Autoimmune gastritis: problems of diagnosis and therapy

Chronic gastritis (CG) is one of the most widespread internal diseases, which affects up to 20 % of the adult population. The modern CG paradigm considers disease as a launchpad for the formation of stomach cancer, as well as erosive and ulcerative lesions, including those induced by anti-inflammatory drugs’ intake. The widespread symptoms of gastric dyspepsia often lead to the CG overdiagnosis, while verification of the diagnosis should be based on clinical endoscopic and pathomorphological criteria. In recent years, a large body of scientific data has been presented on the role of different types of microorganisms, including H. Pylori bacteria, of the duodenogastric reflux, medications’ intake in the CG development and progression. However, the autoimmune form of this disease is poorly understood. It is well known that autoimmune gastritis (AIG) is the most important factor in the development of pernicious anemia, and hypochlorhydria leads to iron deficiency anemia. At the same time, the role of AIG in the formation of gastric atrophy and metaplasia is not well understood. A question of gastro-carcinogenic potential of AIG remains open. Diagnosis of AIG requires the determination of not only clinical endoscopic, histopathological parameters, but also a comprehensive analysis of serological data. From the standpoint of modern classifications: Kyoto consensus and the OLGA/OLGIM CG system, it is of interest to correlate between serological and pathological markers in patients with AIG. The treatment of AIG is not specific and does not fundamentally differ from the treatment of other forms of CG. However, given the pathogenetic features of AIG, the development of methods for the correction of immunopathological processes that characterize this disease is promising. AIG treatment is aimed of the infection eradication, restoration of the motor-evacuation function of the gastroduodenal zone, neutralizing the damaging effects of bile acids, but gastroprotection is a strategic direction in the treatment of the disease. In particular, the use of drugs based on bismuth salts promotes restoration of the structural and functional state of the gastric mucosa, inhibits the progression of AIG, as well as promotes regression of atrophy and intestinal metaplasia.