Eloise Kok

Background: Atrophic gastritis—the end stage of chronic gastritis—is an asymptomatic disease due to Helicobacter pylori infection causing decreased vitamin B12 and folate absorption, which may lead to severe haematological and neuropsychological disorders including Alzheimer’s disease. The diagnosis requires endoscopy and biopsies from symptomatic patients, explaining why its true prevalence in the population is not well-known. Objective: We aimed to evaluate the prevalence of various stages of chronic gastritis in an autopsy series most closely representing the general population. Subjects and Methods: Gastric mucosa samples were collected prospectively from out-of-hospital deaths included in the Tampere Sudden Death Study (n = 70, mean age 63, age range 22–91 years). Antrum and corpus samples were stained with a H. pylori antibody and staged histopathologically. Results: Chronic gastritis with or without atrophic changes was detected in 40% of the cases. The proportion of healthy mucosa decreased age-dependently from 71.4% among individuals aged 70 years), and that of chronic non-atrophic gastritis from 21.4% to 8.7%. In contrast, the prevalence of atrophic gastritis was 27.1% and increased in the age groups from 7.1% to 47.8% (P = .019) among the oldest individuals, showing a strong association (P < .0001) with H. pylori immunopositivity. Conclusions: Atrophic gastritis is a common feature of the ageing stomach, which is observed in every second individual aged 70+ years, showing a strong association with H. pylori immunopositivity. Atrophic gastritis may be a more common risk factor in old age for diseases associated with low serum B12 and folate levels than has been previously known.

Background: When treatments against neurodegenerative diseases eventuate, the most successful time point to administer therapies will be the early stages, most likely before symptoms begin to show. Previous studies have found alpha‐synuclein pathology (Lewy‐related pathology; LRP) in asymptomatic individuals aged 62 years and above, with ranges from 8 to 17%.Method: We performed immunohistochemical staining with the 5G4 antibody against alpha‐synuclein on brain tissue samples from the Tampere Sudden Death Study – a collection of forensic autopsies on individuals that lived outside hospital institutions in Tampere and the surrounding regions, Finland. Representative paraffin‐embedded tissue regions of brainstem (substantia nigra/pons) were available from 562 cases, ranging in age from 16 to 95 years, with a majority of men (74% vs 145 women). Hippocampal regions were available in 476 cases (87% of those with brainstem available). (Kok et al. 2024)Result: Alpha‐synuclein pathology was seen in 46 individuals with varying severity. Of the 46 cases positive for alpha‐synuclein pathology, the youngest (42y female) had clinical records of parkinsonism and neuropathologically determined as multiple system atrophy (MSA). An additional 3 cases also showed MSA‐type glial cytoplasmic inclusions, without clinical history. 42 subjects showed Lewy‐related pathology (LRP) in the brainstem. The youngest case with LRP was 54 years with no reported neurodegenerative issues (see Figure). One positive brainstem case was missing the hippocampal region, but otherwise 25 (61%) also had LRP in hippocampal regions. Surprisingly, 9% of those aged 50 years or older had LRP, with a clear preference for males (31 vs 11 females) and increasing incidence with age.Conclusion: This is the first investigation of a non‐hospitalised population across the adult life span showing the prevalence of LRP in individuals aged as young as their 50’s, suggesting LRP starts much earlier than previously thought and is more common than expected in middle age. The present study has the strength of a large number of younger cases, although may over represent drug abuse and psychiatric issue patients, as well as the obviously higher number of males.