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Autoimmune Gastritis: Causes, Symptoms & Treatment

Autoimmune gastritis is a chronic inflammation of the stomach lining caused by the immune system attacking the body's own gastric cells, leading to vitamin B12 deficiency and anemia.

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Things worth knowing about "Autoimmune gastritis"

Autoimmune gastritis is a chronic inflammation of the stomach lining caused by the immune system attacking the body's own gastric cells, leading to vitamin B12 deficiency and anemia.

What is Autoimmune Gastritis?

Autoimmune gastritis (also known as type A gastritis) is a chronic inflammatory condition of the stomach lining in which the immune system mistakenly attacks the body's own gastric cells. Specifically, it targets the parietal cells (oxyntic cells), which are responsible for producing stomach acid and a protein called the intrinsic factor. The intrinsic factor is essential for the absorption of vitamin B12 in the small intestine.

As the disease progresses, the gastric mucosa becomes increasingly damaged, leading to a reduction in stomach acid production (achlorhydria) and a deficiency of intrinsic factor. This severely impairs vitamin B12 absorption and can ultimately result in pernicious anemia – a serious form of anemia caused by vitamin B12 deficiency.

Causes

The exact causes of autoimmune gastritis are not yet fully understood. It is an autoimmune disorder in which the immune system produces antibodies against the body's own gastric cells. Several factors are believed to contribute:

Genetic predisposition: The condition tends to run in families, suggesting a hereditary component.
Association with other autoimmune diseases: Autoimmune gastritis frequently occurs alongside conditions such as Hashimoto thyroiditis, type 1 diabetes, or Addison disease.
Helicobacter pylori infection: Infection with the bacterium Helicobacter pylori has been proposed as a potential trigger, as certain bacterial proteins may resemble parietal cell proteins, leading the immune system to attack both (molecular mimicry).

Symptoms

In the early stages, autoimmune gastritis often causes no noticeable symptoms. As the disease progresses, the following symptoms may develop:

Fatigue and weakness (signs of anemia)
Pale skin and mucous membranes
Tingling or numbness in the hands and feet (peripheral neuropathy due to vitamin B12 deficiency)
Difficulty concentrating and memory problems
Upper abdominal discomfort, nausea, or loss of appetite
Inflammation of the tongue (glossitis)
In advanced stages: unintended weight loss

Diagnosis

Autoimmune gastritis is diagnosed through a combination of tests:

Blood tests: Detection of antibodies against parietal cells (anti-parietal cell antibodies) and against intrinsic factor (anti-intrinsic factor antibodies). Vitamin B12 levels, complete blood count, and ferritin levels are also assessed.
Gastroscopy (endoscopy): Direct visualization of the stomach lining. In autoimmune gastritis, atrophy (thinning and deterioration) of the gastric corpus mucosa is typically observed.
Biopsy: Microscopic examination of gastric tissue samples to confirm the diagnosis.
Gastrin and pepsinogen levels: Elevated serum gastrin and reduced pepsinogen I levels in the blood can indicate autoimmune gastritis.

Treatment

There is currently no curative treatment for autoimmune gastritis. Management focuses on treating complications and ongoing monitoring:

Vitamin B12 supplementation: Since oral absorption of vitamin B12 is impaired without intrinsic factor, vitamin B12 is typically administered by intramuscular injection or in high-dose oral form.
Iron supplementation: Additional iron supplementation may be required if iron deficiency is also present.
Regular gastroscopy: Patients with autoimmune gastritis have a slightly elevated risk of developing gastric carcinoids (rare neuroendocrine tumors) and gastric cancer, so routine surveillance endoscopies are recommended.
Management of associated conditions: Any co-existing autoimmune diseases are treated according to their respective clinical guidelines.

Prognosis and Outlook

Autoimmune gastritis is a chronic, slowly progressive condition. With consistent vitamin B12 therapy, the consequences of deficiency can be well managed. Long-term medical follow-up is essential, as there is a modestly increased risk of certain gastric tumors. When diagnosed early and monitored regularly, life expectancy is generally not reduced.

References

Vannella L. et al. – Risk for gastric neoplasias in patients with chronic atrophic gastritis: a critical reappraisal. World Journal of Gastroenterology, 2012.
Lahner E., Annibale B. – Pernicious anemia: New insights from a gastroenterological point of view. World Journal of Gastroenterology, 2009.
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) – Gastritis. U.S. Department of Health and Human Services, 2023.

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