Autoimmune chronic atrophic gastritis: association between chronic proton pump inhibitors use and more severe atrophy and gastric intestinal metaplasia

Introduction and aim: Autoimmune chronic atrophic gastritis (ACAG) is a chronic autoimmune disorder whose diagnostic complexity arises from diverse symptoms mimicking other gastrointestinal disorders, often leading to misdiagnosis. Despite diagnosis, patients are often treated with proton pump inhibitors (PPIs) before consulting a gastroenterologist, emphasizing the need for accurate identification and management of ACAG in primary care. This study aimed to explore factors influencing disease progression. Materials and methods: We retrospectively analyzed demographic data, medical history, use of PPI, and clinical, endoscopic, and histological data of consecutive adult patients with a histological diagnosis of ACAG referred to our outpatient clinic between January 2017 and December 2022. Operative link on gastritis assessment (OLGA) and operative link for gastric intestinal metaplasia assessment (OLGIM) were recorded for each patient. Results: Seventy patients with a diagnosis of ACAG (female 74.3%, median age 63.9 years) made up the study cohort. Eighteen patients were asymptomatic (25.7%), while 13 (18.6%), and 10 (14.3%) patients reported epigastric pain and asthenia, respectively. Median age at diagnosis of ACAG was 60.7 years [interquartile range (IQR): 46.4-68.2]. OLGA and OLGIM scores III and IV were associated with higher age at diagnosis (OLGA: 69.2 years, IQR: 65.2-75.1 vs. 57.1 years, IQR: 44.4-67.1, P = 0.005; OLGIM; 68.0 years, IQR: 56.1-73 vs. 58.5 years, IQR: 44.3-67.4, P = 0.031). The use of full-dose PPI was more frequent in patients with higher OLGA and OLGIM scores (OLGA I-II vs. III-IV: n = 11, 17.7% vs. n = 4, 50.0%, P = 0.036; OLGIM 0-II vs. III-IV: n = 10, 16.7% vs. n = 5, 50.0%, P = 0.017). Conclusion: ACAG patients with severe atrophy and those with severe gastric intestinal metaplasia were most likely PPI users. Timely diagnosis and heightened awareness among nongastroenterologists regarding the inappropriate use of PPI in this context are crucial.