Reply to Lenti et al.

We would like to thank the insightful comments by Professor Lenti et al. regarding our recent paper [11]. In our study, we applied internationally recognized criteria to establish autoimmune gastritis (AIG) diagnosis, with clinical, serological, and histopathological confirmation [22] [33] [44]. Given the study’s proof-of-concept nature, we selected cases of “pure” AIG (seropositive and Helicobacter pylori-naïve) to make a differential diagnosis from H. pylori-associated atrophic gastritis (HpAG) and nonatrophic gastritis (NAG).

The primary aim of our study was to develop an artificial intelligence (AI)-assisted system to facilitate diagnosis of AIG during endoscopy and to construct a generalized system capable of classifying different types of gastritis (AIG, HpAG, and NAG). Our AI system demonstrated expert-level visual diagnostic abilities, effectively predicting histology-based diagnosis and showing potential to guide biopsy sampling. We have high regard for the recent studies on the natural history of AIG, which provide valuable clinical insights and descriptions of special types of AIG (i.e. seronegative AIG) [55] [66]. However, owing to retrospective design limitations and cross-center variability, subgroup analysis regarding histopathological staging was not conducted in our study. Nonetheless, we recognize this as a compelling area for future exploration.

Additionally, we agree with the significance of detecting early-stage AIG, which may show no obvious endoscopic signs. To address this, further prospective studies applying AI in real-time endoscopic procedures are needed to validate the feasibility of our AI-assisted system in real-world settings, and to corroborate and expand upon our proof-of-concept findings, with particular attention to early phases of AIG. We look forward to sharing our findings from future studies.

Publikationsverlauf

Artikel online veröffentlicht:
25. März 2025

• References

• 1 Chen S, Xu L, Yan L. et al. A novel endoscopic artificial intelligence system to assist in the diagnosis of autoimmune gastritis: a multicenter study. Endoscopy 2024;
• 2 Lenti MV, Rugge M, Lahner E. et al. Autoimmune gastritis. Nat Rev Dis Primers 2020; 6: 56
• 3 Lahner E, Zagari RM, Zullo A. et al. Chronic atrophic gastritis: natural history, diagnosis and therapeutic management. A position paper by the Italian Society of Hospital Gastroenterologists and Digestive Endoscopists [AIGO], the Italian Society of Digestive Endoscopy [SIED], the Italian Society of Gastroenterology [SIGE], and the Italian Society of Internal Medicine [SIMI]. Dig Liver Dis 2019; 51: 1621-1632
• 4 Rugge M, Bricca L, Guzzinati S. et al. Autoimmune gastritis: long-term natural history in naïve Helicobacter pylori-negative patients. Gut 2023; 72: 30-38
• 5 Miceli E, Lenti MV, Gentile A. et al. Long-term natural history of autoimmune gastritis: results from a prospective monocentric series. Am J Gastroenterol 2024; 119: 837-845
• 6 Lenti MV, Miceli E, Lahner E. et al. Distinguishing features of autoimmune gastritis depending on previous H. pylori infection or positivity to anti-parietal cell antibodies: results from the Autoimmune gastRitis Italian netwOrk Study grOup (ARIOSO). Am J Gastroenterol 2024;