Gender-sex differences in autoimmune atrophic gastritis

Gender-sex differences in autoimmune diseases are gaining increasing attention due to their effects on prevalence and clinical features. Data on gender-sex differences in autoimmune atrophic gastritis (AAG), a chronic not-self-limiting inflamma-tory condition characterized by corpus-oxyntic mucosa atrophy sparing the antrum, are lacking. This study aimed to assess possible gender-sex differences of clinical, serological, histological, and genetic features in AAG patients. Cross-sec-tional study on 435 patients with histological-AAG, stratified according to female-male gender. In subsets of patients, serum gastric-autoantibodies against intrinsic-factor (IFA) and parietal-cells (PCA) by luminescent-immunoprecipitation-system (LIPS) (n = 81) and of HLA-DRB1-genotyping (n = 89) were available and stratified according to sex. Female AAG-patients were preponderant: 69.2% vs 30.8%, P < 0.0001(ratio 2.2:1). Females were more frequently PCA and/or IFA-positive than males (90.9%vs 73.1%, P = 0.0361). HLA-DRB1*06-alleles were significantly more frequent in females (30%vs4%, P = 0.01, OR 10.1(95%CI 1.3-80.4); HLA-DRB1*04-alleles were more frequent and HLA-DRB1*03 and *05-alleles less frequent in females without reaching statistical significance. At logistic regression, iron-deficiency-anemia (OR 3.6(95%CI 1.9-7.0)), body-mass-index < 25m(2)/kg (OR 3.1(95%CI 1.7-5.6)), autoimmune-thyroid-disease (OR 2.5(95%CI 1.4-4.5), and dyspepsia (OR 2.4(95%CI 1.4-4.3) were significantly associated to females. Body-mass-index > 25m(2)/kg (OR 3.2(95%CI1.8-5.6)), absence of autoimmune-thyroid-disease (OR 2.3(95%CI 1.3-4.2)) and dyspepsia (OR 2.1(95%CI 1.2-3.7)), smoking habit (OR 1.8(95% CI 1.1-3.1)), and pernicious-anemia (OR 1.7(95%CI 1.0-3.0)), were significantly associated to males. AAG was preponder-ant in women who showed stronger autoimmune serological responsiveness and differ-ent HLA-DRB1 association. AAG showed differential clinical profiles in female and male patients occurring mainly in normal weight, dyspeptic women with iron-deficiency anemia and autoimmune thyroid disease, but in overweight male smokers with pernicious anemia. Stratification for sex and gender should be considered in future genetic,immunological, and clinical studies on autoimmune atrophic gastritis.

Automated summary

Gender-sex differences in autoimmune atrophic gastritis (AAG) show that females are predominant in AAG cases, with higher rates of positivity for specific antibodies and genetic markers compared to males. Clinical profiles differ between male and female patients, with distinct associations to specific risk factors. Gender and sex stratification should be considered in future studies on AAG.