Dr. Nielsen Fernandez-Becker is an attending Gastroenterologist at Stanford University in the Division of Gastroenterology and Hepatology. She earned her MD and PhD degrees at the Albert Einstein College of Medicine. She served as an internal medicine resident at the Massachusetts General Hospital and trained as a Gastroenterology Fellow at the Beth Israel Deaconess Medical Center/Harvard Medical School. She joined Stanford GI faculty in 2009 and has an interest in antigen driven disorders such as Celiac Disease and Eosinophilic esophagitis and autoimmunity.
Autoimmune gastritis (AIG) is an immune mediated disease that causes destruction of parietal cells of the stomach as well as intrinsic factor, which is necessary for vitamin B12 absorption. AIG results in hypochlorhydria and micronutrient deficiencies such as B12 and iron, rarely causing pernicious anemia and can progress to gastric cancer. It is one of the causes of chronic atrophic gastritis. Inflammation classically involves the body and fundus of the stomach sparing the antrum, unlike pylori induced chronic gastritis, which involves the antrum. The disease thought to be T-cell mediated, however the molecular pathogenesis remains poorly understood. Like other autoimmune diseases, AIG affects women more than men in a 2:1 ratio. Furthermore, AIG increases the risk for other autoimmune conditions including thyroid disease and type I diabetes. The true prevalence of the disease is not understood for a variety of reasons including a dearth of high-quality epidemiological studies and heterogeneity in existing studies with regards to study design and diagnostic criteria used to define AIG. In AIG, over time, inflammation causes atrophy of the stomach acid producing mucosa and development gastric intestinal metaplasia which increases the risk for cancer. Unfortunately, since the disease is asymptomatic in its early stages and symptoms are non-specific at later stages, the diagnosis is often delayed. There is no cure for disease and management consists of supportive care such as repletion of micronutrients, recognition of concomitant conditions and surveillance for neoplastic complications. Studies designed to identify true prevalence of disease and development of early phase biomarkers are necessary to improve detection of AIG and hopefully prevent late complications of the disease such as pernicious anemia and gastric cancer.
