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Autoimmune Gastritis in Pediatrics: A Review of 3 Cases
Tania Mitsinikos1, Nick Shillingford2, Harry Cynamon1
1Division of Gastroenterology, Hepatology and Nutrition.
Insights
Autoimmune gastritis (AIG) is rare in children but can present with anemia, often alongside other autoimmune conditions. Early recognition and management are crucial for these pediatric patients.
Area of Science:
- Pediatric Gastroenterology
- Histopathology
- Autoimmune Diseases
Background:
- Autoimmune gastritis (AIG) is a recognized condition in adults, but infrequently documented in pediatric populations.
- Pediatric AIG cases are often associated with pre-existing autoimmune disorders and unexplained anemia.
- AIG can be linked to immunodeficiencies and has been reported to progress to gastric adenocarcinoma.
Purpose of the Study:
- To increase awareness of autoimmune gastritis (AIG) in pediatric patients.
- To highlight the diagnostic criteria and clinical presentation of AIG in children.
- To emphasize the importance of recognizing AIG in the context of other autoimmune conditions.
Main Methods:
- A retrospective review of the pathology database at Children's Hospital Los Angeles (CHLA) was conducted.
- Cases with a final diagnosis or differential diagnosis of AIG were identified.
- Inclusion required meeting both histopathologic and biochemical criteria for AIG.
Main Results:
- Three pediatric cases of AIG were identified.
- Two patients presented with iron-deficiency anemia, diabetes mellitus, and other autoimmune disorders (Addison's disease, Hashimoto's thyroiditis).
- One patient had pernicious anemia without other autoimmune conditions; all were managed with nutritional support and monitoring.
Conclusions:
- Autoimmune gastritis (AIG) is a rare but significant condition in children.
- Pediatricians should consider AIG in patients with autoimmune disorders or pernicious anemia.
- Timely diagnosis and management, including surveillance for metaplasia, are essential.
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.
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