Autoimmune atrophic gastritis (AAG) is a systemic immune-mediate condition characterized by a gradual loss of oxyntic glands. The natural history of the disease is marked by a slow progression with mucosal atrophy of the stomach taking up to years to develop, eventually leading to vitamin B12 deficiency. Commonly, due to the large reserves naturally present within our organism, clinical evidences of such deficiency only appear in late stages of the pathological process. Therefore, among the clinical manifestations of vitamin B12 deficiency, it has been largely observed that infertility and recurrent miscarriages are important consequences that can be attributed to AAG. Disappointingly, the association between autoimmune atrophic gastritis and complications during pregnancy has poorly been described in the literature. In 2018, Lenti et al. illustrated the clinical case of a patient diagnosed with AAG for a longstanding history of miscarriage and infertility. She naturally became pregnant two months after the beginning of the therapy, however morphological screenings during her first trimester showed a severe neural tube defect, a well know complication of vitamin B12 deficiency, and the patient had to terminate her pregnancy. Luckily, after a through supplementation lasting two years, she gave birth to a healthy baby. The review of the literature revealed that up to date there is no precise indication about the optimal biomarkers to investigate for a correct diagnosis of vitamin B12 deficiency before pregnancy, as only serum folate is screened and supplemented. Hence, we have herein described thirteen clinical cases of women that experienced infertility or recurrent miscarriage, who have been later diagnosed with AAG, and the benefit they received from adequate vitamin B12 supplementation, during the six months preceding pregnancy. The outcome of their pregnancies supports the hypothesis that infertility and miscarriage might be the only evidences of an otherwise silent vitamin B12 deficiency and that women with childbearing potential should undergo a careful evaluation of serum Cobalamin and Homocysteine levels, especially the ones with a history of infertility and recurrent miscarriage, anemia as well as patients with autoimmune diseases.
Complicanze legate alla gravidanza nella Gastrite Atrofica Autoimmune La gastrite atrofica autoimmune (AAG) è una condizione sistemica immunomediata, caratterizzata da una graduale perdita di ghiandole ossintiche. La storia naturale della malattia è caratterizzata da una lenta progressione con atrofia della mucosa dello stomaco che impiega fino a anni per svilupparsi, portando infine alla carenza di vitamina B12. Comunemente, a causa delle grandi riserve naturalmente presenti nel nostro organismo, le evidenze cliniche di tale carenza compaiono solo nelle fasi avanzate del processo patologico. Pertanto, tra le manifestazioni cliniche della carenza di vitamina B12, è stato ampiamente osservato che l'infertilità e gli aborti ricorrenti sono conseguenze importanti che possono essere attribuite all'AAG. Deludentemente, l'associazione tra gastrite atrofica autoimmune e complicanze durante la gravidanza è stata poco descritta in letteratura. Nel 2018, Lenti et al. hanno illustrato il caso clinico di una paziente con diagnosi di AAG per una lunga storia clinica di aborto e infertilità. È rimasta naturalmente incinta due mesi dopo l'inizio della terapia, tuttavia gli screening morfologici durante il suo primo trimestre hanno mostrato un grave difetto del tubo neurale, una complicazione ben nota della carenza di vitamina B12 e la paziente ha dovuto interrompere la gravidanza. Fortunatamente, dopo un'integrazione di due anni, ha dato alla luce un bambino sano. La revisione della letteratura ha rivelato che fino ad oggi non vi sono indicazioni precise sui biomarcatori ottimali da indagare per una diagnosi corretta della carenza di vitamina B12 prima della gravidanza, poiché solo il folato sierico viene sottoposto a screening e integrato. Pertanto, abbiamo qui descritto tredici casi clinici di donne che hanno manifestato infertilità o aborti ricorrenti, a cui è stata successivamente diagnosticata l'AAG, e il beneficio che hanno ricevuto dall'adeguata integrazione di vitamina B12, durante i sei mesi precedenti la gravidanza. Il risultato delle loro gravidanze supporta l'ipotesi che l'infertilità e l'aborto potrebbero essere le uniche prove di una carenza altrimenti silenziosa di vitamina B12 e che le donne in età fertile dovrebbero sottoporsi a un'attenta valutazione dei livelli sierici di cobalamina e omocisteina, in particolare le pazienti con una storia di infertilità e aborti ricorrenti, anemia e pazienti con malattie autoimmuni.
Pregnancy-related complications in Autoimmune Atrophic Gastritis
WANASINGHE ARACHCHIGE, MISHEL MALETHI
2019/2020
Abstract
Autoimmune atrophic gastritis (AAG) is a systemic immune-mediate condition characterized by a gradual loss of oxyntic glands. The natural history of the disease is marked by a slow progression with mucosal atrophy of the stomach taking up to years to develop, eventually leading to vitamin B12 deficiency. Commonly, due to the large reserves naturally present within our organism, clinical evidences of such deficiency only appear in late stages of the pathological process. Therefore, among the clinical manifestations of vitamin B12 deficiency, it has been largely observed that infertility and recurrent miscarriages are important consequences that can be attributed to AAG. Disappointingly, the association between autoimmune atrophic gastritis and complications during pregnancy has poorly been described in the literature. In 2018, Lenti et al. illustrated the clinical case of a patient diagnosed with AAG for a longstanding history of miscarriage and infertility. She naturally became pregnant two months after the beginning of the therapy, however morphological screenings during her first trimester showed a severe neural tube defect, a well know complication of vitamin B12 deficiency, and the patient had to terminate her pregnancy. Luckily, after a through supplementation lasting two years, she gave birth to a healthy baby. The review of the literature revealed that up to date there is no precise indication about the optimal biomarkers to investigate for a correct diagnosis of vitamin B12 deficiency before pregnancy, as only serum folate is screened and supplemented. Hence, we have herein described thirteen clinical cases of women that experienced infertility or recurrent miscarriage, who have been later diagnosed with AAG, and the benefit they received from adequate vitamin B12 supplementation, during the six months preceding pregnancy. The outcome of their pregnancies supports the hypothesis that infertility and miscarriage might be the only evidences of an otherwise silent vitamin B12 deficiency and that women with childbearing potential should undergo a careful evaluation of serum Cobalamin and Homocysteine levels, especially the ones with a history of infertility and recurrent miscarriage, anemia as well as patients with autoimmune diseases.È consentito all'utente scaricare e condividere i documenti disponibili a testo pieno in UNITESI UNIPV nel rispetto della licenza Creative Commons del tipo CC BY NC ND.
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https://hdl.handle.net/20.500.14239/21348