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Atrophic glossitis (AG) is characterized by the partial or complete absence of filiform papillae on the dorsal surface of the tongue. AG may reflect the significant deficiencies of some major nutrients including riboflavin, niacin, pyridoxine, vitamin B12, folic acid, iron, zinc, and vitamin E. Moreover, protein-calorie malnutrition, candidiasis, Helicobacter pylori colonization, xerostomia, and diabetes mellitus are also the etiologies of AG. Our previous study found the serum gastric parietal cell antibody (GPCA), thyroglobulin antibody (TGA), and thyroid microsomal antibody (TMA) positivities in 26.7%, 28.4%, and 29.8% of 1064 AG patients, respectively. We also found anemia, serum iron, vitamin B12, and folic acid deficiencies, and hyperhomocysteinemia in 19.0%, 16.9%, 5.3%, 2.3%, and 11.9% of 1064 AG patients, respectively. Moreover, GPCA-positive AG patients tended to have relatively higher frequencies of hemoglobin, iron, and vitamin B12 deficiencies and hyperhomocysteinemia than GPCA-negative AG patients. Supplementations with vitamin BC capsules plus corresponding deficient hematinics for those AG patients with hematinic deficiencies can achieve complete remission of oral symptoms and AG in some AG patients. Therefore, it is very important to examine the complete blood count, serum hematinic, homocysteine, and autoantibody levels in AG patients before we start to offer treatments for AG patients., (Copyright © 2019 Formosan Medical Association. Published by Elsevier B.V. All rights reserved.)

Background/purpose: Our previous study found that 127 of 1064 atrophic glossitis (AG) patients have hyperhomocysteinemia. This study assessed whether the AG patients with hyperhomocysteinemia had significantly higher frequencies of anemia, hematinic deficiencies, and serum gastric parietal cell antibody (GPCA) positivity than AG patients without hyperhomocysteinemia or healthy control subjects., Methods: The blood hemoglobin (Hb) and serum iron, vitamin B12, folic acid, homocysteine, and GPCA levels in 127 AG patients with hyperhomocysteinemia, 937 AG patients without hyperhomocysteinemia, and 532 healthy control subjects were measured and compared., Results: We found that 127 AG patients with hyperhomocysteinemia had significantly higher frequencies of blood Hb and serum iron, vitamin B12, and folic acid deficiencies and serum GPCA positivity than 532 healthy control subjects (all P-values < 0.001) and significantly higher frequencies of blood Hb and serum vitamin B12 and folic acid deficiencies and serum GPCA positivity than 937 AG patients without hyperhomocysteinemia (all P-values < 0.001). Moreover, 127 AG patients with hyperhomocysteinemia had significantly higher frequencies of macrocytic anemia and significantly lower frequencies of normocytic anemia than 937 AG patients without hyperhomocysteinemia (both P-values < 0.001). Pernicious anemia (22 cases) was found only in AG patients with hyperhomocysteinemia but not in AG patients without hyperhomocysteinemia., Conclusion: AG patients with hyperhomocysteinemia had significantly higher frequencies of anemia, serum iron, vitamin B12, and folic acid deficiencies, and serum GPCA positivity than healthy control subjects and significantly higher frequencies of anemia, serum vitamin B12 and folic acid deficiencies, and serum GPCA positivity than AG patients without hyperhomocysteinemia., (Copyright © 2019 Formosan Medical Association. Published by Elsevier B.V. All rights reserved.)

Background/purpose: Microcytosis is defined as having mean corpuscular volume (MCV) < 80 fL. This study evaluated whether 79 atrophic glossitis (AG) patients with microcytosis and 985 AG patient without microcytosis had higher frequencies of anemia, hematinic deficiencies, hyperhomocysteinemia, and serum gastric parietal cell antibody (GPCA) positivity than 532 healthy control subjects., Methods: Complete blood count, serum iron, vitamin B12, folic acid, homocysteine, and serum GPCA levels in 79 AG patients with microcytosis, 985 AG patient without microcytosis, and 532 healthy control subjects were measured and compared., Results: We found that 69.6%, 43.0%, 5.1%, 3.8%, 11.4%, and 22.8% of 79 AG patients with microcytosis and 14.9%, 14.8%, 5.3%, 2.1%, 12.0%, and 27.0% of 985 AG patients without microcytosis were diagnosed as having blood hemoglobin, iron, vitamin B12, and folic acid deficiencies, hyperhomocysteinemia, and serum GPCA positivity, respectively. Both 79 AG patients with microcytosis and 985 AG patients without microcytosis had significantly higher frequencies of blood hemoglobin, iron, vitamin B12, and folic acid deficiencies, hyperhomocysteinemia, and serum GPCA positivity than 532 healthy control subjects (all P-values < 0.01). Moreover, 79 AG patients with microcytosis had significantly higher frequencies of blood hemoglobin and iron deficiencies than 985 AG patients without microcytosis., Conclusion: There are significantly higher frequencies of anemia, serum iron, vitamin B12, and folic acid deficiencies, hyperhomocysteinemia, and serum GPCA positivity in AG patients with or without microcytosis than in healthy control subjects. AG patients with microcytosis have significantly higher frequencies of blood hemoglobin and iron deficiencies than AG patients without microcytosis., (Copyright © 2019. Published by Elsevier B.V.)

