Infertility and recurrent miscarriage in a patient with autoimmune atrophic gastritis

Excerpt

Autoimmune atrophic gastritis (AAG) is an organ-specific disease characterised by stomach corpus and fundus atrophy with subsequent hypo-achlorhydria, lack of intrinsic factor, and vitamin B₁₂ malabsorption, and may predispose to the development of type I neuroendocrine tumours and gastric adenocarcinoma [1]. Little is known regarding AAG pathogenesis and its natural history, but it is generally considered a slowly progressive condition. Patients suffering from AAG may be asymptomatic or may complain of vague and non-specific gastrointestinal and neurological symptoms, or they may just have a family or personal history of other autoimmune disorders (namely autoimmune thyropathy, Addison’s disease, vitiligo, and type I diabetes mellitus) [2]. Most of AAG manifestations and complications are due to vitamin B₁₂ deficiency that may be clinically silent for many years. Vitamin B₁₂ deficiency has been associated with infertility, very early recurrent miscarriage, failure of assisted reproductive technologies, pregnancy complications, and neural tube defects in the newborn [3‐6]. Disappointingly, the studies published so far focused on vitamin B₁₂ deficiency as a consequence of malnutrition rather than of malabsorption, and AAG has never been ascribed as a possible concern for women of childbearing potential. There are no available data regarding pregnancy outcomes in patients with AAG. We here describe, for the first time, the case of a 37-year-old woman in whom a longstanding history of infertility and recurrent miscarriage were attributed to AAG. …