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HIGH-RISK GASTRIC PATHOLOGY AND PREVALENT AUTOIMMUNE DISEASES IN PATIENTS WITH PERNICIOUS ANEMIA
Insights
Pernicious anemia (PA) is linked to autoimmune gastritis and can cause vitamin B12 deficiency and stomach issues. Early diagnosis via antibody testing and endoscopy is crucial for managing PA and its gastric complications.
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.
Objective:
Pernicious anemia (PA) develops from atrophic gastritis due to autoimmune destruction of parietal cells and results in achlorhydria, vitamin B12 and iron deficiencies, anemia, neurologic deficits, and premalignant and malignant stomach lesions. We report the presentation, diagnosis and gastric complications of PA in patients from an endocrinology practice.
Methods:
Thirty-four patients (31 female, 3 male) with PA who underwent esophagogastroduodenoscopy (EGD) or gastrectomy were identified. Pertinent clinical, laboratory, and pathology findings were reviewed and summarized.
Results:
The mean age of patients was 58.6 ± 14.2 years; the onset of PA was age 50.2 ± 15.3 years. Anemia reflected vitamin B12 and/or iron deficiencies. Parietal cell antibodies (PCA) were detected in 97% of patients, and intrinsic factor blocking antibody (IFBA) was found in 52%. Fasting gastrin and chromogranin A levels were elevated (1,518.0 ± 1,588.3 pg/mL, and 504.9.1 ± 1,524.9 ng/mL respectively). Autoimmune or immunologic diseases (AIDs) were present in 32/34 patients. Stomach pathology showed premalignant or malignant lesions in 26 patients, including gastric neuroendocrine tumors (GNETs) in 6 and adenocarcinoma in 1. One patient presented with neurologic symptoms and subacute combined degeneration of the posterior column of the spinal cord.
Conclusion:
PA should be suspected in patients with unexplained anemia or neurologic symptoms. The diagnosis of PA relies on fasting gastrin and gastric auto-antibody testing, in addition to hematologic evaluation. EGD with measurement of gastric pH and biopsies of the fundus and antrum identifies patients with achlorhydria, atrophic gastritis, and premalignant and malignant stomach lesions. EGD surveillance of patients with high-risk stomach lesions is recommended.
Abbreviations:
AID = autoimmune or immunologic disease; EGD = esophagogastroduodenoscopy; GNET = gastric neuroendocrine tumor; IFBA = intrinsic factor blocking antibody; PA = pernicious anemia; PCA = parietal cell antibody; T1D = type 1 diabetes.
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