Autoimmune Gastropathy in Type 1 Diabetic Patients With Parietal Cell Antibodies: Histological and clinical findings

Epidemiology/Health Services/Psychosocial Research

Autoimmune Gastropathy in Type 1 Diabetic Patients With Parietal Cell Antibodies

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

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Figure 1—
Schematic presentation of manifestations of autoimmune gastropathy. Pathogenetic considerations and a possible role of PCA are discussed in the conclusions section.

Table 1—

Clinical and histological features in PCA⁺ versus PCA⁻ type 1 diabetic patients

	PCA⁺	PCA⁻	P
n (M/F)	47 (26/21)	41 (25/16)	NS
Age (years)	41 ± 13	43 ± 13	NS
Duration of diabetes (years)	19 ± 12	22 ± 10	NS
GADA⁺	37 (79)	23 (56)	0.038
H⁺/K⁺ ATPase (units/ml)	234.7 ± 325.3	7.9 ± 10.5	0.007
HP⁺	24 (51)	23 (56)	NS
Iron deficiency anemia	15 (32)	5 (12)	0.04
Pernicious anemia	11 (23)	1 (2)	0.005
Gastrin (ng/l)	265 ± 292	127 ± 69	0.027
Hypergastrinemia (gastrin > 110 ng/l)	22 (47)	9 (22)	0.025
Hypochlorhydria (n tested 42)	11/15	5/27	0.0008
Maximal acid output (mmol H⁺/h)	7.8 ± 7.0	16.9 ± 10.4	0.004
Autoimmune atrophic gastritis	27 (57)	4 (10)	<0.0001
HP-associated gastritis	10 (21)	17 (41)	NS
Parietal cell mass (%)	20 ± 10	29 ± 6	<0.0001
Corpus atrophy	1 (0–3)	0 (0–2)	0.02
Corpus HP	1 (0–3)	0 (0–2)	NS
Corpus inflammation	1 (0–2)	1 (0–2)	NS
Corpus metaplasia	0 (0–3)	0 (0–2)	NS
Corpus intestinal metaplasia	11 (23)	1 (2)	0.004
Distribution of lymphocytic infiltration	2 (0–3)	2 (0–3)	0.038
Degree of lymphocytic infiltration	2 (0–4)	2 (0–3)	NS
Lymphocytic destruction of glands	0 (0–3)	0 (0–1)	NS (0.06)
State of the oxyntic glands	0 (0–2)	0 (0–1)	0.014
State of the intact parietal cells	0 (0–1)	0 (0–0)	NS
ECL cell⁺	7 (15)	0 (0)	0.013
B-cells (counts/mm²)	1,461 ± 516	698 ± 379	0.031
T-cells (counts/mm²)	645 ± 266	278 ± 147	0.032

Table 2—

Comparison of clinical and histological features in type 1 diabetic patients with and without autoimmune gastritis

	Autoimmune gastritis	No autoimmune gastritis	P
n (M/F)	31 (16/15)	57 (34/23)	NS
Age (years)	44 ± 12	41 ± 13	NS
Duration of diabetes (years)	20 ± 12	20 ± 11	NS
aTPO⁺	10 (32)	16 (28)	NS
PCA⁺	27 (87)	20 (35)	<0.0001
H⁺/K⁺ ATPase (units/ml)	154.6 ± 121.0	21.5 ± 36.2	0.001
HP⁺	13 (42)	34 (60)	NS
Gastrin (ng/l)	333 ± 335	131 ± 88	0.001
Vitamin B12 (pmol/l)	319 ± 229	376 ± 182	NS
Red blood cell folic acid (nmol/l)	923 ± 417	1008 ± 369	NS
Iron deficiency anemia	12 (39)	8 (14)	0.015
Pernicious anemia	8 (26)	4 (7)	0.022
Hypochlorhydria (n tested 42)	10/12	6/30	0.0002
Maximal acid output (mmol H⁺/h)	4.1 ± 3.6	14.3 ± 10.2	0.001
Parietal cell mass (%)	15 ± 8	29 ± 4	<0.0001
Corpus atrophy	1 (0–3)	0 (0–1)	<0.0001
Corpus HP	0 (0–1)	0 (0–3)	0.018
Corpus inflammation	1 (1–2)	1 (0–2)	0.021
Corpus metaplasia	0 (0–3)	0 (0–1)	0.013
Corpus metaplasia	11 (35)	1 (2)	<0.0001
ECL cell⁺	7 (23)	0 (0)	0.0004
B-cell (counts/mm²)	1,595 ± 525	834 ± 418	0.03
T-cell (counts/mm²)	639 ± 259	395 ± 202	NS