What autoimmune diseases can cause gastritis?

Gastritis refers to inflammation of the stomach lining. There are many potential causes of gastritis, including autoimmune diseases. Autoimmune gastritis occurs when the immune system mistakenly attacks the cells of the stomach. This can lead to chronic inflammation and damage to the stomach lining. Some of the autoimmune diseases that are associated with a higher risk of gastritis include pernicious anemia, autoimmune atrophic gastritis, Crohn’s disease, and celiac disease. In autoimmune gastritis, autoantibodies target and destroy specific cells in the stomach, leading to impaired function. Understanding which autoimmune diseases have an increased risk of gastritis can help guide screening and treatment.

Pernicious Anemia

Pernicious anemia is one of the main autoimmune causes of gastritis. This condition is caused by an autoimmune reaction against parietal cells in the stomach lining. Parietal cells are responsible for secreting intrinsic factor, which is needed for the absorption of vitamin B12. In pernicious anemia, the loss of parietal cells leads to a vitamin B12 deficiency. This can cause a wide range of symptoms, including fatigue, shortness of breath, diarrhea, muscle weakness, and nerve problems. Pernicious anemia is diagnosed through blood tests checking vitamin B12 levels, intrinsic factor antibodies, and a complete blood count. About 10-20% of people with pernicious anemia have an associated autoimmune gastritis. Treatment involves vitamin B12 injections or high oral doses of vitamin B12. Monitoring for deficiencies and controlling the autoimmune attack are key to managing pernicious anemia.

Autoimmune Atrophic Gastritis

Autoimmune atrophic gastritis is another autoimmune condition affecting the stomach lining. It is caused by autoantibodies targeting the parietal cells of the stomach. Atrophic gastritis leads to the loss of glandular cells including parietal cells. This impairs the stomach’s acid production capabilities. Some common symptoms include vitamin B12 deficiency, anemia, bacterial overgrowth, and increased risk of stomach cancer. Autoimmune atrophic gastritis tends to have a gradual onset, taking years to develop. Diagnosis involves blood tests, endoscopy, and stomach biopsy. Initial treatment focuses on supplementing vitamin B12 and stomach acid. Long term, immunosuppressants may help control the autoimmune attack on stomach cells. Managing nutritional deficiencies and stomach pH levels are also important. Regular screening for stomach cancer is recommended for those with autoimmune atrophic gastritis.

Crohn’s Disease

Crohn’s disease is an inflammatory bowel disease that causes chronic inflammation potentially affecting any part of the gastrointestinal tract. While it most commonly affects the end of the small intestine and beginning of the colon, Crohn’s can also involve the stomach and lead to gastritis. Studies show up to 69% of Crohn’s disease patients have some microscopic signs of gastritis. Upper endoscopy and biopsy can help confirm the diagnosis. The gastritis is thought to be caused by the autoimmune reaction underlying Crohn’s disease. Treatment focuses on controlling the overall Crohn’s disease activity through medications to suppress the immune system along with dietary changes. This can help resolve associated gastritis. Proton pump inhibitors may also be used to reduce stomach acid production and allow the stomach lining to heal.

Celiac Disease

Celiac disease is an autoimmune disorder triggered by gluten ingestion. It primarily affects the small intestine but can have systemic effects throughout the body. Research indicates that around 16-43% of celiac disease patients will have some inflammation of the stomach lining consistent with gastritis. It is thought that the immune reaction to gluten causes inflammation in the stomach in addition to the small intestine damage. Following a strict gluten-free diet is the main treatment for celiac disease. This can help heal inflammation throughout the gut. Proton pump inhibitors may also be used to reduce excess stomach acid and aid gastritis healing. Due to vitamin and mineral deficiencies in celiac disease, supplements are often needed. In most patients, the gastritis and associated symptoms will improve once the autoimmune reaction is controlled by a gluten-free diet.

Other Autoimmune Diseases

In addition to the autoimmune diseases discussed above, there are a few other conditions that also have an increased association with autoimmune gastritis. These include:

Type 1 Diabetes

Around 24% of patients with type 1 diabetes have autoimmune gastritis. There appears to be some shared genetic factors underlying both conditions. Gastritis risk should be monitored in type 1 diabetes patients.

Autoimmune Thyroid Disease

Both Graves’ disease and Hashimoto’s thyroiditis have an increased prevalence of autoimmune gastritis, around 13-20%. Thyroid hormone imbalances may contribute to stomach lining inflammation.

