Francesco Calabrese, Andrea Pasta, Giorgia Bodini, Manuele Furnari, Federica Grillo, Luca Mastracci, Edoardo V Savarino, Vincenzo Savarino, Patrizia Zentilin, Edoardo G Giannini, Elisa Marabotto
{"title":"自身免疫性慢性萎缩性胃炎：慢性质子泵抑制剂的使用与更严重的萎缩和胃肠道化生之间的关系","authors":"Francesco Calabrese, Andrea Pasta, Giorgia Bodini, Manuele Furnari, Federica Grillo, Luca Mastracci, Edoardo V Savarino, Vincenzo Savarino, Patrizia Zentilin, Edoardo G Giannini, Elisa Marabotto","doi":"10.1097/MEG.0000000000002989","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction and aim: </strong>Autoimmune chronic atrophic gastritis (ACAG) is a chronic autoimmune disorder whose diagnostic complexity arises from diverse symptoms mimicking other gastrointestinal disorders, often leading to misdiagnosis. Despite diagnosis, patients are often treated with proton pump inhibitors (PPIs) before consulting a gastroenterologist, emphasizing the need for accurate identification and management of ACAG in primary care. This study aimed to explore factors influencing disease progression.</p><p><strong>Materials and methods: </strong>We retrospectively analyzed demographic data, medical history, use of PPI, and clinical, endoscopic, and histological data of consecutive adult patients with a histological diagnosis of ACAG referred to our outpatient clinic between January 2017 and December 2022. Operative link on gastritis assessment (OLGA) and operative link for gastric intestinal metaplasia assessment (OLGIM) were recorded for each patient.</p><p><strong>Results: </strong>Seventy patients with a diagnosis of ACAG (female 74.3%, median age 63.9 years) made up the study cohort. Eighteen patients were asymptomatic (25.7%), while 13 (18.6%), and 10 (14.3%) patients reported epigastric pain and asthenia, respectively. Median age at diagnosis of ACAG was 60.7 years [interquartile range (IQR): 46.4-68.2]. OLGA and OLGIM scores III and IV were associated with higher age at diagnosis (OLGA: 69.2 years, IQR: 65.2-75.1 vs. 57.1 years, IQR: 44.4-67.1, P = 0.005; OLGIM; 68.0 years, IQR: 56.1-73 vs. 58.5 years, IQR: 44.3-67.4, P = 0.031). The use of full-dose PPI was more frequent in patients with higher OLGA and OLGIM scores (OLGA I-II vs. III-IV: n = 11, 17.7% vs. n = 4, 50.0%, P = 0.036; OLGIM 0-II vs. III-IV: n = 10, 16.7% vs. n = 5, 50.0%, P = 0.017).</p><p><strong>Conclusion: </strong>ACAG patients with severe atrophy and those with severe gastric intestinal metaplasia were most likely PPI users. Timely diagnosis and heightened awareness among nongastroenterologists regarding the inappropriate use of PPI in this context are crucial.</p>","PeriodicalId":11999,"journal":{"name":"European Journal of Gastroenterology & Hepatology","volume":" ","pages":"905-910"},"PeriodicalIF":1.8000,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12188784/pdf/","citationCount":"0","resultStr":"{\"title\":\"Autoimmune chronic atrophic gastritis: association between chronic proton pump inhibitors use and more severe atrophy and gastric intestinal metaplasia.\",\"authors\":\"Francesco Calabrese, Andrea Pasta, Giorgia Bodini, Manuele Furnari, Federica Grillo, Luca Mastracci, Edoardo V Savarino, Vincenzo Savarino, Patrizia Zentilin, Edoardo G Giannini, Elisa Marabotto\",\"doi\":\"10.1097/MEG.0000000000002989\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction and aim: </strong>Autoimmune chronic atrophic gastritis (ACAG) is a chronic autoimmune disorder whose diagnostic complexity arises from diverse symptoms mimicking other gastrointestinal disorders, often leading to misdiagnosis. Despite diagnosis, patients are often treated with proton pump inhibitors (PPIs) before consulting a gastroenterologist, emphasizing the need for accurate identification and management of ACAG in primary care. This study aimed to explore factors influencing disease progression.</p><p><strong>Materials and methods: </strong>We retrospectively analyzed demographic data, medical history, use of PPI, and clinical, endoscopic, and histological data of consecutive adult patients with a histological diagnosis of ACAG referred to our outpatient clinic between January 2017 and December 2022. Operative link on gastritis assessment (OLGA) and operative link for gastric intestinal metaplasia assessment (OLGIM) were recorded for each patient.