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High-Risk Gastric Pathology and Prevalent Autoimmune Diseases in Patients with Pernicious Anemia
- Source :
- Endocrine Practice. 23:1297-1303
- Publication Year :
- 2017
- Publisher :
- Elsevier BV, 2017.
-
Abstract
- 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.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.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.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.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.
- Subjects :
- Adult
Gastritis, Atrophic
Male
medicine.medical_specialty
Adolescent
Atrophic gastritis
Anemia
Endocrinology, Diabetes and Metabolism
medicine.medical_treatment
Achlorhydria
Gastroenterology
Autoimmune Diseases
Young Adult
03 medical and health sciences
0302 clinical medicine
Endocrinology
Gastrectomy
hemic and lymphatic diseases
Internal medicine
Anemia, Pernicious
Gastrins
Humans
Medicine
Endoscopy, Digestive System
Vitamin B12
Young adult
Aged
Retrospective Studies
pernicious anemia
Aged, 80 and over
business.industry
digestive, oral, and skin physiology
General Medicine
Middle Aged
medicine.disease
Gastric Mucosa
030220 oncology & carcinogenesis
Female
030211 gastroenterology & hepatology
Gastritis
medicine.symptom
business
Subjects
Details
- ISSN :
- 1530891X
- Volume :
- 23
- Database :
- OpenAIRE
- Journal :
- Endocrine Practice
- Accession number :
- edsair.doi.dedup.....14ba170ddb56ae483b3c2ad2307e6fbc