Background/purpose: Our previous study found that 304 of 1064 atrophic glossitis (AG) patients have thyroglobulin antibody (TGA) positivity and/or thyroid microsomal antibody (TMA) positivity but without gastric parietal cell antibody positivity (GPCA־TGA + /TMA + AG patients). This study mainly assessed whether the serum TGA/TMA positivity was significantly associated with anemia, hematinic deficiencies, and hyperhomocysteinemia in GPCA־TGA + /TMA + AG patients., Methods: The mean blood hemoglobin (Hb), iron, vitamin B12, folic acid, and homocysteine levels were measured and compared between 304 GPCA־TGA + /TMA + AG patients and 476 GPCA-negative, TGA-negative, and TMA-negative AG patients (GPCA־TGA־TMA־AG patients) or 532 healthy control subjects., Results: We found significantly lower MCV and lower mean blood Hb and iron levels as well as significantly greater frquencies of microcytosis, macrocytosis, blood Hb, iron, vitamin B12, and folic acid deficiencies and hyperhomocysteinemia in 304 GPCA־TGA + /TMA + AG patients than in 532 healthy control subjects. However, no significant differences in the MCV and mean blood Hb, iron, vitamin B12, folic acid, and homocysteine leve1s as well as no significant differences in the frequencies of microcytosis, macrocytosis, blood Hb, iron, and folic acid deficiencies, and hyperhomocysteinemia were discovered between 304 GPCA־TGA + /TMA + AG patients and 476 GPCA־TGA־TMA־AG patients. The 304 GPCA־TGA + /TMA + AG patients had a significantly greater frquency of serum vitamin B12 deficiency than 476 GPCA־TGA־TMA־AG patients., Conclusion: The disease of AG itself plays a significant role in causing anemia, hematinic deficiencies, and hyperhomocysteinemia in GPCA־TGA + /TMA + AG patients. However, the serum TGA/TMA-positivity is not significantly associated with anemia, serum iron and folic acid deficiencies, and hyperhomocysteinemia in GPCA־TGA + /TMA + AG patients., (Copyright © 2019 Formosan Medical Association. Published by Elsevier B.V. All rights reserved.)

Background/purpose: Our previous study found that 177 of 1064 atrophic glossitis (AG) patients have serum gastric parietal cell antibody (GPCA) positivity only (so-called GPCA + AG patients). This study assessed whether serum GPCA positivity or AG itself was a significant factor causing hematinic deficiencies and hyperhomocysteinemia in GPCA + AG or GPCA-negative, thyroglobulin antibody (TGA)-negative, and thyroid microsomal antibody (TMA)-negative AG (GPCA־TGA־TMA־AG) patients., Methods: The mean blood hemoglobin (Hb), iron, vitamin B12, folic acid, and homocysteine levels were measured and compared between any two of three groups of 177 GPCA + AG patients, 476 GPCA־TGA־TMA־AG patients, and 532 healthy control subjects., Results: GPCA + AG patients had significantly lower mean blood Hb and iron (for women only) levels and a significantly higher mean serum homocysteine level than healthy control subjects. Moreover, GPCA + AG patients had significantly greater frequencies of blood Hb, iron, and vitamin B12 deficiencies and hyperhomocysteinemia than healthy control subjects. GPCA + AG patients have a lower mean serum vitamin B12 level and a significantly higher mean serum homocysteine level as well as significantly greater frequencies of vitamin B12 deficiency and hyperhomocysteinemia than GPCA־TGA־TMA־AG patients. Moreover, GPCA־TGA־TMA־AG patients did have significantly lower mean blood Hb and iron levels and significantly greater frequencies of blood Hb, iron, vitamin B12, and folic acid deficiencies and hyperhomocysteinemia than healthy control subjects., Conclusion: The GPCA is a major factor causing vitamin B12 deficiency and hyperhomocyteinemia in GPCA + AG patients. AG itself does play a significant role in causing anemia, hematinic deficiencies, and hyperhomocysteinemia in both GPCA + AG and GPCA־TGA־TMA־AG patients., (Copyright © 2019. Published by Elsevier B.V.)

