vitamin-b-12 and Gastritis--Atrophic

Current guidelines recommend surveillance for gastric adenocarcinoma in patients with extensive chronic atrophic gastritis (CAG), which is considered a premalignant condition. Although the association between vitamin B12 deficiency and CAG is well described, the indication for endoscopic investigation is only advised in patients with pernicious anaemia. Our case did not have evidence of autoimmune or

Topics: Female; Gastritis, Atrophic; Gastroscopy; Helicobacter Infections; Humans; Vitamin B 12; Vitamin B 12 Deficiency

Pernicious Anemia (PA), the most common cause of cobalamin deficiency anemia worldwide, is an autoimmune disease of multifactorial etiologies involving complex environmental and immunological factors. Although it was first reported by Addison in 1849 with subsequent advances in understanding of pathogenesis and molecular biology, diagnosis of PA is still challenging for clinicians because of its complexity and diverse clinical presentations.. Herein, we provide an overview of PA, mainly focusing on its scientific and practical aspects in diagnosis. We also discuss the limitations of currently available diagnostic tools for the evaluation of cobalamin deficiency and PA.

Topics: Anemia, Pernicious; Autoantibodies; Gastritis, Atrophic; Humans; Vitamin B 12; Vitamin B 12 Deficiency

Atrophic gastritis (AG) results most often from Helicobacter pylori (H. pylori) infection. AG is the most important single risk condition for gastric cancer that often leads to an acid-free or hypochlorhydric stomach. In the present paper, we suggest a rationale for noninvasive screening of AG with stomach-specific biomarkers.. The paper summarizes a set of data on application of the biomarkers and describes how the test results could be interpreted in practice.. In AG of the gastric corpus and fundus, the plasma levels of pepsinogen I and/or the pepsinogen I/pepsinogen II ratio are always low. The fasting level of gastrin-17 is high in AG limited to the corpus and fundus, but low or non-elevated if the AG occurs in both antrum and corpus. A low fasting level of G-17 is a sign of antral AG or indicates high intragastric acidity. Differentiation between antral AG and high intragastric acidity can be done by assaying the plasma G-17 before and after protein stimulation, or before and after administration of the proton pump inhibitors (PPI). Amidated G-17 will rise if the antral mucosa is normal in structure. H. pylori antibodies are a reliable indicator of helicobacter infection, even in patients with AG and hypochlorhydria.. Stomach-specific biomarkers provide information about the stomach health and about the function of stomach mucosa and are a noninvasive tool for diagnosis and screening of AG and acid-free stomach.

Topics: Achlorhydria; Antibodies, Bacterial; Biomarkers; Gastric Mucosa; Gastrins; Gastritis, Atrophic; Helicobacter Infections; Helicobacter pylori; Humans; Mass Screening; Pepsinogen A; Pepsinogen C; Stomach Neoplasms; Vitamin B 12

Pernicious anemia (PA) is a macrocytic anemia that is caused by vitamin B(12) deficiency, as a result of intrinsic factor deficiency. PA is associated with atrophic body gastritis (ABG), whose diagnosis is based on histological confirmation of gastric body atrophy. Serological markers that suggest oxyntic mucosa damage are increased fasting gastrin and decreased pepsinogen I. Without performing Schilling's test, intrinsic factor deficiency may not be proven, and intrinsic factor and parietal cell antibodies are useful surrogate markers of PA, with 73% sensitivity and 100% specificity. PA is mainly considered a disease of the elderly, but younger patients represent about 15% of patients. PA patients may seek medical advice due to symptoms related to anemia, such as weakness and asthenia. Less commonly, the disease is suspected to be caused by dyspepsia. PA is frequently associated with autoimmune thyroid disease (40%) and other autoimmune disorders, such as diabetes mellitus (10%), as part of the autoimmune polyendocrine syndrome. PA is the end-stage of ABG. Long-standing Helicobacter pylori infection probably plays a role in many patients with PA, in whom the active infectious process has been gradually replaced by an autoimmune disease that terminates in a burned-out infection and the irreversible destruction of the gastric body mucosa. Human leucocyte antigen-DR genotypes suggest a role for genetic susceptibility in PA. PA patients should be managed by cobalamin replacement treatment and monitoring for onset of iron deficiency. Moreover, they should be advised about possible gastrointestinal long-term consequences, such as gastric cancer and carcinoids.

Topics: Anemia, Pernicious; Gastritis, Atrophic; Helicobacter Infections; Humans; Thyroiditis, Autoimmune; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin B Complex

Pernicious anemia and Vitamin B12 deficiency have a wide range of symptoms and are a common finding in the elderly. A 73 year old female is admitted to the hospital because of dyspnea, fatigue and loss of appetite and weight. While previous medical history and physical examination are inconspicuous, laboratory findings show severe pancytopenia with macrocytosis, low reticulocyte count and marked signs of hemolysis. A very low serum level of vitamin B12 and chronic atrophic type A gastritis upon endoscopy with presence of parietal cell antibodies in the serum lead to the diagnosis of pernicious anemia. Complete restitution is achieved by parenteral vitamin B12 substitution. Nowadays, severe pernicious anemia is only rarely seen. The differential diagnosis of pancytopenia (with macrocytic anemia) combined with hemolysis and the essential hints to the diagnosis of pernicious anemia are discussed, and thereby practical aspects including therapy actualized.

