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We present the case report of a 48-year-old male with no relevant past medical history, which presented with chronic fatigue and paresthesias; after a full medical evaluation he was diagnosed with megaloblastic anemia associated with vitamin B12 deficiency, sensitive polineuropathy and gastric atrophy. He was treated with vitamin B12, folic acid and erradication of H. pylori infection; after two months of treatment symptoms disappeared. Megaloblastic anemias are macrocytic anemias in which the progenitors of red cells from bone marrow have alterations of DNA synthesis. The most frequent cause of megaloblastic anemia is the lack of vitamin B12 and/or folic acid. Cobalamin or vitamin B12 is synthesized by intestinal bacteria, the major cause of vitamin B12 deficiency is pernicious anemia (PA), which is presented as the final stage of autoimmune atrophic gastritis; however, environmental chronic atrophic gastritis associated with H. pylori can cause deficit of vitamin B12 absorption and consequently lead to megaloblastic anemia. Chronic atrophic gastritis is considered by some authors a preneoplastic disease, as it has been demonstrated the evolution from gastric atrophy intestinal metaplasia to gastric dysplasia and consequently to adenocarcinoma in a small groupp of patients. Upper endoscopy with biopsy is essential to identify the presence and type of gastric atrophy, typical endoscopic findings are: the absence of gastric folds, pale mucosa and submucosal vessels display, these findings must be confirmed via histopathological study and then to determine the presence or absence of autoimmune gastritis with serological markers to have a proper following, diagnosis and treatment. [ABSTRACT FROM AUTHOR]