</p><p><strong>Results: </strong>Seventy patients with a diagnosis of ACAG (female 74.3%, median age 63.9 years) made up the study cohort. Eighteen patients were asymptomatic (25.7%), while 13 (18.6%), and 10 (14.3%) patients reported epigastric pain and asthenia, respectively. Median age at diagnosis of ACAG was 60.7 years [interquartile range (IQR): 46.4-68.2]. OLGA and OLGIM scores III and IV were associated with higher age at diagnosis (OLGA: 69.2 years, IQR: 65.2-75.1 vs. 57.1 years, IQR: 44.4-67.1, P = 0.005; OLGIM; 68.0 years, IQR: 56.1-73 vs. 58.5 years, IQR: 44.3-67.4, P = 0.031). The use of full-dose PPI was more frequent in patients with higher OLGA and OLGIM scores (OLGA I-II vs. III-IV: n = 11, 17.7% vs. n = 4, 50.0%, P = 0.036; OLGIM 0-II vs. III-IV: n = 10, 16.7% vs. n = 5, 50.0%, P = 0.017).</p><p><strong>Conclusion: </strong>ACAG patients with severe atrophy and those with severe gastric intestinal metaplasia were most likely PPI users. 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引用次数: 0
摘要
自身免疫性慢性萎缩性胃炎（ACAG）是一种慢性自身免疫性疾病，其诊断的复杂性源于多种症状，与其他胃肠道疾病相似，经常导致误诊。尽管诊断，患者通常在咨询胃肠病学家之前接受质子泵抑制剂（PPIs）治疗，强调在初级保健中准确识别和管理ACAG的必要性。本研究旨在探讨影响疾病进展的因素。材料和方法：我们回顾性分析了2017年1月至2022年12月在我们门诊就诊的组织学诊断为ACAG的连续成年患者的人口统计学资料、病史、PPI使用情况以及临床、内镜和组织学资料。记录每位患者胃炎评估（OLGA）手术环节和胃肠道化生评估（OLGIM）手术环节。结果：70例诊断为ACAG的患者（女性74.3%，中位年龄63.9岁）组成了研究队列。18例患者无症状（25.7%），13例（18.6%）和10例（14.3%）报告胃脘痛和乏力。诊断为ACAG的中位年龄为60.7岁[四分位数间距（IQR）： 46.4-68.2]。OLGA和OLGIM评分III和IV与较高的诊断年龄相关(OLGA: 69.2岁，IQR: 65.2-75.1比57.1岁，IQR: 44.4-67.1, P = 0.005；OLGIM;68.0岁，IQR: 56.1-73 vs. 58.5岁，IQR: 44.3-67.4, P = 0.031)。OLGA和OLGIM评分较高的患者更常使用全剂量PPI (OLGA I-II vs. III-IV: n = 11,17.7% vs. n = 4,50.0%, P = 0.036；OLGIM 0-II与iii iv: n = 10,与n = 5 16.7%, 50.0%, P = 0.017)。结论：严重萎缩的ACAG患者和严重的胃肠化生患者最可能使用PPI。在这种情况下，及时诊断和提高非星象学家对不适当使用PPI的认识是至关重要的。
Autoimmune chronic atrophic gastritis: association between chronic proton pump inhibitors use and more severe atrophy and gastric intestinal metaplasia.
Introduction and aim: Autoimmune chronic atrophic gastritis (ACAG) is a chronic autoimmune disorder whose diagnostic complexity arises from diverse symptoms mimicking other gastrointestinal disorders, often leading to misdiagnosis. Despite diagnosis, patients are often treated with proton pump inhibitors (PPIs) before consulting a gastroenterologist, emphasizing the need for accurate identification and management of ACAG in primary care. This study aimed to explore factors influencing disease progression.
Materials and methods: We retrospectively analyzed demographic data, medical history, use of PPI, and clinical, endoscopic, and histological data of consecutive adult patients with a histological diagnosis of ACAG referred to our outpatient clinic between January 2017 and December 2022. Operative link on gastritis assessment (OLGA) and operative link for gastric intestinal metaplasia assessment (OLGIM) were recorded for each patient.
Results: Seventy patients with a diagnosis of ACAG (female 74.3%, median age 63.9 years) made up the study cohort. Eighteen patients were asymptomatic (25.7%), while 13 (18.6%), and 10 (14.3%) patients reported epigastric pain and asthenia, respectively. Median age at diagnosis of ACAG was 60.7 years [interquartile range (IQR): 46.4-68.2]. OLGA and OLGIM scores III and IV were associated with higher age at diagnosis (OLGA: 69.2 years, IQR: 65.2-75.1 vs. 57.1 years, IQR: 44.4-67.1, P = 0.005; OLGIM; 68.0 years, IQR: 56.1-73 vs. 58.5 years, IQR: 44.3-67.4, P = 0.031). The use of full-dose PPI was more frequent in patients with higher OLGA and OLGIM scores (OLGA I-II vs. III-IV: n = 11, 17.7% vs. n = 4, 50.0%, P = 0.036; OLGIM 0-II vs. III-IV: n = 10, 16.7% vs. n = 5, 50.0%, P = 0.017).
Conclusion: ACAG patients with severe atrophy and those with severe gastric intestinal metaplasia were most likely PPI users. Timely diagnosis and heightened awareness among nongastroenterologists regarding the inappropriate use of PPI in this context are crucial.
期刊介绍：
European Journal of Gastroenterology & Hepatology publishes papers reporting original clinical and scientific research which are of a high standard and which contribute to the advancement of knowledge in the field of gastroenterology and hepatology.
The journal publishes three types of manuscript: in-depth reviews (by invitation only), full papers and case reports. Manuscripts submitted to the journal will be accepted on the understanding that the author has not previously submitted the paper to another journal or had the material published elsewhere. Authors are asked to disclose any affiliations, including financial, consultant, or institutional associations, that might lead to bias or a conflict of interest.
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