Preatrophic autoimmune gastritis. A practice-oriented concept for diagnosis and treatment

Helicobacter pylori infection sometimes leads to an antigastric autoimmunit y that ultimately develops into complete atrophy of the glands of the gastr ic mucosal glands. It has been found that the "classical" parietal cell ant ibody positive and H. pylori induced autoimmune gastritis share common aspe cts of histomorphology, stages, and pathomechanisms. Healing of H. pylori a ssociated active preatrophic autoimmune gastritis by eradication treatment has been confirmed both in case reports and in prospective and retrospectiv e studies. This leads to a general practice-oriented four-step concept for diagnosis and treatment in daily routine: (a) Histological work-up on the b asis of: lymphocytic infiltration of the glands of the corpus and fundic mu cosa,focal destruction in individual corpus glands, reactive hypertrophy of the parietal cells, and search for H.pylori. (b) Additional serological wo rk-up if histological evidence of H.pylori is lacking:determination of H.py lori and parietal cell antibodies in the serum.(c) Initiation of an establi shed H. pylori eradication therapy if histology and/or serology is positive for H.pylori.(d) Histological and serological follow-up for 9-12 months to monitor the results of treatment.