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Autoimmune Gastritis
Autoimmune diseases have varying types, causes, symptoms, and attacks. What they all have in common is that your immune system sees a part of your body as an enemy and sets forth to destroy it.
Today, we will discuss Autoimmune Gastritis (or AIG) and it’s attack on the stomach.
The stomach is like a pouch and has different regions: the fundus, corpus, and the antram.
 1
Also, it's important to mention that there is autoimmune gastritis and (just) gastritis. Generally, gastritis is caused by an infection caused by Helibactor Pylori (commonly known as H. pylori) bacteria.
H. Pylori is really common -- 50% of the US population has an overgrowth of H. Pylori and upwards of 80% of the world has it.
H.Pylori tends to colonize and create issues resulting in gastritis down in the base of the stomach, which is referred to as the antrum. When a gastroenterologist goes in and looks at the stomach of someone with autoimmune gastritis, they see effects in the oxyntic mucosa more in the body of the stomach than the antrum.
Autoimmune Gastritis (AIG) is where a person's immune system literally attacks their stomach. When the immune system attacks the stomach, the parietal cells are affected. These parietal cells have proton pumps which you may have heard of. Proton Pump Inhibitors or PPI are a common medication. So when a person has AIG, their antibodies attack these proton pumps. Proton pumps lead to hydrogen ions going into the stomach. This is good because it creates an acidic environment in the stomach which is what breaks down our food, and absorbs vitamins.
If you don’t have an acidic environment in your stomach, you will have a hard time breaking down and digesting your food and absorbing your vitamins.
One of the first manifestations of AIG is iron deficiency anemia. If you have been told you have this, but you have no bleeding ulcers and your Doctor doesn’t have an explanation, you may want to consider autoimmune gastritis.
Many of our patients come in with Autoimmune Gastritis but have never been diagnosed or tested. We aren’t really sure why this is since it is becoming a better known condition, but it just isn’t always on the radar in mainstream medicine.
In the World Journal of Gastroenterology, they published an article called "Autoimmune gastritis: Pathologist’s Viewpoint" 2
A diagram from the study.
The feelings of dyspepsia are feeling full, bloating, getting full after just starting their meal, nausea, heartburn, discomfort, and sometimes vomiting.
According to this study, AIG is becoming more and more prevalent and we aren’t sure why, but more people need to be tested for it.
They show that H. Pylori Associated Gastritis will not necessarily result in patients having high gastrin. Other markers will be normal relative to pepsinogen. They will have high antibodies to H. Pylori and an increased chance of gastric cancers according to the gastric stage.
AIG is a little different though, not just in location, as it tends to be higher in the stomach, but these patients will have high gastrin, pepsinogen may be low, and they *may* have symptoms of dyspepsia. They will present with antibodies such as intrinsic factor and anti-parietal cells. Intrinsic factor is what binds to the vitamin B12 that you eat and carries it down through your small intestines to the last part of your small intestine, the ilium, which is where B12 is absorbed. This B12 absorption only happens as long as it is attached to intrinsic factor. If you are low in intrinsic factor because your immune system is obliterating your stomach, and the intrinsic factor is not being produced then you are not going to absorb B12.
In the study they also make the point that with corpus restricted gastritis, (or autoimmune gastritis) that gastric cancers are increased according to the gastritis stage and then carcinoid increases according to their oxyntic atrophy score.
Next we will talk about the study, “Hashimoto’s Thyroiditis and Autoimmune Gastritis” which describes the relationship between the thyroid and the stomach. 3
Why is this relationship worth studying? Because your thyroid and stomach both develop from the same embryonic tissue! It makes sense then, that if your immune system sees your thyroid as enemy tissue, then it could also view the stomach as enemy tissue as well and vice versa.
What the authors talk about here is that the thyroid and the stomach have very similar features. They both have sodium iodine pumps that are very similar to each other. Researchers started noticing in the 1960’s that a lot of AIG patients have Hashimoto's and vice versa. If someone has AIG, by the time the AIG gets to a more severe form, 40% of those people will have Hashimoto’s and vice versa.
This is important to know as a Hashimoto’s patient. If you start being iron or B12 deficient then you really should be screened for AIG. Many doctors will tell you the deficiencies are a result of the Hashimoto’s slowing everything down in the gastric region and that would include absorption as well. This may be true, but it could also be Autoimmune Gastritis.
