Relationship of Gastric
Autoantibodies, the State of the Gastric Mucosa and Helicobacter pylori Infection
Fixa B. 1 , Komárková O. 2 , Nožička Z. 3 , Nožička J. 3 , Petrová J. 4 , Faller G. 5
1 II. katedra interních oborů, LF UK, Hradec Králové, 2 II. interní klinika, FN, Hradec Králové 3 Fingerlandův ústav patologické anatomie, FN, Hradec Králové 4 Soukromá gastroenterologická a revmatologická ordinace, Hradec Králové 5 Institute für Pathologie, Universität Erlangen-Nürnberg, SRN |
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Summary:
The objective of the work was to evaluate the relationship of newly described gastric antibodies (anticanalicu-
lar and antiluminal) to antibodies against the cytoplasm of parietal cells assessed in the traditional way, and
to evaluate at the same time their relationship to the gastric mucosa and infections with Helicobacter (H)
pylori.
Patients and methods: The study included a total of 33 patients. In all, upper endoscopy was performed and
two specimens from the gastric antrum of the gastric body were collected for histological examination and
assessment of H. pylori (rapid urease test, histology). Gastric antibodies were assessed by the classic method
of indirect immunofluorescence and intracanalicular and antiluminal antibodies by Faller’s method (1996).
Indication for inclusions of the patients into the study was the finding of antibodies against parietal cells by
the classical method or a histological finding suspicious of autoimmune damage of the gastric mucosa. Six
patients where gastric antibodies were not detected served as a control group.
Results: Of 23 patients where by classical methods antibodies against parietal cells were detected, anticanali-
cular anti-bodies were found in 17 (73.9 %). False positivity assessed in the classical way in 6 patients was associated with their weak positivity and the concurrent finding of antibodies against the thyroid gland
(crossed reactivity). Evidence of anticanalicular antibodies makes it possible to assess more accurately the
specificity of gastric autoantibodies. Comparison of the presence of gastric antibodies (anticanalicular and
antiluminal) with the state of the gastric mucosa revealed that evidence of gastric antibodies implies in the
majority of cases chronic gastritis, more frequently with atrophy and intestinal metaplasia, however, a nor-
mal or almost normal gastric mucosa (3 cases) cannot be ruled out. Explanation of this observation is lacking
(initial stage of the autoimmune process?). The activity of the inflammation correlated with the presence of H.
pylori in the gastric mucosa. Gastritis in the control group of patients without gastric antibodies was also
associated with H. pylori. However, in one instance also autoimmune gastritis without H. pylori and without
antibodies was found which cannot be explained so far. In patients with gastric antibodies H. pylori was
detected 7× (41.2 %). In four patients H. pylori was not present in the gastric mucosa, there were however
antibodies against H. pylori suggesting infection with H. pylori in the past and a possible relationship
between H. pylori and gastric autoimmunity.
Conclusions: Evidence of anticanalicular or antiluminal antibodies is more accurate for evaluation of gastric
autoimmunity than classical evidence of antibodies against parietal cells. Even modern assessment of gastric
antibodies does not provide accurate information on the state of the gastric mucosa. Gastritis is frequently
associated with H. pylori. However, we are unable to explain a normal gastric mucosa in patients with gastric
antibodies and conversely the autoimmune type of gastritis without gastric antibodies and without H. pylori
infection (rare cases). It is important to take into consideration also possible primary H. pylori infection and
a secondary autoimmune process.
Key words:
Helicobacter pylori – gastric autoimmunity – gastritis
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