Helicobacter pylori and autoimmunity in atrophic gastritis - comparison of clinical, endoscopic and histopathological features

Ana Maria Filip; Sabrina Nicoleta Munteanu; Simona Mocan; Dragos Hutanu; Monica Pantea; Anca Negovan

doi:10.2478/amma-2024-0028

Ana Maria Filip, AMF Internal Medicine Department, Emergency County Hospital of Târgu Mureș, 540136 Târgu Mureș, Romania
Sabrina Nicoleta Munteanu, SNM Department of Clinical Science-Internal Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, Mureș 540139, Romania;
Simona Mocan, SM Pathology Department, Emergency County Hospital of Targu Mures, Mureș 540136, Romania;
Dragos Hutanu, DH Pulmonology Department, Mureș County Clinical Hospital, Târgu Mureș, Mureș 540011, Romania;
Monica Pantea, MP Department of Clinical Science-Internal Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, Mureș 540139, Romania;
Anca Negovan, AN Department of Clinical Science-Internal Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, Mureș 540139, Romania;

DOI: https://doi.org/10.2478/amma-2024-0028

Keywords: atrophic gastritis, H. pylori, autoimmune gastritis

Abstract

Objective: This study aims to investigate the clinical, endoscopic, biologic and histopathological differences between Helicobacter pylori-associated and autoimmune gastric atrophy.

Methods: A retrospective analysis was conducted on 95 patients diagnosed with either H. pylori-related corporal and antral atrophy (43 patients) or autoimmune corporal atrophic gastritis (52 patients).

Results: A significant male predisposition for H. pylori-associated atrophic changes in both the antrum and corpus regions (p=0.007, OR=3.24) was observed in comparison with autoimmune etiology of atrophy. While comorbidities and lifestyle factors showed similar distributions across groups, only unintentional self-reported weight loss demonstrated a significant association with H. pylori atrophy (p=0.0177, OR=3.94). Corporal erosions were strongly associated with antral and corporeal atrophic gastritis (p=0.04, OR=8.27), but the rest of mucosal lesions are comparable among groups. Interestingly, patients with H. pylori-related pangastric atrophy exhibited lower frequencies of altered triglyceride (p=0.018) and cholesterol (p=0.029) levels compared to the autoimmune group. Linear regression analysis identified low triglyceride levels as an independent predictor for H. pylori-associated antral and corporal atrophic gastritis (p=0.04) in endoscopic population with atrophy, but no hematological or clinical parameters were predictive for these changes.

Conclusions: Male patients are more likely to present with corpus atrophic gastritis associated with H. pylori infection than with an autoimmune etiology. Patients with atrophic gastritis tend to have similar clinical characteristics, except for dyslipidemia, which is more prevalent in those with H. pylori pangastritis. Corporal erosions are associated with active H. pylori infection in atrophic mucosa.