Autoimmune Gastritis: An Evolving Entity

Abstract

Autoimmune gastritis (AIG) has long occupied an awkward place in clinical practice.For most of the 21th century, it was viewed mainly through its hematologic endpoint-pernicious anemia-and seen as a rare, late diagnosis of limited relevance to the endoscopist.That perception has changed.AIG is now found earlier and more often, frequently in patients who have no symptoms or who present only with iron-deficiency anemia, and it is increasingly recognized as a corpus-restricted gastric disease with meaningful neoplastic implications.1,2 In this issue of the Korean Journal of Helicobacter and Upper Gastrointestinal Research, 3 trace this shift through a hybrid bibliometric-conceptual analysis of AIG research from 1995 to 2025.Across 1298 articles from 5608 authors in 45 countries, annual output rose from 24 in 1995 to 86 in 2025, and the focus of the field changed clearly over time.Early studies centered on pernicious anemia, gastric autoimmunity, and chronic gastritis, whereas recent studies focus on endoscopic recognition, biomarker-based diagnosis, gastric neuroendocrine tumors (NETs), and neoplastic risk.Co-citation analysis frames this as a movement from immunologic and pathophysiologic investigation toward clinically oriented disease recognition and surveillance.3 This shift reflects a real change in daily practice.Corpus biopsy is still the diagnostic standard, but serologic and functional markers-the pepsinogen I/II ratio, serum gastrin, and anti-parietal cell and intrinsic factor antibodies-now allow corpus-predominant atrophy to be suspected before or alongside endoscopy, 2,4 and artificial intelligence tools that help detect corpus atrophy, noted here as one of the newest topics, point toward earlier detection.3 This change matters most for cancer risk.Hypergastrinemia can lead to indolent type 1 gastric NETs, while corpus atrophy and intestinal metaplasia raise the risk of gastric adenocarcinoma-if still debated.2,5 Because no treatment reverses the disease itself, management focuses on correcting iron and vitamin B12 deficiency and on regular endoscopic surveillance with adequate corpus sampling.4 For readers of this journal, the analysis carries a pointed regional message.Despite the significant contributions Asian researchers are making to the field of gastrointestinal research, their integration into the international AIG research network, which is centered on European and North American groups, remains limited.3 This is important because most diagnostic thresholds and surveillance recommendations in use came from studies in Western populations.In Korea, where the incidence of Helicobacter pylori-associated atrophy and gastric cancer is notably high, distinguishing AIG from advanced H. pylori-induced atrophic gastritis, validating serologic cutoff values tailored to the local context, and clarifying the neoplastic risk attributable to autoimmunity against a higher infection-relat-