Background/purpose: Gastric parietal cell antibody (GPCA), thyroglobulin antibody (TGA), and thyroid microsomal antibody (TMA) are organ-specific autoantibodies. This study mainly assessed the frequencies of presence of serum GPCA, TGA, and TMA in atrophic glossitis (AG) patients., Methods: Serum GPCA, TGA, and TMA levels were measured in 1064 AG patients and in 532 age- and sex-matched healthy control subjects., Results: We found that 26.7%, 28.4%, and 29.8% of 1064 AG patients and 2.3%, 2.1%, and 2.6% of 532 healthy control subjects had the serum GPCA, TGA, and TMA positivities, respectively. AG patients had a significantly higher frequency of GPCA, TGA, or TMA positivity than healthy control subjects (all P-values < 0.001). We also found that 67 (6.3%), 181 (17.0%), and 340 (32.0%) AG patients and 3 (0.6%), 10 (1.9%), and 8 (1.5%) healthy control subjects had the presence of three (GPCA + TGA + TMA), two (GPCA + TGA, GPCA + TMA, or TGA + TMA), or one (GPCA only, TGA only, or TMA only) organ-specific autoantibody in their sera, respectively. Of 373 TGA/TMA-positive AG patients whose serum thyroid-stimulating hormone (TSH) levels were measured, 78.6%, 8.0%, and 13.4% of these TGA/TMA-positive AG patients had normal, lower, and higher serum TSH levels, respectively., Conclusion: Approximately 55.3% of 1064 AG patients have serum GPCA/TGA/TMA positivity. Because part of GPCA-positive AG patients may develop pernicious anemia, autoimmune atrophic gastritis, and gastric carcinoma, and part of TGA/TMA-positive AG patients may have thyroid dysfunction such as hyperthyroidism and hypothyroidism, these autoantibody-positive AG patients should be referred to medical doctors for further management., (Copyright © 2019 Formosan Medical Association. Published by Elsevier B.V. All rights reserved.)

Background/purpose: Approximately 27% of atrophic glossitis (AG) patients have the serum gastric parietal cell antibody (GPCA) positivity. This study assessed whether the serum GPCA or AG itself was a significant factor causing anemia, hematinic deficiencies, and hyperhomocysteinemia in GPCA-positive AG (GPCA + AG) and GPCA-negative AG (GPCA - AG) patients., Methods: The mean corpuscular volume (MCV) and mean blood hemoglobin (Hb), iron, vitamin B12, folic acid, and homocysteine levels were measured and compared between any two of three groups of 284 GPCA + AG, 780 GPCA - AG patients, and 532 healthy control subjects., Results: Both 284 GPCA + AG and 780 GPCA - AG patients had significantly higher frequencies of microcytosis, macrocytosis, blood Hb, iron, vitamin B12, and folic acid deficiencies, and hyperhomocysteinemia than 532 healthy control subjects. Moreover, 284 GPCA + AG patients had significantly higher frequencies of macrocytosis, vitamin B12 deficiency, and hyperhomocysteinemia than 780 GPCA - AG patients. Sixty-three (22.2%) of 284 GPCA + AG patients and 139 (17.8%) of 780 GPCA - AG patients had anemia. The normocytic anemia (42.9%), pernicious anemia (34.9%), and iron deficiency anemia (15.9%) were the three most common types of anemia in the 63 anemic GPCA + AG patients. Moreover, the normocytic anemia (64.8%), iron deficiency anemia (14.4%), and thalassemia trait-induced anemia (13.7%) were the three most common types of anemia in 139 anemic GPCA - AG patients., Conclusion: The disease of AG itself is a significant factor causing anemia, hematinic deficiencies, and hyperhomocysteinemia in both GPCA + AG and GPCA - AG patients. The serum GPCA also plays a significant role in causing macrocytosis, vitamin B12 deficiency, and hyperhomocysteinemia in GPCA + AG patients., (Copyright © 2018 Formosan Medical Association. Published by Elsevier B.V. All rights reserved.)

