Patients with corpus atrophic gastritis and antrum involvement may have antral healing at long term follow-up: real regression or sampling error?

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Aims Corpus Atrophic Gastritis (CAG) is characterized by inflammation and oxyntic gland loss. CAG is defined as autoimmune when sparing antrum and as Helicobacter pylori (Hp)-related (multifocal) when antrum is involved. Possible antral healing has been supposed. Since antrum sparing is crucial for autoimmune gastritis diagnosis and implies a lowering of OLGA-OLGIM risk scores for gastric cancer, we aimed to analyse antral histology at long-term follow-up (FU) in patients with CAG and concomitant antral involvement. Methods Retrospective study on 117 patients (pts) with CAG and antrum involvement [mean age 63 (range 20-87) yrs; F 67.5%]) diagnosed and followed-up with gastroscopy with biopsies according to Sydney Syestem. Mean time of FU was 66 months (range 4-192). At baseline 47 pts (40.2%) had antral non-atrophic and 70 (59.8%) had antral atrophic gastritis, metaplastic in 84.3%. Hp infection at histology was found in 27.3% of pts, all treated [ 1 ] [ 2 ] [ 3 ] [ 4 ]. Results At FU 24.8% of pts showed a complete restitutio ad integrum. Antral atrophy and intestinal metaplasia regression was observed 15/70 pts (21.4%). Both antral complete healing and atrophy regression were similar in Hp-cured and not-cured/negatives (p>0.05). At FU, 3 pts showed intestinal metaplasia (not present at baseline), while 5 pts developed atrophy. Conclusions In nearly ¼ of CAG pts concomitant antral involvement may regress at long-term FU, irrespective of Hp, thus resembling autoimmune gastritis and lowering OLGA-OLGIM scores. Sampling error of antrum mucosa responsible of misdiagnosed antral histological alterations at FU has to be considered. This raises concern about autoimmune gastritis diagnosis and the importance of increasingly accurate and targeted gastric biopsies in patients with CAG. Publication History Article published online: 14 April 2023 © 2023. European Society of Gastrointestinal Endoscopy. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany

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