title: Refractory iron-deficiency anemia and autoimmune atrophic gastritis in pediatric age group: analysis of 8 clinical cases.
abstract: BACKGROUND
  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.
  
  
  METHODS
  Retrospective analysis of clinical process of children/adolescents with the diagnosis of AAG.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors: *Department of Pediatrics, Centro Hospitalar Trás-os-Montes e Alto Douro, Vila Real Departments of †Hematology §Pediatric Gastroenterology ∥Pathology, Centro Hospitalar do Porto, Oporto ‡Department of Pediatrics, Centro Hospitalar do Alto Ave, Guimarães, Portugal.
authors: Natalina
authors: N
authors: Miguel
authors: Emília
authors: E
authors: Costa
authors: Marta
authors: M
authors: Santalha
authors: Rosa
authors: R
authors: Lima
authors: José Ramon
authors: JR
authors: Vizcaino
authors: Fernando
authors: F
authors: Pereira
authors: José
authors: J
authors: Barbot
mesh_terms: D000293:Adolescent; D018798:Anemia, Iron-Deficiency / Q000209:etiology*; D001327:Autoimmune Diseases / Q000150:complications*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005757:Gastritis, Atrophic / Q000150:complications*; D006801:Humans; D008297:Male; D012189:Retrospective Studies