gastrointestinal disorders
Autoimmune Metaplastic Atrophic Gastritis
Diagnosis of AMAG
Endoscopic biopsy There are no specific symptoms that point to this disorder. It is most often discovered when patients undergo endoscopy to evaluate upper abdominal discomfort or unexplained anemia. Endoscopic biopsy confirms the diagnosis. Serum B12 levels should be obtained. Parietal cell antibodies are usually present but are not measured routinely. The American Gastroenterological Association's (AGA)2020 guidelines on management of gastric intestinal metaplasiarecommend testing for and treatingH. pyloriin patients with gastric intestinal metaplasia. The AGA guidelines also recommend against routine surveillance endoscopy in patients with autoimmune metaplastic atrophic gastritis and gastric intestinal metaplasia. Patients with atrophic gastritis and gastric intestinal metaplasia who have an increased risk of gastric cancer may elect to undergo surveillance, but they should be made aware of the low value of surveillance and the potential adverse effects of repeated upper endoscopies. Factors that increase the risk of gastric cancer include Incomplete metaplasia Extensive metaplasia Family history of gastric cancer Immigration from regions with high incidence of gastric cancer such as Korea, Japan, and South America Routine short-interval (within 1 year) repeat endoscopy and biopsy is not recommended unless the baseline endoscopy was inadequate or showed high-risk histology or unless the patient is at increased risk of gastric cancer. Again, the decision to repeat the endoscopy within 1 year should be made after patients understand the low value of surveillance and the potential adverse effects of repeated upper endoscopies. Longer-interval (every 3 to 5 years) surveillance endoscopy among patients with incidentally detected gastric intestinal metaplasia may be reasonable if shared decision-making favors surveillance. There is no consensus on surveillance in patients with autoimmune gastritis without intestinal metaplasia. One guideline recommends endoscopic surveillance for gastric tumors every 3 to 5 years, but there is no evidence to suggest that this is cost effective ( Diagnosis references ). emphasizes the use of high-definition endoscopy with chromoendoscopy in endoscopic evaluation of these patients. The guidelines recommend endoscopy every 3 years in patients with advanced atrophic gastritis or in patients with intestinal metaplasia. A small longitudinal study reported a 10% incidence of gastric tumors at 3 years in a cohort of patients with autoimmune and multifocal atrophic gastritis who underwent endoscopy at 3 years as recommended by the guidelines ( Diagnosis references ). 1.Lahner E, Zagari RM, Zullo A, et al: 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].Dig Liver Dis51(12):1621–1632, 2019. doi: 10.1016/j.dld.2019.09.016 2.Esposito G, Dilaghi E, Cazzato M, et al: Endoscopic surveillance at 3 years after diagnosis, according to European guidelines, seems safe in patients with atrophic gastritis in a low-risk region.Dig Liver Dis53(4):467–473, 2021. doi: 10.1016/j.dld.2020.10.038 