Pediatric autoimmune gastritis: clinical correlates and histologic features

• Published in: Human pathology 2021-10, Vol.116, p.31-38
• Main Authors: Kulak, Ozlem, Gurram, Bhaskar, Montgomery, Elizabeth A., Park, Jason Y.
• Format: Article
• Language: English
• Subjects: Adolescent; African Americans; Age; AMAG; Anemia; Antibodies; Apoptosis; APS; Atrophy; Autoimmune Diseases - pathology; Autoimmune gastritis; Autoimmune metaplastic atrophic gastritis; Autoimmune polyendocrine syndromes; Biopsy; Child; Child, Preschool; Cloning; Diabetes; Disease; Electronic health records; Female; Gastritis - pathology; Hispanic people; Humans; Hyperplasia; Immune system; Infant; Inflammation; Information systems; Iron; Laboratories; Male; Medical records; OLGA; Pediatrics; Thyroid gland
• ISSN: 0046-8177; 1532-8392
• DOI: 10.1016/j.humpath.2021.07.002

Autoimmune gastritis is a well-known pathologic entity, but there are few studies that examine its clinical and histologic presentation in children. This is a single institution, retrospective study performed on patients diagnosed from 2011 through 2019. Patients were identified by their pathologic diagnosis within the laboratory information system. The electronic medical record and archived slides were reviewed. Twenty-two children (3 months to 18 years; median, 10.9 years) with autoimmune gastritis were diagnosed of a total of 14,257 nonconsultation gastric biopsies from unique patients (0.15% prevalence). Patients with autoimmune gastritis were diagnosed at an average age of 10.9 years and were mostly female (68.2% women, 31.8% men). The majority had extragastric immune disorders (13/22; 59.1%). All patients in the study had gastric body mucosa with enterochromaffin-like cell hyperplasia, atrophy, and histologic features of chronic injury. Most biopsies showed gastric body metaplasia (n = 19) or active gastric inflammation. However, antral atrophy was also observed in 12 patients, and antral metaplasia was identified in one patient; four patients had active chronic antral gastritis. All biopsies were negative for Helicobacter pylori. Pediatric autoimmune gastritis is a rare disorder that should be recognized because of its systemic effects with long-term morbidity. In addition, the possibility of tandem extragastric immune disorders should be considered when a diagnosis of pediatric autoimmune gastritis is established. •Pediatric autoimmune gastritis occurs by antibody-mediated injury of gastric body parietal cells.•Late stages of disease are associated with vitamin B12 deficiency and pernicious anemia.•In this study, pediatric autoimmune gastritis was frequently identified in the setting of extragastric immune disorders.