Diagnostic Approach to Hypertrophic Inflamed Gastric Folds in Body with Atrophied Fundus

Understanding the Condition

• The American Gastroenterological Association suggests that the combination of hypertrophic inflamed folds in the gastric body and fundal atrophy is highly characteristic of autoimmune gastritis (AIG), with atrophy primarily involving the gastric corpus and fundus, due to autoantibody-mediated destruction of parietal cells 1, 2
• The European Society of Gastrointestinal Endoscopy recommends that early-phase AIG often presents with subtle mucosal changes, including nonspecific erythema and inflammation, before complete atrophy develops, and can be missed without proper biopsies 2

Diagnostic Steps

• The American College of Gastroenterology recommends obtaining topographical biopsies following the updated Sydney protocol, with specimens placed in separately labeled jars, including 2 biopsies from the antrum, 2 biopsies from the gastric corpus, 1 biopsy from the incisura angularis, and targeted biopsies from the hypertrophic inflamed folds in the body and any other visible mucosal abnormalities 2
• The American Gastroenterological Association suggests checking for antiparietal cell antibodies, anti-intrinsic factor antibodies, and Helicobacter pylori testing (serology, stool antigen, or urea breath test) in all individuals with atrophic gastritis 3

Laboratory Evaluation

• The European Society of Gastrointestinal Endoscopy recommends evaluating for micronutrient deficiencies, including iron deficiency, which occurs in up to 50% of patients with corpus-predominant atrophic gastritis, and vitamin B-12 deficiency, due to reduced intrinsic factor from parietal cell destruction 4
• The American College of Gastroenterology suggests assessing for anemia with a complete blood count 3

Risk Stratification and Surveillance

• The American Gastroenterological Association recommends using the OLGA (Operative Link for Gastritis Assessment) or OLGIM (Operative Link for Gastric Intestinal Metaplasia Assessment) staging systems based on histology to determine gastric cancer risk, with corpus-predominant atrophy with intestinal metaplasia carrying significant cancer risk 1, 3
• The European Society of Gastrointestinal Endoscopy suggests considering surveillance endoscopy every 3 years for patients with confirmed advanced atrophic gastritis, and every 1-2 years depending on gastric neuroendocrine tumor (NET) burden 3, 4

Screening for Associated Conditions

• The American College of Gastroenterology recommends screening for autoimmune thyroid disease in all patients with confirmed AIG, as it is present in up to one-third of patients, and maintaining a low threshold to evaluate for type 1 diabetes mellitus and Addison's disease 4, 5