Diseases
business
Diagnosi
Subjects
Details
- Language :
- English
- Database :
- OpenAIRE
- Accession number :
- edsair.doi.dedup.....dbc34cb4a208a205cbdeebde8621839a