Rheumatoid Arthritis

Some research shows an increased risk of gastritis in rheumatoid arthritis patients, likely related to chronic inflammation and drug treatments.

Vitiligo

Vitiligo involves autoimmune destruction of melanocytes in the skin. Those with vitiligo have up to a 4-fold higher risk of concurrent autoimmune gastritis.

Addison’s Disease

Adrenal insufficiency in Addison’s disease is also linked to a higher prevalence of autoimmune gastritis, up to 17% of patients.

Diagnosing Autoimmune Gastritis

Diagnosing autoimmune gastritis involves testing for autoantibodies along with evaluating any vitamin deficiencies caused by the condition. The main autoantibodies to test for include:

– Parietal cell autoantibodies – Targets stomach lining cells
– Intrinsic factor autoantibodies – Targets intrinsic factor needed for B12 absorption
– H+/K+ ATPase autoantibodies – Targets stomach acid pumps

Vitamin B12 levels are also checked, as deficiency indicates impaired parietal cell function. Complete blood count can reveal anemia. Gastroscopy with tissue biopsy can help confirm gastric inflammation and atrophy. Treatment is then tailored based on the extent of autoimmune damage to the stomach lining.

Treatment Options

Treatment for autoimmune gastritis focuses on replacing any vitamin deficiencies, controlling acid levels, and regulating the autoimmune attack when possible. Key treatment approaches include:

Vitamin Supplementation

Vitamin B12, iron, calcium, and folic acid supplements may be needed depending on the level of stomach damage. This helps correct any deficiencies.

HCl Secretion Blockers

Medications like proton pump inhibitors or H2 blockers reduce excess acid production and allow the stomach lining to heal.

Immunosuppressants

Corticosteroids and other immunosuppressive medications may be used in more severe cases to control the autoimmune reaction.

Dietary Modifications

Eliminating trigger foods and eating smaller, low-fat meals can ease symptoms. For associated conditions like celiac disease, a gluten-free diet is key.

Regular follow-up is needed to monitor vitamin levels and stomach function. Treatment aims to prevent complications like stomach cancer. With proper management, those with autoimmune gastritis can often achieve improved quality of life.

Complications

Some potential complications that can occur with autoimmune gastritis include:

Anemia

Due to vitamin B12 deficiency, iron deficiency, or folate deficiency reducing red blood cell production.

Osteoporosis

Decreased calcium and vitamin D absorption can lead to low bone mineral density and fractures.

Small Intestinal Bacterial Overgrowth

Lack of stomach acid allows overgrowth of bacteria in the small intestine causing bloating, diarrhea and nutrient malabsorption.

Stomach Cancer

The chronic inflammation from autoimmune gastritis increases the risk of both gastric adenocarcinoma and gastric mucosa associated lymphoid tissue (MALT) lymphoma.

Gastric Polyps

Also related to the chronic gastritis, hyperplastic gastric polyps can develop and require monitoring.

Careful monitoring and follow-up is important for identifying and managing these potential complications early. Adhering closely to treatment recommendations helps reduce risks.

Prevention

There are no definitive ways to prevent autoimmune gastritis given the nature of autoimmunity. However, prompt treatment of associated conditions like pernicious anemia and celiac disease is important. Following a balanced, low-fat diet and limiting use of NSAID pain relievers may reduce stomach irritation in those with a genetic predisposition. Quitting smoking and avoiding alcohol are also generally recommended to support stomach health. While autoimmune diseases can’t yet be cured, slowly emerging research on resetting the immune system provides hope for the future.

Conclusion

Autoimmune gastritis is a condition where the immune system mistakenly attacks the stomach lining, leading to chronic inflammation and impaired function. Some of the main autoimmune diseases associated with an increased risk of gastritis include pernicious anemia, autoimmune atrophic gastritis, Crohn’s disease, and celiac disease. Diagnosis is made through autoantibody blood tests, vitamin level checks, endoscopy and biopsy. Treatment involves vitamin supplementation, reducing stomach acid, immunosuppressant medications, and dietary changes. Complications like anemia, osteoporosis, bacterial overgrowth and stomach cancer need to be monitored. While the autoimmune basis can’t be reversed at this time, controlling inflammation and nutrient deficiencies through treatment can greatly improve outcomes. Increased recognition of the role of autoimmunity in gastritis allows for earlier intervention and preserved quality of life.

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