Autoimmune Gastritis in Children: a Case Study of Diagnosis in Twins and the Role of Endoscopy in Early Diagnosis

Background. Autoimmune gastritis (AIG) is a chronic immune-mediated disease that primarily affects the cells of the gastric mucosa and fundus, characterized by the development of two main types of autoantibodies: antibodies to gastric parietal cells and antibodies to intrinsic factor. The characteristics of the manifestation and diagnosis of AIG in children are currently not defined worldwide.

Case description. A 13-year-old girl complains of intermittent abdominal pain. She is being monitored at her community hospital for recurrent iron deficiency anemia. A blood test revealed an increase in the level of antibodies to deamidated gliadin peptides of the IgG class — 26.0 U/ml, antibodies to gliadin of the IgG class — 72.0 U/ml, antibodies to gliadin of the IgA class — 38.0 U/ml. She was referred to the Children’s Endoscopy Center of the N.F. Filatov Children’s City Hospital of the Moscow Health Department to rule out celiac disease. An esophagogastroduodenoscopy was performed, and pseudopyloric metaplasia of the gastric mucosa was suspected. This was confirmed histologically, and AIG was suspected. Subsequently, IgG antibodies to gastric parietal cells (> 100.0 U/ml) were detected, and the child was finally diagnosed with AIG. The girl’s twin sister, who had similar complaints, was then examined. According to the research conducted, she also had verified AIG.

Conclusion. In children, AIG often occurs with latent clinical symptoms, which leads to the diagnosis being established only years after the onset of the disease. Early diagnosis of AIG is of particular importance, since this pathology can lead to the development of serious complications, including adenocarcinoma, neuroendocrine tumors of the stomach, atrophy of the mucous membrane, pernicious anemia, etc. In this regard, a comprehensive approach and vigilance are necessary when examining patients with risk factors (iron deficiency anemia, pernicious anemia, autoimmune thyroid diseases, type 1 diabetes mellitus, celiac disease, vitiligo, Addison’s disease). Currently, endoscopic examination with biopsy is one of the leading diagnostic methods.

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