title: Autoimmune gastritis and parietal cell reactivity in two children with abnormal intestinal permeability.
abstract: Autoimmune gastritis is characterised by lymphocytic infiltration of the gastric submucosa, with loss of parietal and chief cells and achlorhydria. Often, gastritis is expressed clinically as cobalamin deficiency with megaloblastic anaemia, which is generally described as a disease of the elderly. Here, we report on two prepubertal children who developed autoimmune gastritis. One child developed autoimmune gastritis as part of a polyglandular autoimmune disease from a family with polyglandular autoimmune disease type II (PGA type II) and the other as part of a classic "thyro-gastric cluster," which may have been triggered by emotional trauma. Both children presented with normal small bowel biopsies, with abnormal gut permeability, which subsequently resolved. These patients are among the youngest reported to date. The immune systems targetted the gastric parietal cell autoantigens (ATP4A and ATP4B) in both children, similar to the elderly. The study of children with autoimmune gastritis and their families may provide additional insights into the disease's pathogenesis and may also lead to the identification of inheritable factors influencing susceptibility. This report underlines the necessity to screen paediatric patients with organ-specific autoimmune diseases for co-existent conditions. Children with polyglandular autoimmune disease are at particularly high risk.
authors.affiliation: Department of Medicine, Central and Eastern Clinical School, Monash University, Prahran, Victoria, 3181, Australia. deanneg@unimelb.edu.au
authors.forename: Deanne L V
authors.initials: DL
authors.lastname: Greenwood
authors.forename: Patricia
authors.initials: P
authors.lastname: Crock
authors.forename: Stephen
authors.initials: S
authors.lastname: Braye
authors.forename: Patricia
authors.initials: P
authors.lastname: Davidson
authors.forename: John W
authors.initials: JW
authors.lastname: Sentry
mesh_terms: D000309:Adrenal Insufficiency / Q000175:diagnosis; D018798:Anemia, Iron-Deficiency / Q000453:epidemiology; D000752:Anemia, Pernicious / Q000453:epidemiology; D001327:Autoimmune Diseases / Q000453:epidemiology / Q000276:immunology* / Q000378:metabolism / Q000523:psychology; D002463:Cell Membrane Permeability; D002648:Child; D015897:Comorbidity; D005260:Female; D019084:Fluorescent Antibody Technique, Indirect; D005756:Gastritis / Q000276:immunology*; D006801:Humans; D007413:Intestinal Mucosa / Q000378:metabolism; D007792:Lactulose / Q000378:metabolism; D008297:Male; D010295:Parietal Cells, Gastric / Q000276:immunology*; D016884:Polyendocrinopathies, Autoimmune / Q000453:epidemiology / Q000235:genetics / Q000276:immunology* / Q000378:metabolism; D012210:Rhamnose / Q000378:metabolism; D013315:Stress, Psychological / Q000453:epidemiology
chemical_list: D007792:Lactulose; D012210:Rhamnose