Atrophic gastritis in pernicious anemia: diagnosis by double-contrast radiography

A retrospective study was performed to determine whether the areae gastricae pattern in the stomach or other radiologic features could be used on double-contrast upper gastrointestinal examinations to accurately diagnose atrophic gastritis in pernicious anemia. The double-contrast studies from 21 patients with pernicious anemia and 55 age-matched controls were interspersed and reviewed blindly to assess gastric size, mucosal folds, and the areae gastricae pattern in the stomach. The best set of criteria for differentiating the pernicious anemia group from the controls included a fundal diameter of 8 cm or less, absent mucosal folds in the fundus or body, and small (i.e., 1-2 mm in size) or absent areae gastricae. This combination of findings was present in 81% of patients with pernicious anemia but it also was present in 11% of the controls, so that atrophic gastritis in pernicious anemia could not be reliably diagnosed on radiologic criteria. Nevertheless, patients with pernicious anemia invariably had small or absent areae gastricae in the stomach, so that the presence of prominent areae gastricae, particularly in the fundus, may be a useful criterion for excluding this disease.