«Glomus-like lesions» of the gastric fundic type mucosa — a novel endoscopic sign of autoimmune atrophic gastritis

Objective. To assess the diagnostic value of a novel endoscopic feature — glomus-like lesions (GLL) of the gastric mucosa in the fundus and body — for the detection of autoimmune atrophic gastritis (AIG). Material and methods. The study included 111 patients with chronic atrophic gastritis (29 men and 82 women; mean age 57.7±10.6 years). AIG was diagnosed in 57 patients, while 54 patients had Helicobacter pylori — associated chronic multifocal atrophic gastritis (MAG). All patients underwent upper gastrointestinal endoscopy using standard white-light imaging, followed by magnified evaluation using optical image-enhancement techniques (NBI, BLI, or i-scan OE). Histological verification included targeted forceps biopsies or endoscopic mucosal resection from areas with GLL, as well as random biopsies from the antrum and corpus. Results. GLL were identified in 44 (77.2%) patients with AIG and in all patients with neuroendocrine tumors (NETs), whereas none of the 54 patients with MAG exhibited this feature (p=0.0001). Histological analysis of GLL-positive areas consistently revealed fundic gland atrophy, enterochromaffin-like (ECL) cell hyperplasia, and foveolar epithelial retention cysts. The sensitivity, specificity, and overall accuracy of GLL for diagnosing AIG were 0.77, 1.00, and 0.88, respectively. The positive and negative predictive values were 1.00 and 0.81. Conclusion. This study presents the first detailed description of glomus-like lesions as a novel endoscopic marker of AIG. GLL represent a highly specific feature of AIG, correlate with its characteristic histopathological changes, and may facilitate earlier identification of NETs in this patient population.