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World J Gastroenterol. Jan 28, 2017; 23(4): 563-572
Published online Jan 28, 2017. doi: 10.3748/wjg.v23.i4.563
Micronutrient deficiencies in patients with chronic atrophic autoimmune gastritis: A review
Federica Cavalcoli, Alessandra Zilli, Dario Conte, Sara Massironi
Federica Cavalcoli, Alessandra Zilli, Dario Conte, Sara Massironi, Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
Federica Cavalcoli, Alessandra Zilli, Dario Conte, Postgraduate School of Gastroenterology, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, 20122 Milan, Italy
Author contributions: Cavalcoli F and Massironi S planned the work; Zilli A performed the literature search; Cavalcoli F and Zilli A wrote the first draft of the manuscript; Cavalcoli F, Zilli A and Massironi S edited the subsequent versions of the manuscript; Conte D critically revised the manuscript for relevant intellectual content; finally, all authors read and approved the final manuscript.
Conflict-of-interest statement: No conflict of interests (including but not limited to commercial, personal, political, intellectual, or religious interests) to declare.
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: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Federica Cavalcoli, MD, Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milan, Italy. cavalcoli.federica@gmail.com
Telephone: +39-2-55033445 Fax: +39-2-55033644
Received: August 27, 2016
Peer-review started: August 31, 2016
First decision: September 30, 2016
Revised: October 8, 2016
Accepted: November 12, 2016
Article in press: November 13, 2016
Published online: January 28, 2017

Chronic atrophic autoimmune gastritis (CAAG) is an organ-specific autoimmune disease characterized by an immune response, which is directed towards the parietal cells and intrinsic factor of the gastric body and fundus and leads to hypochlorhydria, hypergastrinemia and inadequate production of the intrinsic factor. As a result, the stomach’s secretion of essential substances, such as hydrochloric acid and intrinsic factor, is reduced, leading to digestive impairments. The most common is vitamin B12 deficiency, which results in a megaloblastic anemia and iron malabsorption, leading to iron deficiency anemia. However, in the last years the deficiency of several other vitamins and micronutrients, such as vitamin C, vitamin D, folic acid and calcium, has been increasingly described in patients with CAAG. In addition the occurrence of multiple vitamin deficiencies may lead to severe hematological, neurological and skeletal manifestations in CAAG patients and highlights the importance of an integrated evaluation of these patients. Nevertheless, the nutritional deficiencies in CAAG are largely understudied. We have investigated the frequency and associated features of nutritional deficiencies in CAAG in order to focus on any deficit that may be clinically significant, but relatively easy to correct. This descriptive review updates and summarizes the literature on different nutrient deficiencies in CAAG in order to optimize the treatment and the follow-up of patients affected with CAAG.

Keywords: Chronic atrophic autoimmune gastritis, Nutritional deficiency, Vitamin B12, Iron, Vitamin C, Vitamin D, Calcium, Malabsorption

Core tip: Chronic atrophic autoimmune gastritis is an autoimmune disease characterized by progressive parietal cells destruction leading to hypochlorhydria and intrinsic factor deficiency. These alterations may result in vitamin B12 deficiency and iron malabsorption. A possible role of chronic atrophic autoimmune gastritis in the development of several nutritional deficiencies (e.g., calcium, vitamin D, vitamin C) has been reported. However, the prevalence and clinical impact of these deficiencies has not been elucidated. The present paper aims at investigating the relevance, frequency and clinical presentation of nutritional deficiencies in chronic atrophic gastritis to enable clinicians to promptly identify and correct any possible nutritional impairment.