gastrins and Anemia--Megaloblastic

Topics: Anemia, Megaloblastic; Bile; Bile Ducts; Cholecystokinin; Defecation; Gallbladder; Gastric Juice; Gastric Mucosa; Gastrins; Gastrointestinal Motility; Humans; Insulin; Intestine, Small; Liver; Pancreas; Pentagastrin; Pepsin A; Secretin; Stomach; Vagotomy; Vagus Nerve

In a study of the pathogenesis and clinical features of megaloblastic anaemia in southern Africa, we evaluated 144 consecutive Zimbabwean patients with megaloblastic haemopoiesis. Vitamin B12 deficiency was diagnosed in 86.1% of patients and was usually due to pernicious anaemia; isolated folate deficiency accounted for only 5.5% of cases. Anaemia was present in 95.8% of patients; the haemoglobin (Hb) was < or = 6 g/dl in 63.9%. Neurological dysfunction was noted in 70.2% of vitamin B12-deficient patients and was most striking in those with Hb values > 6 g/dl. Serum levels of methylmalonic acid, homocysteine, or both, were increased in 98.5% of patients. Vitamin B12 deficiency is the primary cause of megaloblastic anaemia in Zimbabwe and, contrary to textbook statements, is often due to pernicious anaemia. Isolated folate deficiency is less common. As reported in industrialized countries 75 years ago, anaemia is almost always present and often severe. Neurological dysfunction due to vitamin B12 deficiency is most prominent in patients with mild to moderate anaemia.

Topics: Anemia, Megaloblastic; Anemia, Pernicious; Erythrocyte Indices; Female; Folic Acid; Folic Acid Deficiency; Gastrins; Hemoglobins; Homocysteine; Humans; Methylmalonic Acid; Nervous System Diseases; Neutrophils; Vitamin B 12 Deficiency; Zimbabwe

We examined causes and hematological consequences of low serum cobalamin (vitamin B12) concentration in two representative population samples of 70-year-old (N = 293) and 75-year-old subjects (N = 486). Subjects with values below 130 pmol/liter (4.8% and 5.6%, respectively) were investigated with Schilling test, upper gastrointestinal endoscopy, determination of serum gastrin and group I pepsinogens, and bone marrow examination. Gastrointestinal abnormalities of etiologic significance were found in 26 of the 32 examined subjects: atrophy of the gastric body mucosa (N = 16, with pernicious anemia in six), partial gastrectomy (N = 6), and intestinal malabsorption (N = 4). Megaloblastic hematopoiesis was found in 10 individuals, four of whom had macrocytic anemia. Our results indicate that low serum cobalamin concentration in the elderly is usually a consequence of disease rather than of high age per se and that gastric mucosal atrophy is a major etiologic factor.

Topics: Aged; Aging; Anemia, Macrocytic; Anemia, Megaloblastic; Anemia, Pernicious; Bone Marrow Examination; Digestive System; Endoscopy; Female; Gastrins; Gastrointestinal Diseases; Humans; Male; Pepsinogens; Schilling Test; Vitamin B 12

A middle-aged woman developed a postgastric bypass megaloblastic anemia which responded to treatment. She eventually had the bypass reversed 6 1/2 yr after it had been performed. Gastric parietal cell function has remained abnormal almost 3 yr after reversal of the bypass, as demonstrated by abnormal Schilling tests and high serum gastrin levels. Parietal cell antibodies in high titer, but no intrinsic factor antibodies, were demonstrated in her blood. These observations are interpreted as indicating the development of irreversible chronic atrophic gastritis probably related to reflux of bile into the bypassed stomach.

Topics: Adult; Anemia, Megaloblastic; Female; Gastric Acid; Gastrins; Humans; Intrinsic Factor; Parietal Cells, Gastric; Postoperative Complications; Stomach; Vitamin B 12 Deficiency

A total of 1 035 routine serum gastrin investigations was undertaken with a commercially available kit. Levels in 49 normal subjects were similar to those found in 200 patients with duodenal ulcertaion, in 42 patients with gastric ulcers, in 9 patients with carcinoma of the stomach, in 55 patients with chronic alcohol-induced pancreatitis, and in 27 with iron deficiency anaemia. Significantly raised levels of serum gastrin were found in 32 patients with megaloblastic anaemias, where the rise in serum gastrin concentration correlated with a fall in maximal acid output, and in 14 patients with complete vagotomies. It is suggested that a level of less than 2 mEq/h of acid after insulin and a raised serum gastrin level are useful criteria of completeness of vagotomy.

Topics: Adult; Anemia, Hypochromic; Anemia, Megaloblastic; Duodenal Ulcer; Female; Gastric Juice; Gastrins; Gastrointestinal Diseases; Humans; Male; Pancreatitis; Stomach Neoplasms; Stomach Ulcer; Vagotomy