Introduction

Corpus Atrophic Gastritis (CAG) is a precancerous inflammatory condition of the oxyntic mucosa. Up today, two types of CAG are distinguished: 1) autoimmune (corpus-restricted), defined for CAG sparing the antrum 2) Helicobacter pylori (Hp)-related (multifocal), which involves antrum too.
Antrum involvement/sparing is crucial for both CAG definition as autoimmune and gastric cancer risk level, which is increased in case of pan-atrophy/pan-metaplasia, according to OLGA and OLGIM scores. CAG natural history is still poorly known, especially regarding antrum evolution. In cases with previous antral involvement, possible antrum healing after cure of Hp infection was formerly described. So, given the importance of the criterium antrum-sparing, we aimed to assess antral mucosa changes at long-term follow-up(FU) beside baseline in a cohort of CAG patients.

Aims & Methods

Given the importance of the criterium antrum-spared, we aimed to assess antral mucosa changes at long-term follow-up(FU) beside baseline in a cohort of CAG patients.
We performed a retrospective study on 130 patients with CAG and antrum involvement according to updated Sydney System. Mean time of FU gastroscopy was 40.6(range 4-192) months. In 13 patients corpus atrophy was not confirmed at FU, so were excluded. At baseline, among the remaining 117 patients [mean age 63 (range 20-87) years; F 67.5%], 47 (40.2%) had antral non-atrophic and 70 (59.8%) had antral atrophic gastritis, metaplastic in 84.3%. Histologically diagnosed Hp infection was present in 27.3% of patients, all receiving eradication therapy, anti-parietal cells antibodies (APCA) were positive in 53.8%.

Results

At FU 29/117(24.8%) of patients with tout-court involved antrum showed a complete restitutio ad integrum of antral mucosa. In particular, on 70 cases with antral atrophy at baseline, atrophy regressed in 15 (21.4%). Hp infection at baseline was present in 38% of patients who reported complete antral healing at FU, cured in all but one. Both antral healing and atrophy regression were found to be similar in Hp-cured and not-cured/negatives (p>0.05). In 8 patients (6.8%) a worsening of antral histology at FU was reported: 5 developed antral atrophy, not present at baseline, and 3 antral atrophic patients developed intestinal metaplasia.

Conclusion

Nearly 25% of CAG patients with antral involvement showed complete antrum healing, with regression of baseline antral atrophy in 21.4%. Antral healing occurred also in patients without history of Hp infection and/or eradication. These data suggest that in CAG natural history, concomitant antral involvement may regress irrespective of Hp cure, implying cancer risk reduction and raising queries about histology as sole criteria diagnostic for autoimmune gastritis.

References

1. Lahner et al. Dig LIver Dis 2019
2. Sipponen P et al. Gastroenterology clinics of North America 2000
3. Annibale B Helicobacter 1997

Introduction

Nutritional deficiencies are common in IBD patients and have been widely reported in Crohn's disease (CD) patients in particular. Nonetheless micronutrient screening is not routine in all centres in the UK. Body Mass Index (BMI) is widely used for detecting malnutrition in clinical practice but it is not sensitive marker of muscle mass. Hand grip strength (HGS) is quick to perform and may be an effective parameter to predict muscle function and health in IBD patients in busy outpatient settings. Different cut points are used in clinical practice to determine muscle weakness and may yield different results.

Aims & Methods

The aims of this study were (1) To examine micronutrient status (2) To establish the incidence of over- and under-weight and (3) To measure hand grip strength to determine the frequency of dynapenia in stable patients with IBD referred to specialist dietitian clinic for advice.
A baseline micronutrient screen including 9 vitamin and minerals (Vitamins A,D, E, folate, B12, ferritin, selenium, copper and zinc as well as haemoglobin) was performed on all consenting patients at initial dietitian appointment. Inflammatory marker, C reactive protein, was also checked. Patients with raised CRP, were excluded from the micronutrient analysis. All patients were weighed, height measured and BMI calculated. Hand grip strength was measured using Marsden hand grip dynamometer. The maximum result of 6 trials was recorded and its corresponding percentile (1). Dynapenia was defined as HGS<16kg for females and <27kg for males (2) . Results of Ulcerative colitis (UC) and Crohn’s disease (CD) patients were compared.

Results

A total of 292 consecutive patients, (108m, 184 f) referred for dietitian input from April 2023 to March 2025 were included. Mean age was 45 years (SD18). 201 patients with CD and 91 with UC were included. Results are presented in Table 1. No difference in micronutrient status was found between CD and UC patients apart from vitamin D where a higher incidence of deficiency was found in UC compared with CD patients (p=0.045). Contrary to widespread belief incidence of underweight was low in both CD and UC with a higher incidence of obesity in both groups than underweight. Over a quarter of the IBD population had muscle weakness defined by both Dodds et al (2014) and Cruz-Jentofft et al (2019) which is concerning (1,2).

Conclusion

Vitamin D status in particular should be monitored in all stable patients with IBD. A high proportion of both UC and CD patients were found to have weak muscle strength. HGS is a readily obtainable measure quick to perform and could be easily incorporated into routine clinical practice. Further research is needed to establish its clinical significance for stable IBD patients.

References

1. Dodds RM, Syddall HE, Cooper R, Benzeval M, Deary IJ, Dennison EM, Der G, Gale CR, Inskip HM, Jagger C, Kirkwood TB, Lawlor DA, Robinson SM, Starr JM, Steptoe A, Tilling K, Kuh D, Cooper C, Sayer AA. Grip strength across the life course: normative data from twelve British studies. PLoS One. 2014 Dec 4;9(12):e113637. doi: 10.1371/journal.pone.0113637. PMID: 25474696; PMCID: PMC4256164.
2. Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyère O, Cederholm T, Cooper C, Landi F, Rolland Y, Sayer AA, Schneider SM, Sieber CC, Topinkova E, Vandewoude M, Visser M, Zamboni M; Writing Group for the European Working Group on Sarcopenia in Older People 2 (EWGSOP2), and the Extended Group for EWGSOP2. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019 Jan 1;48(1):16-31. doi: 10.1093/ageing/afy169. Erratum in: Age Ageing. 2019 Jul 1;48(4):601. doi: 10.1093/ageing/afz046. PMID: 30312372; PMCID: PMC6322506.

Disclosure

No conflict of interest to disclose