HIGH-RISK GASTRIC PATHOLOGY AND PREVALENT AUTOIMMUNE DISEASES IN PATIENTS WITH PERNICIOUS ANEMIA.
Endocr Pract. 2017 Nov;23(11):1297-1303
Authors: Hughes JW, Muegge BD, Tobin GS, Litvin M, Solar L, Saenz JB, Gyawali CP, McGill JB
OBJECTIVE: Pernicious anemia (PA) develops from atrophic gastritis as a consequence of autoimmune destruction of parietal cells and leads to achlorhydria, vitamin B12 and iron deficiencies, anemia, neurologic deficits, and premalignant and malignant abdomen lesions. We report the presentation, analysis and gastric issues of PA in sufferers from an endocrinology apply.
METHODS: Thirty-four sufferers (31 feminine, three male) with PA who underwent esophagogastroduodenoscopy (EGD) or gastrectomy have been recognized. Pertinent medical, laboratory, and pathology findings have been reviewed and summarized.
RESULTS: The imply age of sufferers was 58.6 ± 14.2 years; the onset of PA was age 50.2 ± 15.three years. Anemia mirrored vitamin B12 and/or iron deficiencies. Parietal cell antibodies (PCA) have been detected in 97% of sufferers, and intrinsic issue blocking antibody (IFBA) was present in 52%. Fasting gastrin and chromogranin A ranges have been elevated (1,518.zero ± 1,588.three pg/mL, and 504.9.1 ± 1,524.9 ng/mL respectively). Autoimmune or immunologic illnesses (AIDs) have been current in 32/34 sufferers. Abdomen pathology confirmed premalignant or malignant lesions in 26 sufferers, together with gastric neuroendocrine tumors (GNETs) in 6 and adenocarcinoma in 1. One affected person introduced with neurologic signs and subacute mixed degeneration of the posterior column of the spinal wire.
CONCLUSION: PA must be suspected in sufferers with unexplained anemia or neurologic signs. The analysis of PA depends on fasting gastrin and gastric auto-antibody testing, along with hematologic analysis. EGD with measurement of gastric pH and biopsies of the fundus and antrum identifies sufferers with achlorhydria, atrophic gastritis, and premalignant and malignant abdomen lesions. EGD surveillance of sufferers with high-risk abdomen lesions is really useful.
ABBREVIATIONS: AID = autoimmune or immunologic illness; EGD = esophagogastroduodenoscopy; GNET = gastric neuroendocrine tumor; IFBA = intrinsic issue blocking antibody; PA = pernicious anemia; PCA = parietal cell antibody; T1D = sort 1 diabetes.
PMID: 29190137 [PubMed – indexed for MEDLINE]