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Elusive Gastric Atrophy in Children: Diagnostic Pitfalls and a Stepwise Approach
Nikita Rodenbach1, Annette Venter2, Alfonso Rodriguez-Herrera1
1Paediatric Department, St Luke's Hospital Kilkenny, Kilkenny, Co Kilkenny, Ireland.
Case Reports in Pediatrics
|June 1, 2026
Summary
Autoimmune atrophic gastritis, rare in children, was diagnosed in a boy with fatigue and iron deficiency anemia. Diagnosis was confirmed by antibodies and endoscopy findings.
Area of Science:
- Gastroenterology
- Pediatrics
- Immunology
Background:
- Autoimmune atrophic gastritis is characterized by antibodies against gastric parietal cells and intrinsic factor.
- It is rarely diagnosed in pediatric patients, often overlooked in differential diagnoses.
- Autoimmune conditions can manifest with varied symptoms, including fatigue and anemia.
Purpose of the Study:
- To report an extremely rare case of autoimmune atrophic gastritis in a child.
- To highlight the diagnostic challenges and delayed presentation of this condition in pediatrics.
- To emphasize the importance of considering autoimmune disorders in pediatric patients with unexplained symptoms.
Main Methods:
- Case report of a middle childhood male patient.
- Clinical presentation included auditory hallucinations, fatigue, and iron deficiency anemia.
- Diagnostic workup involved serological testing for autoantibodies (ANA, antiparietal cell antibody) and upper endoscopy with histopathology.
Main Results:
- Patient presented with symptoms suggestive of an autoimmune disorder.
- Antibody testing revealed positive antinuclear antibody (ANA) and strongly positive antiparietal cell antibody.
- Endoscopic histopathology confirmed atrophic gastritis with intestinal metaplasia, but no dysplasia or malignancy.
Conclusions:
- Autoimmune atrophic gastritis is exceptionally rare in the pediatric population.
- Delayed diagnosis is common due to its rarity and nonspecific initial symptoms.
- Comprehensive autoimmune workup is crucial for pediatric patients with persistent, unexplained gastrointestinal issues and anemia.
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