Revisiting autoimmune gastritis in children and adolescents with type 1 diabetes.

ObjectiveAssess the frequency of anti-H+/K+ adenosine triphosphatase (ATPase) autoantibodies (AAB) and symptoms of autoimmune gastritis in children and adolescents with type 1 diabetes (T1D). Research Design and MethodsAnti-H+/K+ ATPase AAB were measured in 402 children and adolescents (210 boys and 192 girls, 11.14.5years) treated for T1D (screened positive for -cell AAB), along with search of symptoms of anemia (hemoglobin, serum iron, and ferritin levels) and gastric pain. The AAB specific for thyroperoxydase, thyroglobulin, and transglutaminase were also measured. ResultsAnti-H+/K+ ATPase AAB were present in 6.5% of children. Their frequency increased with age: 4% at 10years, 10% at 15years, and 20% at 20years. Iron deficiency (45% vs 3.8%), iron deficiency anemia (36% vs 3.8%), antithyroid AAB (24% vs 9.7%), and family history of Graves' disease (25% vs 5.6%) were more frequent in patients with anti-H+/K+ ATPase AAB. Two patients, a 13-year-old girl and a 11-year-old boy, experienced symptoms (iron deficiency anemia and epigastric pain) which led to diagnosis of autoimmune gastritis confirmed upon fibroscopy. Both showed high levels of anti-H+/K+ ATPase AAB and atrophic gastritis. Conclusions Autoimmune gastritis presents an age-dependent frequency in children and adolescents with T1D but is rarely symptomatic. Screening for anti-H+/K+ ATPase AAB should thus target patients with iron deficiency, anemia, epigastralgia, autoimmune thyroiditis, or age over 15years.