National Center for Advancing and Translational Sciences Genetic and Rare Diseases Information Center, a program of the National Center for Advancing and Translational Sciences

Autoimmune atrophic gastritis

Not a rare disease Not a rare disease
Autoimmune atrophic gastritis is a chronic inflammatory disease in which the immune system mistakenly destroys a special type of cell (parietal cells) in the stomach. Parietal cells make stomach acid (gastric acid) and a substance our body needs to help absorb vitamin B12 (called intrinsic factor). The progressive loss of parietal cells may lead to iron deficiency and finally vitamin B12 deficiency. The clinical signs and symptoms of iron deficiency anemia include tiredness, pale complexion, and heart problems such as exercise intolerance and palpitations. B12 deficiency may lead to pernicious anemia as well as gastrointestinal and neurological problems. Autoimmune atrophic gastritis may also be associated with an increased risk of certain types of stomach cancers.[1][2][3] 

The cause of autoimmune gastritis is unknown, but affected people are likely to have other autoimmune disorders including autoimmune thyroiditis, diabetes type I, Addison’s disease, and vitiligo. Diagnosis is made through a combination of clinical findings (certain blood tests and presence of other autoimmune conditions) and biopsy of stomach lining. Treatment is based on the signs and symptoms present in each person, but may include iron infusions, vitamin B12 injections and endoscopic surveillance.[1][2][3]
Last updated: 11/28/2016
In some cases, autoimmune atrophic gastritis does not cause any obvious signs and symptoms. However, some people may experience nausea, vomiting, a feeling of fullness in the upper abdomen after eating, or abdominal pain. It is often associated with impaired absorption of vitamin B12 and possibly other vitamin deficiencies (such as folate and iron). People with vitamin B12 deficiency are at risk for pernicious anemia, a condition in which the body does not have enough healthy red blood cells.[4][5]

Autoimmune atrophic gastritis is considered a "precancerous" condition and it may be responsible for the development of gastric adenocarcinoma or carcinoids.[6]
Last updated: 10/20/2015
Autoimmune atrophic gastritis is considered an autoimmune disorder. In people who are affected by this condition, the immune system mistakenly attacks the healthy cells of the stomach lining. Overtime, this can wear away the stomach's protective barrier and interfere with the absorption of several key vitamins (i.e. vitamin B12, iron, folate). This leads to the signs and symptoms of autoimmune atrophic gastritis.[4][7]
Last updated: 10/20/2015
In some cases, more than one family member can be affected by autoimmune atrophic gastritis. Although the underlying genetic cause has not been identified, studies suggest that the condition may be inherited in an autosomal dominant manner in these families.[4]

In autosomal dominant conditions, an affected person only needs a change (mutation) in one copy of the responsible gene in each cell. In some cases, an affected person inherits the mutation from an affected parent. Other cases may result from new (de novo) mutations in the gene. These cases occur in people with no history of the disorder in their family. A person with the condition has a 50% chance with each pregnancy of passing along the altered gene to his or her child.
Last updated: 10/20/2015
A diagnosis of autoimmune atrophic gastritis is generally not suspected until characteristic signs and symptoms are present. Additional testing can then be ordered to confirm the diagnosis. This generally includes:[1][8]
  • A biopsy of the affected tissue obtained through endoscopy
  • Blood work that demonstrates autoantibodies against certain cells of the stomach
Last updated: 10/21/2015
The treatment of autoimmune atrophic gastritis is generally focused on preventing or treating vitamin B12 and iron deficiencies. If pernicious anemia is already present at the time of diagnosis, vitamin B12 shots (injections) may be recommended. Since dietary and oral iron supplements do not usually improve iron levels, alternative iron therapy approaches may include receiving periodic intravenous (IV) iron (iron infusion) to increase iron stores or a daily dose of oral ferrous glycine sulfate to meet daily iron requirements. People with autoimmune atrophic gastritis should have their levels of B12 and iron monitored for the rest of their life.[1][2][3]

