Assessment of comorbidity and structure of thyroid gland in patients with chronic metaplastic atrophic gastritis: review and own research

Abstract

Background. Comorbidity remains a challenge for researchers. The frequency of comorbid diseases and the role of the thyroid gland (TG) in the etiopathogenesis in patients with metaplastic atrophic gastritis (MAG) are not finally determined. The purpose of the study was to assess comorbidity and thyroid structural changes in patients with MAG and to investigate the literature data on this problem. Materials and methods. The study enrolled 41 patients with MAG, among whom 29 women and 12 men. The patients’ age was (60.1 ± 2.4) years. They underwent gastroscopy with narrow-band imaging and gastric biopsy, an ultrasound examination of the thyroid gland. Comorbidity was studied using a questionnaire (Сumulative Illness Rating Scale, CIRS) and patients’ medical histories. Results. 82.9 % of patients with MAG had ultrasound diffuse thyroid chan­ges, which are firstly revealed in 48.8 % of them; 37.8% of observed patients had ultrasound thyroid diffuse changes combined with TG nodules. Besides, 9.8 % of patients had ultrasonic signs of Hashimoto’s disease (Hashimoto’s thyroiditis). 97.6 % of patients with MAG had polymorbidity, which was observed in 3 or more systems in 92.7 % of patients and in 2 systems in 4.9 %. Positive correlation (r = 0.412, p = 0.04) between patients’ age and CIRS score was established. According to CIRS data, the pathology of the upper and lower gastrointestinal tract was observed in 97.7 and 53.7 % of patients, respectively. Patients had comorbidity of the musculoskeletal and integumentary system (68.3 %), eyes, ears, throat, nose, and larynx (56.1 %), vascular system (56.1 %), heart diseases (51.2 %), and endocrine-metabolic patho­logy (34.1 %). Conclusions. 82.9 % of patients with MAG had ultrasound structural changes in the thyroid gland. Further research on autoimmune processes in the stomach and thyroid gland is needed to figure out a possible relationship between Hashimoto’s disease and autoimmune metaplastic atrophic gastritis, their pathogenesis, as well as the peculiarities of the course of these comorbid diseases. It is required to pay attention to MAG not only as of the disease, which can lead to stomach cancer development but also as a possible marker for comorbid thyroid pathology.