Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 14, 2015; 21(42): 12179-12189
Published online Nov 14, 2015. doi: 10.3748/wjg.v21.i42.12179
Autoimmune gastritis: Pathologist’s viewpoint
Irene Coati, Matteo Fassan, Fabio Farinati, David Y Graham, Robert M Genta, Massimo Rugge
Irene Coati, Matteo Fassan, Massimo Rugge, Department of Medicine (DIMED), Surgical Pathology Unit, University of Padua, 35121 Padua, Italy
Fabio Farinati, Department of Surgery, Oncology and Gastroenterology, Gastroenterology Unit, University of Padua, 35121 Padua, Italy
David Y Graham, Department of Medicine, Veterans Administration Hospital, Baylor College of Medicine, Houston, TX 77030, United States
Robert M Genta, Miraca Life Sciences Research Institute, Irving, TX 75039, United States
Robert M Genta, Departments of Pathology and Medicine, VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, TX 75390, United States
Author contributions: Coati I and Fassan M contributed equally to this work, generated the figures and wrote the manuscript; Farinati F, Graham DY and Genta RM contributed to the writing of the manuscript; Rugge M designed the aim of the editorial and wrote the manuscript.
Supported by A grant from the Italian Association for Cancer Research (partly, AIRC Regional grant 2008 No. 6421); and published under the auspices of the Healthy Stomach Initiative (HIS)
Conflict-of-interest statement: Dr. Graham is an unpaid consultant for Novartis in relation to vaccine development for treatment or prevention of H. pylori infection. Dr. Graham is a paid consultant for RedHill Biopharma regarding novel H. pylori therapies and has received research support for culture of H. pylori. He is a consultant for Otsuka Pharmaceuticals regarding diagnostic breath testing. Dr. Graham has received royalties from Baylor College of Medicine patents covering materials related to 13C-urea breath test.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Matteo Fassan, MD, PhD, Assistant Professor of Pathology, Department of Medicine (DIMED), Surgical Pathology Unit, University of Padua, Via Gabelli 61, 35121 Padua, Italy.
Telephone: +39-49-8211312 Fax: +39-49-8272277
Received: February 24, 2015
Peer-review started: February 26, 2015
First decision: June 2, 2015
Revised: June 15, 2015
Accepted: September 2, 2015
Article in press: September 2, 2015
Published online: November 14, 2015

Western countries are seeing a constant decline in the incidence of Helicobacter pylori-associated gastritis, coupled with a rising epidemiological and clinical impact of autoimmune gastritis. This latter gastropathy is due to autoimmune aggression targeting parietal cells through a complex interaction of auto-antibodies against the parietal cell proton pump and intrinsic factor, and sensitized T cells. Given the specific target of this aggression, autoimmune gastritis is typically restricted to the gastric corpus-fundus mucosa. In advanced cases, the oxyntic epithelia are replaced by atrophic (and metaplastic) mucosa, creating the phenotypic background in which both gastric neuroendocrine tumors and (intestinal-type) adenocarcinomas may develop. Despite improvements in our understanding of the phenotypic changes or cascades occurring in this autoimmune setting, no reliable biomarkers are available for identifying patients at higher risk of developing a gastric neoplasm. The standardization of autoimmune gastritis histology reports and classifications in diagnostic practice is a prerequisite for implementing definitive secondary prevention strategies based on multidisciplinary diagnostic approaches integrating endoscopy, serology, histology and molecular profiling.

Keywords: Autoimmune gastritis, Metaplasia, Carcinoids, Operative link for gastritis assessment staging

Core tip: Autoimmune gastritis (AIG) is an emerging gastropathy with a significant epidemiological and clinical impact on Western populations. Despite a better understanding of the phenotypic changes or cascades occurring in this autoimmune setting, the etiopathogenic mechanisms behind the disease are still poorly understood, histology reporting is not standardized, and both the AIG-associated cancer risk and its secondary prevention strategies remain confusing.