Background/purpose: Atrophic glossitis (AG) patients are prone to have anemia, hematinic deficiencies, hyperhomocysteinemia, and serum gastric parietal cell antibody (GPCA) positivity. This study evaluated whether 1064 AG patients had significantly higher frequencies of anemia, hematinic deficiencies, hyperhomocysteinemia, and serum GPCA positivity than 532 healthy control subjects., Methods: The complete blood count, serum iron, vitamin B12, folic acid, homocysteine, and serum GPCA levels in 1064 AG patients and 532 age- and sex-matched healthy control subjects were measured and compared., Results: We found that 7.4%, 3.9%, 19.0%, 16.9%, 5.3%, 2.3%, 11.9%, and 26.7% of 1064 AG patients were diagnosed as having microcytosis, macrocytosis, hemoglobin, iron, vitamin B12, and folic acid deficiencies, hyperhomocysteinemia, and serum GPCA positivity, respectively. Moreover, 1064 AG patients had significantly higher frequencies of microcytosis, macrocytosis, hemoglobin, iron, vitamin B12, and folic acid deficiencies, hyperhomocysteinemia, and serum GPCA positivity than 532 healthy control subjects (all P-values < 0.005). Of the 202 anemic AG patients, 22 had pernicious anemia, eight had macrocytic anemia rather than pernicious anemia, 117 had normocytic anemia, 30 had iron deficiency anemia, and 21 had thalassemia trait-induced anemia, and four had microcytic anemia rather than iron deficiency anemia and thalassemia trait-induced anemia., Conclusion: There are significantly higher frequencies of anemia, serum iron, vitamin B12, and folic acid deficiencies, hyperhomocysteinemia, and serum GPCA positivity in AG patients than in healthy control subjects. The normocytic anemia and iron deficiency anemia are the two most common types of anemia in our 1064 AG patients., (Copyright © 2018. Published by Elsevier B.V.)

Background/purpose: Patients with serum antigastric parietal cell antibody (GPCA) positivity may have vitamin B12 deficiency and some oral symptoms. This study assessed the changes of serum GPCA titer in GPCA-positive patients after effective vitamin B12 treatment., Methods: Two hundred and ten GPCA-positive oral mucosal disease patients became oral symptom free (complete response) after 1.0-67.1 months of treatment with regular and continuous intramuscular injection of vitamin B12 once per week. The changes of serum GPCA titers after treatment were evaluated in these 210 patients., Results: We found a significant drop of the GPCA positive rate from 100% to 42.9% in our 210 complete response patients after effective vitamin B12 treatment (p < 0.001). When 210 patients were further divided into seven subgroups according to the low to high serum GPCA titers, we noted that the higher serum GPCA titers decreased to significantly lower levels after treatment in all seven subgroups (all p < 0.001). However, serum GPCA titers increased to significantly higher levels in 46 GPCA-positive control patients receiving only oral administration of two vitamin BC capsules (containing 10 μg of vitamin B12) plus deficient hematinic supplements per day after a follow-up period of 2.7-27 months. A maintenance vitamin B12 treatment once a month could retain the GPCA-negative status in 87% of treated-to GPCA-negative patients compared with those (10%) without further maintenance vitamin B12 treatment., Conclusion: Regular and continuous effective vitamin B12 treatment can reduce the relatively higher serum GPCA titers to significantly lower or undetectable levels in GPCA-positive patients., (Copyright © 2016. Published by Elsevier B.V.)

Background: Atrophic glossitis (AG) is considered to be a marker of nutritional deficiency. In this study, we evaluated whether there was an intimate association of the deficiency of hemoglobin, iron, vitamin B12 or folic acid, high blood homocysteine level, and serum gastric parietal cell antibody (GPCA) positivity with AG., Methods: The blood hemoglobin, iron, vitamin B12, folic acid, and homocysteine concentrations and the serum GPCA level in 176 AG patients were measured and compared with the corresponding levels in 176 age- and sex-matched healthy control subjects., Results: We found that 39 (22.2%), 47 (26.7%), 13 (7.4%), and 3 (1.7%) AG patients had deficiencies of Hb (men < 13 g/dl, women < 12 g/dl), iron (<60 μg/dl), vitamin B12 (<200 pg/ml), and folic acid (<4 ng/ml), respectively. Moreover, 38 (21.6%) AG patients had abnormally high blood homocysteine level, and 47 (26.7%) AG patients had serum GPCA positivity. AG patients had a significantly higher frequency of Hb, iron, or vitamin B12 deficiency, of abnormally elevated blood homocysteine level, or of serum GPCA positivity than healthy control subjects (all P-values = 0.000). However, no significant difference in frequency of folic acid deficiency was found between AG patients and healthy control subjects., Conclusion: We conclude that there is a significant association of deficiency of hemoglobin, iron and vitamin B12, abnormally high blood homocysteine level, and serum GPCA positivity with AG., (© 2011 John Wiley & Sons A/S.)