ArticleFrontiers in immunology2026
Endoscopic spectrum of autoimmune gastritis across disease stages: a focus on Barrett's esophagus and ME-NBI features.
Article in Frontiers in immunology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background and aim: Autoimmune gastritis (AIG) is an immune-mediated disorder characterized by corpus-predominant atrophy. While serological markers are useful for screening, they inadequately reflect the dynamic progression of mucosal atrophy. Endoscopy remains the diagnostic cornerstone, yet a systematic analysis of its features across AIG stages is lacking. This study aimed to comprehensively analyze the clinical and endoscopic characteristics of AIG and evaluate the potential of endoscopic manifestations in defining disease stages, with particular focus on the intriguingly high prevalence of Barrett's esophagus (BE). Methods: In this retrospective study, 52 Chinese patients fulfilling both serological (positivity for anti-parietal cell and/or anti-intrinsic factor antibodies) and endoscopic/histopathological criteria for AIG were enrolled. Patients were classified into early-stage (remnant oxyntic mucosa, ROM >10%) or late-stage (ROM ≤10%) AIG. White light endoscopy (WLE) and magnifying endoscopy with narrow-band imaging (ME-NBI) were used to evaluate a comprehensive set of endoscopic features. Results: The cohort had a mean age of 56.68 years and a female predominance (61.5%). Hypergastrinemia was present in 82.5% of patients, with significantly decreased pepsinogen I levels and pepsinogen I (PG I)/pepsinogen II (PG II) ratio (PGR). Late-stage AIG exhibited significantly lower levels of PG I and PG II compared to early-stage (P = 0.05 and P = 0.04, respectively). Endoscopically, sticky adherent dense mucus (51.9%) and swelling of areae gastricae (55.8%) were common WLE findings. ME-NBI revealed a high frequency of pseudopyloric metaplasia (75%). Notably, BE was detected in 73.08% of patients, with short-segment BE (SSBE) being more frequent in early-stage (60.9% vs. 31.0%, P<0.05) and long-segment BE (LSBE) in late-stage disease (37.9% vs. 17.4%). Features suggesting advanced atrophy, such as cast-off skin appearance (CSA) and white globe appearance (WGA), were more prevalent in late-stage AIG (P = 0.03 for both). However, in multivariate analysis, no single endoscopic feature emerged as an independent predictor of AIG stage. Conclusions: The endoscopic landscape of AIG is diverse and evolves with disease progression. The high prevalence of BE, particularly its association with disease stage, challenges the conventional acid-reflux pathogenesis and suggests a role for duodenogastric reflux in the context of achlorhydria. While no single endoscopic feature can definitively stage AIG, a multimodal assessment combining WLE and ME-NBI provides valuable insights for diagnosis and stratification.
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