Factors associated with parietal cell autoantibodies in the general population☆
Highlights
► Serum parietal cell autoantibodies (PCA) are typical of autoimmune gastritis. ► In the general population PCA are more frequent in postmenopausal women. ► PCA are more frequent in people with insulin resistance. ► Smoking and alcohol consumption have a strong protective association with PCA. ► In patients who smoke or drink alcohol, clinicians should be cautious about PCA.
Introduction
The presence in serum of parietal cell autoantibodies (PCA) and less frequently, intrinsic factor autoantibodies (IFA), is a characteristic of autoimmune gastritis (AIG). This organ-specific disease leads to atrophy of the fundus and body of the stomach, but spares the antrum. In patients with AIG parietal and zymogenic cells are lost from the gastric mucosa, and a chronic humoral and cellular inflammatory infiltrate appears. The detection of PCA identifies individuals with asymptomatic AIG [1], the most common form of the disease before mucosal atrophy leads to iron malabsorption, ferropenic anemia, impaired vitamin B12 absorption [2] and pernicious anemia [3]. Parietal cell autoantibodies recognize the gastric proton pump (H+/K+-ATPase) of parietal cells in the gastric mucosa as an autoantigen [4].
The bacteria Helicobacter pylori is also involved in the etiology of AIG [5], [6]. The annual incidence of the disease may be as high as 11% among individuals with H. pylori infection, and is less than 1% in noninfected persons [7]. H. pylori infection is linked to lifestyle [8] and has been related with type 2 diabetes [9] and insulin resistance (IR) [10]. However, to our knowledge there have been no attempts thus far to analyze the relationship between PCA and type 2 diabetes, IR or lifestyle factors linked to H. pylori infection.
Autoimmune gastritis is a risk factor for stomach cancer [11], [12], and patients often have detectable serum concentrations of PCA [13] and elevated serum concentrations of the soluble CD40 ligand (sCD40L) [14]. However, it is not known whether PCA titers are associated with sCD40L levels in the general population.
The aims of this study were to determine the prevalence of autoantibodies associated with AIG in the general population of the Canary Islands, and to determine the relationships between PCA and (i) health problems (type 2 diabetes and IR), (ii) lifestyle factors known to be related with H. pylori infection, and (iii) serum sCD40L concentration.
Section snippets
Study population and sample
This cross-sectional study involved 429 individuals selected from the participants in the “CDC de Canarias” cohort study (CDC is the acronym for Cardiovascular, Diabetes and Cancer). The study design and preliminary results were published elsewhere [15]. Briefly, the cohort is a random sample of the adult (aged 18–75 years) general population of the Canary Islands. A total of 6729 participants were enrolled between January 2000 and December 2005, and the participation rate was 70%. During their
Results
Of the 429 samples analyzed (262 women and 167 men), PCA was positive in 36. The overall prevalence for the sample was 8.4%, and after weighting for sex distribution the overall prevalence was 7.8% (95% CI = 10.3–5.3). The prevalence was significantly higher for women (10.7%) than for men (4.8%, p = 0.032). The IFA assay was positive in 2 of 36 samples (5.6%), for a prevalence of 0.5% in the general population.
Mean age between PCA-positive and PCA-negative individuals did not differ significantly
Discussion
We found that smoking and alcohol consumption had a strong protective association with PCA. In contrast, the greatest risk for PCA was seen in postmenopausal women. Other risk factors for PCA identified in our analysis were high sCD40L concentration, female sex and IR.
Smoking has been known for more than 50 years to be a risk factor for some gastrointestinal diseases [17]. In smokers, parietal cells produce larger amounts of acid, making the gastric mucosa more vulnerable the appearance of
Funding
This study was supported by the Canarian Health Service and the Spanish Fund for Health Research (FIS PI0901314).
Conflict of interest
None.
Acknowledgment
We thank K. Shashok for translating the original manuscript into English.
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Financial support: Canary Islands Health Service, Spanish Government (Fondo de Investigación Sanitaria) project 0901314.