In some cases, periodic endoscopy may also be recommended due to the increased risk of certain types of cancer.[1][2][3]
Last updated: 11/28/2016
The long-term outlook (prognosis) for people with autoimmune atrophic gastritis varies. The condition is associated with an increased risk of pernicious anemia, gastric polyps and gastric adenocarcinoma. Significant risk factors for the development of gastric cancer in autoimmune atrophic gastritis include pernicious anemia, severity of atrophy, intestinal metaplasia, length of disease duration, and age older than 50 years. Fortunately, early diagnosis and proper treatment can reduce the mortality of the condition.[1]
Last updated: 10/21/2015

Research helps us better understand diseases and can lead to advances in diagnosis and treatment. This section provides resources to help you learn about medical research and ways to get involved.

Clinical Research Resources

  • ClinicalTrials.gov lists trials that are related to Autoimmune atrophic gastritis. Click on the link to go to ClinicalTrials.gov to read descriptions of these studies.

    Please note: Studies listed on the ClinicalTrials.gov website are listed for informational purposes only; being listed does not reflect an endorsement by GARD or the NIH. We strongly recommend that you talk with a trusted healthcare provider before choosing to participate in any clinical study.

Support and advocacy groups can help you connect with other patients and families, and they can provide valuable services. Many develop patient-centered information and are the driving force behind research for better treatments and possible cures. They can direct you to research, resources, and services. Many organizations also have experts who serve as medical advisors or provide lists of doctors/clinics. Visit the group’s website or contact them to learn about the services they offer. Inclusion on this list is not an endorsement by GARD.

Organizations Providing General Support

These resources provide more information about this condition or associated symptoms. The in-depth resources contain medical and scientific language that may be hard to understand. You may want to review these resources with a medical professional.

Where to Start

In-Depth Information

  • Medscape Reference provides information on this topic. You may need to register to view the medical textbook, but registration is free.
  • The Merck Manual for health care professionals provides information on Autoimmune atrophic gastritis.
  • PubMed is a searchable database of medical literature and lists journal articles that discuss Autoimmune atrophic gastritis. Click on the link to view a sample search on this topic.

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  1. Park JY, Lam-Himlin D, Vemulapalli R. Review of autoimmune metaplastic atrophic gastritis. Gastrointest Endosc. February 2013; 77(2):284-292. https://www.ncbi.nlm.nih.gov/pubmed/23199649.
  2. Miguel N, Costa E, Santalha M Jr, Lima R, Vizcaino JR, Pereira F, and Barbot J. Refractory Iron-deficiency Anemia and Autoimmune Atrophic Gastritis in Pediatric Age Group: Analysis of 8 Clinical Cases. J Pediatr Hematol Oncol. March 2014; 36(2):134-9. https://www.ncbi.nlm.nih.gov/pubmed/24327126.
  3. Kulnigg-Dabsch S. Autoimmune gastritis. Wiener Medizinische Wochenschrift. September 26 2016; 166(13):424-430. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5065578/.
  4. Nafea Zayouna, MD. Atrophic Gastritis. Medscape Reference. December 2014; http://emedicine.medscape.com/article/176036-overview.
  5. Pamela J Jensen, MD; Mark Feldman, MD, MACP, AGAF, FACG. Metaplastic (chronic) atrophic gastritis. UpToDate. December 17 2015; http://www.uptodate.com/contents/metaplastic-chronic-atrophic-gastritis.
  6. Miceli E, Lenti MV, Padula D, Luinetti O, Vattiato C, Monti CM, Di Stefano M, Corazza GR. Common features of patients with autoimmune atrophic gastritis. Clin Gastroenterol Hepatol. July 2012; 10(7):812-814.
  7. Gastritis. National Institute of Diabetes and Digestive and Kidney Diseases. July 2015; http://www.niddk.nih.gov/health-information/health-topics/digestive-diseases/gastritis/Pages/facts.aspx#signs.
  8. Neumann WL, Coss E, Rugge M, Genta RM. Autoimmune atrophic gastritis--pathogenesis, pathology and management. Nat Rev Gastroenterol Hepatol. September 2013; 10(9):529-541. https://www.ncbi.nlm.nih.gov/pubmed/23774773.