title: Chronic autoimmune atrophic gastritis associated with primary hyperparathyroidism: a transversal prospective study.
abstract: METHODS
  The coexistence of chronic autoimmune atrophic gastritis (CAAG) and primary hyperparathyroidism (PHPT) has been described previously, even if its extent and underlying mechanisms remain poorly understood. We therefore prospectively evaluated this association in two series of patients, one with CAAG and the other with sporadic PHPT.
  
  
  METHODS
  From January 2005 to March 2012, 107 histologically confirmed CAAG patients and 149 PHPT patients were consecutively enrolled. Routine laboratory assays included serum calcium, parathyroid hormone (PTH), plasma gastrin and chromogranin A (CgA). In CAAG patients with high PTH levels, ionized calcium and 25(OH)-vitamin D were evaluated. All CAAG and hypergastrinemic PHPT patients received an upper gastrointestinal endoscopy. Exclusion criteria were familial PHPT, MEN1 syndrome, treatment with proton pump inhibitor drugs, Helicobacter pylori infection and renal failure.
  
  
  RESULTS
  Of the 107 CAAG patients, nine (8.4%) had PHPT and 13 (12.1%) had secondary hyperparathyroidism stemming from vitamin D deficiency. Among the 149 PHPT patients, 11 (7.4%) had CAAG. Gastrin and CgA levels were similar in the CAAG patients with vs those without hyperparathyroidism (either primary or secondary), and calcium and PTH levels were similar in the PHPT patients with vs those without CAAG.
  
  
  CONCLUSIONS
  This study confirms a non-casual association between PHPT and CAAG. The prevalence of PHPT in CAAG patients is threefold that of the general population (8.4 vs 1-3%), and the prevalence of CAAG in PHPT patients is fourfold that of the general population (7.4 vs 2%). The mechanisms underlying this association remain unknown, but a potential role for autoimmunity is suggested.
authors: Gastroenterology Unit II, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy. sara.massironi@policlinico.mi.it
authors: Sara
authors: S
authors: Massironi
authors: Federica
authors: F
authors: Cavalcoli
authors: Roberta Elisa
authors: RE
authors: Rossi
authors: Dario
authors: D
authors: Conte
authors: Matilde Pia
authors: MP
authors: Spampatti
authors: Clorinda
authors: C
authors: Ciafardini
authors: Uberta
authors: U
authors: Verga
authors: Paolo
authors: P
authors: Beck-Peccoz
authors: Maddalena
authors: M
authors: Peracchi
mesh_terms: D000328:Adult; D000368:Aged; D001327:Autoimmune Diseases / Q000097:blood / Q000453:epidemiology*; D002118:Calcium / Q000097:blood; D015897:Comorbidity; D005260:Female; D005757:Gastritis, Atrophic / Q000097:blood / Q000453:epidemiology*; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000097:blood / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D014807:Vitamin D / Q000097:blood
chemical_list: D014807:Vitamin D; D002118:Calcium