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Autoimmune Gastropathy in Type 1 Diabetic Patients With Parietal Cell Antibodies

Histological and clinical findings

¹ Department of Endocrinology-Diabetology, Faculty of Medicine, University of Antwerp, University Hospital Antwerp, Edegem, Belgium
² Department of Pathology, Faculty of Medicine, University of Antwerp, University Hospital Antwerp, Edegem, Belgium
³ Department of Gastroenterology and Hepatology, Faculty of Medicine, University of Antwerp, University Hospital Antwerp, Edegem, Belgium
⁴ Department of Microbiology, Faculty of Medicine, University of Antwerp, University Hospital Antwerp, Edegem, Belgium

OBJECTIVE—Approximately 15–20% of type 1 diabetic patients exhibit parietal cell antibodies (PCAs) targeting gastric H⁺/K⁺ATPase. We examined whether iron deficiency anemia, pernicious anemia, and autoimmune gastritis, which may predispose to gastric tumors, were more frequent in PCA⁺ than in PCA^- patients.

RESEARCH DESIGN AND METHODS—Gastric biopsies from 88 consecutively recruited type 1 diabetic patients (51 men and 37 women, 47 PCA⁺ and 41 PCA^-, aged 42 ± 13 years) were evaluated using the updated Sydney system. Immunostaining was done for parietal cells, B- and T-cells, enterochromaffin-like (ECL) cells, and Helicobacter pylori (HP). PCAs were assayed by indirect immunofluorescence, H⁺/K⁺ATPase antibodies by enzyme immunoassay, and HP by serology, urea breath test, and histology. Pentagastrin tests were performed in 42 subjects.

RESULTS—Autoimmune gastritis (AG) was present in 57% of PCA⁺ and 10% of PCA^- cases (OR 12.5, P < 0.0001). PCA positivity (ß = 1.44; P = 0.04) and hypergastrinemia (ß = 0.01; P = 0.026), but not HP, age, diabetes duration, sex, and HLA-DQ type were risk factors for AG. Iron deficiency anemia (OR 3.9, P = 0.015), pernicious anemia (OR = 4.6, P = 0.022), and hypochlorhydria (OR = 20.0, P = 0.0002) were more frequent in AG⁺ individuals. HP infection was present in 47 patients but did not influence corpus histology or gastrinemia. (Pre)malignant lesions were found in 26% of PCA⁺ subjects: ECL cell hyperplasia in 7 AG⁺ patients, comprising 1 with a gastric carcinoid tumor, and corpus intestinal metaplasia in 11 AG⁺ patients, including 1 with linitis plastica.

CONCLUSIONS—PCA⁺ type 1 diabetic patients should be screened for autoimmune gastritis, iron deficiency, and pernicious anemia. Particularly hypergastrinemic PCA⁺ patients with autoimmune gastritis are at increased risk for (pre)malignant gastric lesions.

Abbreviations: AG, autoimmune gastritis • AIF, antibodies to intrinsic factor • ECL, enterochromaffin-like • GADA, GAD antibody • HP, Helicobacter pylori • PCA, parietal cell antibody

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