Autoimmune Gastritis in Pediatrics: A Review of 3 Cases.
Study Goal
The researchers aimed to evaluate the occurrence and management of autoimmune gastritis (AIG) in pediatric patients, particularly focusing on its association with iron-deficiency anemia and other autoimmune disorders.
Results Summary
The study found that iron replacement therapy effectively treated iron-deficiency anemia in pediatric patients with AIG, particularly those with concurrent autoimmune disorders. One patient with pernicious anemia was successfully treated with oral vitamin supplementation, showing stable intestinal metaplasia without dysplasia.
Population
Pediatric patients with autoimmune gastritis (AIG), including those with diabetes mellitus, Addison's disease, Hashimoto's thyroiditis, or pernicious anemia.
Effective Dosage
Not specified
Duration
Not specified
Interactions
None mentioned
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
iron replacement therapy | decrease | iron-deficiency anemia | patients with diabetes mellitus and Addison's disease; and diabetes mellitus and Hashimoto's thyroiditis | - | treated | #1 |
iron replacement therapy | decrease | iron-deficiency anemia | patients with diabetes mellitus and Hashimoto's thyroiditis | - | treated | #2 |
oral vitamin supplementation | decrease | pernicious anemia | patient with symptomatic anemia | - | successfully treated | #3 |
routine surveillance endoscopy with biopsy | neutral | metaplastic and dysplastic changes | patients with autoimmune gastritis | - | management includes | #4 |
nutritional replacement | neutral | - | patients with autoimmune gastritis | - | management includes | #5 |
OBJECTIVES: To bring heightened awareness to a condition, autoimmune gastritis (AIG), which is a well-established entity in adults; however, rarely described in pediatrics. Currently, the literature describes AIG in pediatric patients who also suffer from other autoimmune disorders, which precedes the diagnosis of AIG, and often presents with unexplained anemia. Additionally, there have been case reports describing patients with immunodeficiencies and AIG, which progress to gastric adenocarcinoma. AIG is a histopathologic diagnosis, demonstrating chronic inflammatory process with loss of parietal cells with or without intestinal metaplasia and enterochromaffin-like cell hyperplasia. Management of these patients includes nutritional replacement as well as routine surveillance endoscopy with biopsy in search of metaplastic and dysplastic changes. METHODS: We queried the pathology database at Children's Hospital Los Angeles (CHLA) for cases with a final diagnosis of AIG and for those with a differential diagnosis that includes AIG in the diagnostic comment. All cases that were identified were selected as long as they did not only meet the histopathologic criteria, but also the biochemical criteria for this condition. RESULTS: Of the 3 patients, 2 were referred to gastroenterology for the evaluation of iron-deficiency anemia in the context of diabetes mellitus and Addison's disease; and diabetes mellitus and Hashimoto's thyroiditis. AIG was confirmed on the biopsies, which showed a reduction in parietal cell mass, pseudopyloric metaplasia and enterochromafin-like cell hyperplasia. Both patients were treated with iron replacement therapy. The third patient presented with symptomatic anemia and diagnosed with pernicious anemia without other autoimmune disorders. She was successfully treated with oral vitamin supplementation. In this case, serial gastric biopsies demonstrated stable intestinal metaplasia without evidence of dysplasia. CONCLUSION: Although AIG is rare in children, pediatric gastroenterologists and pathologists should have a heightened suspicion for this entity in those patients with a history of autoimmune disorders and/or pernicious anemia.