We thank Drs Guo, Spaander, and Fuhler for their interest in our article; we were pleased to learn of their data related to autoimmune gastritis (AIG) in the setting of ongoing or remote Helicobacter pylori infection.1 Similar to our findings, these authors found that enterochromaffin-like (ECL) cell hyperplasia is a relatively specific and sensitive marker of AIG.
We wish to highlight 2 aspects of the work by Guo et al that are complementary to our findings. First, their AIG–H pylori cohort comprises anti–parietal cell antibody (APCA)–positive cases. These antibodies are present in the 80% to 90% of patients with AIG; thus, their presence supports the histologic diagnosis, as the pathologic features do overlap somewhat with those of longstanding H pylori infection.2,3 Serologic studies for AIG-associated antibodies were performed (and were positive) in only 3 of our cases. Using an additional line of evidence to diagnose AIG strengthens the conclusion that ECL cell hyperplasia is a reliable marker for this disorder. Second, inclusion criteria for our H pylori control group specified that cases would have at least 10 years of follow-up and would be H pylori–negative at follow-up. As Drs Guo, Spaander, and Fuhler point out, no intestinal metaplasia was detected in this group. This may have been due to successful eradication therapy, but also likely reflects sampling error in a small cohort (n = 10). Thus, we were not able to determine whether ECL cell hyperplasia was a distinguishing feature between AIG and cases of H pylori infection with intestinal metaplasia or extensive atrophy. The authors specifically chose cases that showed atrophy or intestinal metaplasia and arrived at the conclusion that ECL cell hyperplasia is equally reliable in this setting.
In summary, the findings of Guo et al are in agreement with our recent work and further clarify the diagnostic features of AIG in various settings. These findings are clinically important, particularly in light of recent clinical surveillance guidelines.4
The author has no relevant financial interest in the products or companies described in this article.