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Iron deficiency workup reveals high incidence of autoimmune gastritis with parietal cell antibody as reliable screening test.
Semin Hematol 2018; 55(4):256-261SH

Abstract

Iron deficiency (ID) workup is a common challenge for gastrointestinal endoscopy. In premenopausal women current guidelines recommend serologic evaluation of coeliac disease only. Here we systematically tested serologic screening for autoimmune gastritis (AIG) in a large cohort of patients with ID. This is a retrospective analysis of patients who attended an out-patient clinic specialized for ID. Patients with ferritin <50 µg/L or transferrin saturation <15% were included. Laboratory workup included endomysial antibodies and parietal-cell antibodies (PCA). Upper gastrointestinal endoscopy with pH-measurement of gastric juice and histology was performed to confirm positive serologic results. Three hundred seventy-three patients with ID were included, about half of whom were anemic. Patients were predominately female with a median age of 40 (confidence interval 11). Positive endomysial antibodies were found in 4 (1%) patients, elevated levels of PCA (>20 U/mL) were found in 69 (18.5%) patients, PCA >100 U/mL in 23 (6.2%). Twenty-six were followed up by gastroscopy; in 12 of 26 patients the diagnosis of AIG was confirmed by histology with 2 additional patients diagnosed as early and/or questionable AIG. A sensitivity of 93% and a specificity of 98% were estimated for a PCA cut-off of 100 U/mL. In 20 patients gastric pH was measured. Achlorhydria was found in 7 patients all diagnosed with AIG. In this ID cohort AIG is by far more common than coeliac disease. PCA above 100 U/mL are a sensitive and specific cut-off for workup of patients with ID prior to endoscopy. Serologic suspicion of AIG helps preselection of patients for endoscopic workup for ID.

Authors+Show Affiliations

Division of Gastroenterology and Hepatology, Medical University of Vienna, Austria.Division of Gastroenterology and Hepatology, Medical University of Vienna, Austria.Clinical Pathology, Medical University of Vienna, Austria.Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Austria.Loha for life, Center of Excellence for Iron Deficiency, Vienna, Austria.Division of Gastroenterology and Hepatology, Medical University of Vienna, Austria; Loha for life, Center of Excellence for Iron Deficiency, Vienna, Austria. Electronic address: christoph.gasche@meduniwien.ac.at.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30502855

Citation

Kulnigg-Dabsch, Stefanie, et al. "Iron Deficiency Workup Reveals High Incidence of Autoimmune Gastritis With Parietal Cell Antibody as Reliable Screening Test." Seminars in Hematology, vol. 55, no. 4, 2018, pp. 256-261.
Kulnigg-Dabsch S, Resch M, Oberhuber G, et al. Iron deficiency workup reveals high incidence of autoimmune gastritis with parietal cell antibody as reliable screening test. Semin Hematol. 2018;55(4):256-261.
Kulnigg-Dabsch, S., Resch, M., Oberhuber, G., Klinglmueller, F., Gasche, A., & Gasche, C. (2018). Iron deficiency workup reveals high incidence of autoimmune gastritis with parietal cell antibody as reliable screening test. Seminars in Hematology, 55(4), pp. 256-261. doi:10.1053/j.seminhematol.2018.07.003.
Kulnigg-Dabsch S, et al. Iron Deficiency Workup Reveals High Incidence of Autoimmune Gastritis With Parietal Cell Antibody as Reliable Screening Test. Semin Hematol. 2018;55(4):256-261. PubMed PMID: 30502855.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Iron deficiency workup reveals high incidence of autoimmune gastritis with parietal cell antibody as reliable screening test. AU - Kulnigg-Dabsch,Stefanie, AU - Resch,Maximilian, AU - Oberhuber,Georg, AU - Klinglmueller,Florian, AU - Gasche,Anke, AU - Gasche,Christoph, Y1 - 2018/08/07/ PY - 2018/04/20/received PY - 2018/07/12/revised PY - 2018/07/29/accepted PY - 2018/12/4/entrez PY - 2018/12/7/pubmed PY - 2019/5/8/medline KW - Anemia KW - Autoimmune gastritis KW - Iron deficiency KW - Parietal cell antibody SP - 256 EP - 261 JF - Seminars in hematology JO - Semin. Hematol. VL - 55 IS - 4 N2 - Iron deficiency (ID) workup is a common challenge for gastrointestinal endoscopy. In premenopausal women current guidelines recommend serologic evaluation of coeliac disease only. Here we systematically tested serologic screening for autoimmune gastritis (AIG) in a large cohort of patients with ID. This is a retrospective analysis of patients who attended an out-patient clinic specialized for ID. Patients with ferritin <50 µg/L or transferrin saturation <15% were included. Laboratory workup included endomysial antibodies and parietal-cell antibodies (PCA). Upper gastrointestinal endoscopy with pH-measurement of gastric juice and histology was performed to confirm positive serologic results. Three hundred seventy-three patients with ID were included, about half of whom were anemic. Patients were predominately female with a median age of 40 (confidence interval 11). Positive endomysial antibodies were found in 4 (1%) patients, elevated levels of PCA (>20 U/mL) were found in 69 (18.5%) patients, PCA >100 U/mL in 23 (6.2%). Twenty-six were followed up by gastroscopy; in 12 of 26 patients the diagnosis of AIG was confirmed by histology with 2 additional patients diagnosed as early and/or questionable AIG. A sensitivity of 93% and a specificity of 98% were estimated for a PCA cut-off of 100 U/mL. In 20 patients gastric pH was measured. Achlorhydria was found in 7 patients all diagnosed with AIG. In this ID cohort AIG is by far more common than coeliac disease. PCA above 100 U/mL are a sensitive and specific cut-off for workup of patients with ID prior to endoscopy. Serologic suspicion of AIG helps preselection of patients for endoscopic workup for ID. SN - 1532-8686 UR - https://www.unboundmedicine.com/medline/citation/30502855/Iron_deficiency_workup_reveals_high_incidence_of_autoimmune_gastritis_with_parietal_cell_antibody_as_reliable_screening_test L2 - https://linkinghub.elsevier.com/retrieve/pii/S0037-1963(18)30053-2 DB - PRIME DP - Unbound Medicine ER -