Insights into Pediatric Autoimmune Gastritis: Is There a Role for Helicobacter Pylori Infection?

Objectives: Autoimmune gastritis (AIG) is a chronic inflammatory condition of the gastric mucosa, mainly described in adults presenting with pernicious anemia. It results from antibody-mediated destruction of parietal cells, but the precise initiating event is unknown. The pathogenicity of Helicobacter pylori (H. pylori) has been suggested but not established. This study aimed to better characterize AIG in pediatric patients and to address the possible role of H. pylori infection. Methods: Descriptive single-center study, retrospectively describing 20 patients with a diagnosis of AIG based on positivity for anti-parietal cell autoantibodies (PCA), in addition to analytical and/or histological findings of oxyntic mucosa atrophy. Results: In the majority (18/20), AIG diagnosis was suggested during investigation of refractory iron-deficient anemia. One patient had dyspepsia and none of the others had gastrointestinal symptoms. Fifty five percent (11/20) were H. pylori positive, but there were no significant differences regarding mean Hemoglobin values at presentation (10.6 ± 2.5 g/dL vs. 9.5 ± 1.0 g/dL, p > 0.05), analytical indicators of gastric atrophy (gastrin, 564.4 ± 184 pg/mL vs. 721.2 ± 220.6 pg/mL, p > 0.05), nor in the presence or the grade of oxyntic mucosa atrophy. Conclusions: Our findings highlight that AIG may have an age-dependent presentation, thus we can consider a pediatric phenotype that in contrast to adults, is manifested by refractory iron-deficient anemia and associated with PCA positivity, but not intrinsic factor autoantibodies. A correlation between H. pylori and AIG was not evident in the current study and it is still unclear if H. pylori is a trigger for AIG. Address correspondence and reprint requests to Helena Moreira Silva, MD, Pediatric Gastroenterology Unit. Centro Materno Infantil do Norte – CMIN. Porto University Hospital Center. Porto, Portugal. Largo Prof. Abel Salazar 4099–001 Porto, Portugal (hel.m.silva@hotmail.com). Received 20 September, 2018 Accepted 8 January, 2019 Conflicts of interest and sources of funding: There are no funding sources. There are no financial disclosures and no conflict of Interest. © 2019 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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