Refractory iron-deficiency anemia with no obvious etiology in pediatric age can be a puzzling problem. Screening of iron malabsorption conditions, including autoimmune atrophic gastritis (AAG), is emerging as a priority in the investigational procedure.
Retrospective analysis of clinical process of children/adolescents with the diagnosis of AAG.
Eight patients (aged between 4.7 and 18 years old) were identified. The diagnosis was triggered on the basis of high serum gastrin levels and strong positivity of antiparietal cell antibodies. Upper endoscopy and biopsy revealed atrophic gastritis in all patients, with 2 of them with intestinal metaplasia. Four patients presented with Helicobacter pylori infection object of eradication therapy. After a medium follow-up of 36.6 months, antiparietal cell antibodies and hypergastrinemia did not show evidence of regression. Of the 3 patients who underwent endoscopic reevaluation, a similar anatomo-pathologic pattern was observed in 2 and intestinal metaplasia in 1 patient. Normalization of hematological parameters was achieved, using alternative iron formulas.
AAG must be recognized as a pathology affecting pediatric patients. Gastric autoimmune lesion is a chronic process with potential evolution to malignancy. Management guidelines in childhood are not available. Their elaboration is important considering an important risk factor in these age group: a long life expectancy.
*Department of Pediatrics, Centro Hospitalar Trás-os-Montes e Alto Douro, Vila Real
Departments of †Hematology
∥Pathology, Centro Hospitalar do Porto, Oporto
‡Department of Pediatrics, Centro Hospitalar do Alto Ave, Guimarães, Portugal
The authors declare no conflict of interest.
Reprints: Natalina Miguel, MD, Serviço de Pediatria do Centro Hospitalar Trás-os-Montes e Alto Douro, Avenida da Noruega, 5000-514 Vila Real, Portugal (e-mail: firstname.lastname@example.org).
Received August 20, 2012
Accepted October 16, 2013