In the study, "Association of autoimmune type atrophic corpus gastritis with Helicobacter pylori infection." 4 Researchers showed that H. pylori can also induce autoimmune gastritis.
Other articles you can read will say that there is no relationship between H. pylori and AIG and this can be confusing but in our practice, our observation backs up what this study finds.
As well, this study "Polymorphism in Toll-Like Receptors and Helicobacter Pylori Motility in Autoimmune Atrophic Gastritis and Gastric Cancer” 5 worked to see if there were genetic risk factors that when combined with H. pylori infections, they would translocate into a higher risk of autoimmune atrophic gastritis and risk of gastric cancer.
The answer is basically yes.
Gastric cancers can happen because in this AIG condition where we develop autoimmune atrophic gastritis, the parietal cells start to change into intestinal cells and metaplastic cells. It is almost like the skin of your stomach changes into the intestines and it can go into metaplasia which is not necessarily a good thing because it can translocate into cancer.
With all of this information, here are some key takeaways:
-If you have Hashimoto’s and are deficient in iron or B12, be sure to be screened for Autoimmune Gastritis.
-If you have Autoimmune Gastritis, it is important to follow up with a gastroenterologist to be on the lookout for a development of gastric cancer.
-If you know someone who is deficient in B12 and/or iron, and does not have a bleeding ulcer, they should be checked for autoimmune gastritis.
There are talks of B12 therapy and bismuth therapy making big changes to help AIG patients. At Gates Brain Health we consistently see big improvements with AIG patients in our office- not saying we have a cure but Dr. Gates’s protocol is working well to reestablish gut health and reduce H. pylori infection.
Are you ready to let us cheer you on as you walk your healing journey? Are you ready to find out how Gates Brain Health can help you reduce inflammation, clear your skin, minimize stomach discomfort, brain fog, fatigue, arthritis, leaky gut, and allergies? Schedule your free consultation today!
This Article was written by Gemma Ward based on information shared by Dr. Gates here and here.
Images:
1. https://www.autoimmunedietitian.com/
2. Lenti, M.V., Rugge, M., Lahner, E. et al. Autoimmune gastritis. Nat Rev Dis Primers 6, 56 (2020). https://doi.org/10.1038/s41572-020-0187-8 https://www.nature.com/articles/s41572-020-0187-8#Abs1
3. https://www.slideshare.net/ImranaTanvir/lec-2-gastritis-gastric-neoplasm
4. Coati I, Fassan M, Farinati F, Graham DY, Genta RM, Rugge M. Autoimmune gastritis: Pathologist’s viewpoint. World J Gastroenterol 2015; 21(42): 12179-12189 https://www.wjgnet.com/1007-9327/full/v21/i42/12179.htm
5. https://www.easy-immune-health.com/vitamin-b-12-deficiency-symptoms.html
6. https://www.verywellhealth.com/fixing-low-iron-thyroid-3232716
Sources:
1. Lenti, M.V., Rugge, M., Lahner, E. et al. Autoimmune gastritis. Nat Rev Dis Primers 6, 56 (2020). https://doi.org/10.1038/s41572-020-0187-8 https://www.nature.com/articles/s41572-020-0187-8#Abs1
2. Coati I, Fassan M, Farinati F, Graham DY, Genta RM, Rugge M. Autoimmune gastritis: Pathologist’s viewpoint. World J Gastroenterol 2015; 21(42): 12179-12189 https://www.wjgnet.com/1007-9327/full/v21/i42/12179.htm
3. Cellini, Miriam et al. “Hashimoto's Thyroiditis and Autoimmune Gastritis.” Frontiers in endocrinology vol. 8 92. 26 Apr. 2017, doi:10.3389/fendo.2017.00092
4. Veijola, Lea Irene et al. “Association of autoimmune type atrophic corpus gastritis with Helicobacter pylori infection.” World journal of gastroenterology vol. 16,1 (2010): 83-8. doi:10.3748/wjg.v16.i1.83
5. De Re, Valli et al. “Polymorphism in Toll-Like Receptors and Helicobacter Pylori Motility in Autoimmune Atrophic Gastritis and Gastric Cancer.” Cancers vol. 11,5 648. 10 May. 2019, doi:10.3390/cancers11050648
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