HIGH-RISK GASTRIC PATHOLOGY AND PREVALENT AUTOIMMUNE DISEASES IN PATIENTS WITH PERNICIOUS ANEMIA

Area of Science:

• Gastroenterology
• Endocrinology
• Immunology

Background:

• Pernicious anemia (PA) results from autoimmune destruction of gastric parietal cells, leading to atrophic gastritis.
• This condition causes achlorhydria, vitamin B12 and iron deficiencies, anemia, neurological deficits, and increases the risk of gastric premalignant and malignant lesions.

Purpose of the Study:

• To report the clinical presentation, diagnostic findings, and gastric complications of pernicious anemia in patients managed within an endocrinology practice.

Main Methods:

• A retrospective review of 34 patients diagnosed with PA who underwent esophagogastroduodenoscopy (EGD) or gastrectomy.
• Analysis of clinical, laboratory, and histopathological data, including antibody testing, gastrin levels, and endoscopic findings.

Main Results:

• The average age of PA onset was 50.2 years, with anemia often reflecting vitamin B12 and/or iron deficiencies.
• High prevalence of positive parietal cell antibodies (97%) and intrinsic factor blocking antibodies (52%). Elevated fasting gastrin and chromogranin A levels were observed.
• Significant gastric pathology, including premalignant or malignant lesions (26/34 patients), gastric neuroendocrine tumors (6/34), and adenocarcinoma (1/34). Autoimmune or immunologic diseases were present in 32/34 patients.

Conclusions:

• PA diagnosis requires a combination of hematologic evaluation, fasting gastrin levels, and gastric auto-antibody testing.
• EGD with pH measurement and biopsies is essential for identifying atrophic gastritis and gastric lesions in PA patients.
• Regular endoscopic surveillance is recommended for patients with high-risk gastric lesions associated with PA.