Clinical Characteristics of Patients With Previous Helicobacter pylori Infection-Induced Atrophic Gastritis

• Published in: Curēus (Palo Alto, CA) Vol. 16; no. 6; p. e63368
• Main Authors: Kishikawa, Hiroshi, Nakamura, Kenji, Takarabe, Sakiko, Katayama, Tadashi, Sasaki, Aya, Miura, Soichiro, Hayashi, Yukie, Hoshi, Hitomi, Kanai, Takahiro, Nishida, Jiro
• Format: Journal Article
• Language: English
• Published: United States Cureus Inc 28-06-2024; Cureus
• Subjects: Antibodies; Antigens; Atrophy; Classification; Endoscopy; Gastric cancer; Gastroenterology; Infections; Pathogenesis; Serology; Japan; atrophic gastritis; gastric cancer screening; autoimmune gastritis; helicobacter pylori; pepsinogen
• ISSN: 2168-8184; 2168-8184
• DOI: 10.7759/cureus.63368

Patients with atrophic gastritis unrelated to autoimmune gastritis (AIG) and without active
(
) infection or previous eradication therapy are considered to have previous
infection-induced atrophic gastritis (PHIG). This study aimed to clarify the clinical characteristics of patients with PHIG.
Consecutive patients who underwent upper gastrointestinal endoscopy during the study period were enrolled in the study. Pepsinogen and gastrin levels,
serology, and endoscopic atrophic grade were assessed. Patients were divided into five groups based on their
status and disease history (PHIG, without
infection, with active
infection, with successful
eradication, and AIG). Their gastric cancer risk status was classified according to the ABC method of serological gastric cancer screening.
Of 536 consecutive patients who underwent upper gastrointestinal endoscopy during the study period, 318 were included (31 with PHIG, 77 without
infection, 101 with active
infection, 80 with successful
eradication, and 29 with AIG). Of the 31 patients with PHIG, 21 (68%) were
-seronegative
 and 20 (65%) were classified as group A (normal pepsinogen,
-seronegative). Patients with PHIG accounted for 90.1% of the patients at high risk for gastric cancer misclassified as group A. The pepsinogen and
serological profiles of patients with PHIG were similar to those of patients with successful
eradication more than six years previously. A receiver-operating characteristic curve (ROC) analysis that included 13 patients with AIG and without active
infection and no previous eradication therapy and 31 patients with PHIG revealed that an endoscopic atrophy grade of O-III or greater according to the Kimura-Takemoto classification can predict AIG.
Two-thirds of the patients with PHIG were misclassified as being at low risk (group A) according to the ABC method, suggesting that endoscopy is necessary for group A patients. The results of the serological evaluation of PHIG indicated that patients with PHIG may have experienced spontaneous
eradication, possibly because of the use of antibiotics for other conditions. Autoimmune gastritis should be considered in the presence of grade 0-III or greater gastric mucosal atrophy in patients with suspected PHIG, even if the autoantibody and histological findings are not available.