Topics: Age Factors; Aged; Anemia, Macrocytic; Anemia, Pernicious; Diagnosis, Differential; Female; Folic Acid; Gastritis, Atrophic; Hemolysis; Humans; L-Lactate Dehydrogenase; Pancytopenia; Vitamin B 12

Topics: Anemia; Gastritis, Atrophic; Humans; Liver Diseases; Luminescent Measurements; Myeloproliferative Disorders; Radioligand Assay; Reference Values; Specimen Handling; Vitamin B 12; Vitamin B 12 Deficiency

It has been suggested that there is an association between Helicobacter pylori infection, reduced cobalamin absorption and cobalamin status and, consequently, elevated homocysteine levels. This would offer an explanation why H. pylori infection is associated with coronary heart disease. To date, more than 25 studies have been published that either deal with H. pylori infection and homocysteine, H. pylori infection and cobalamin status, or both. The design of these studies differs widely in terms of definition of H. pylori status, measuring cobalamin status, selection of study cohorts and geographical study areas. Therefore, results are fairly inconclusive at present and do not suggest a major role of H. pylori infection in the development of cobalamin deficiency and elevated homocysteine levels.

Topics: Anemia, Pernicious; Gastritis, Atrophic; Helicobacter Infections; Helicobacter pylori; Homocysteine; Humans; Intestinal Absorption; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Animals; Autoantibodies; Diagnosis, Differential; Gastritis, Atrophic; H(+)-K(+)-Exchanging ATPase; Helicobacter Infections; Humans; Intrinsic Factor; Parietal Cells, Gastric; Prognosis; Vitamin B 12

We performed a systematic literature search for diagnostic criteria in establishing cobalamin deficiency. The diagnostic procedure is particularly uncertain in elderly patients with neurological symptoms and in cases with borderline cobalamin values. In any patient with suspected cobalamin deficiency we recommend analysing a full blood count and determining cobalamin concentration in a serum sample. Particularly in elderly patients and cases with neurological symptoms presenting borderline cobalamin values and no abnormalities in the blood count, we recommend further investigation with methylmalonic acid, homocystein and Schilling test. These additional tests should make it possible to decide whether to recommend lifelong substitution with cobalamin. Various cobalamin assays, Schilling test, food cobalamin test, gastroscopic evaluation and the problems surrounding these assays in the elderly are discussed. Our own experience with methylmalonic acid, homocystein determination and food cobalamin test did not reveal a simple diagnostic procedure in such cases. We conclude that there is still no "gold standard" for diagnostic procedure in the special cases mentioned.

Topics: Aging; Anemia, Pernicious; Blood Cell Count; Diagnosis, Differential; Folic Acid Deficiency; Gastritis, Atrophic; Gastroscopy; Homocysteine; Humans; Methylmalonic Acid; Schilling Test; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Pernicious; Animals; Autoantibodies; Autoimmune Diseases; Disease Models, Animal; Gastric Mucosa; Gastritis, Atrophic; H(+)-K(+)-Exchanging ATPase; Humans; Mice; Parietal Cells, Gastric; Vitamin B 12; Vitamin B 12 Deficiency

A 69-year-old woman reported marked restriction of voluntary movements of the hands in the preceding 6 months. She had also experienced loss of motivation, memory and concentration. Her skin was pale yellow, and scratches on her skin indicated marked pruritus.. Neurological examination revealed decreased vibratory sense in both legs. Haemoglobin concentration was 8.3 g/dl, mean corpuscular volume 114 fl, vitamin B12 level < 100 ng/l, folic acid level normal. Antibody titre against parietal cells was increased, vitamin B12 resorption diminished. Gastroscopy revealed small raised lesions, made up of hyperplastic cells which stained with chromogranin, indicating a diagnosis of microcarcinoid of the gastric mucosa.. On administration of cobalamine (1,000 micrograms i.m. daily for 2 weeks, twice weekly for 6 weeks, then once per week for the last 7 months) the blood picture returned to normal, but the microcarcinoids, the psychological symptoms and the apraxia of the hands were unchanged.

Topics: Aged; Carcinoid Tumor; Chronic Disease; Female; Gastritis, Atrophic; Hematinics; Humans; Memory Disorders; Nervous System Diseases; Psychopathology; Stomach Neoplasms; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Absorption; Cimetidine; Duodenal Ulcer; Gastrectomy; Gastric Acid; Gastritis, Atrophic; Humans; Intrinsic Factor; Omeprazole; Ranitidine; Reference Values; Vitamin B 12

The objective of this study was to test the efficacy of three different treatment modalities on the reduction of serum anti-gastric parietal cell autoantibody (GPCA) level in GPCA-positive oral lichen planus (OLP) patients.. Of 147 GPCA-positive OLP patients, 100 were treated with levamisole plus vitamin B12, 10 with vitamin B12 only and 37 with levamisole only. The serum GPCA levels in 147 OLP patients were measured at baseline and after treatment.. Treatment with levamisole plus vitamin B12 for a period of 2-50 months and treatment with vitamin B12 only for a period of 4-44 months could effectively reduce the high serum GPCA level to undetectable level in 100 and 10 OLP patients, respectively. However, treatment with levamisole only for a period of 2-50 months could not modulate the high mean serum GPCA titer to a significantly lower level in 37 OLP patients. A 92% GPCA recurrence rate was found in 25 OLP patients receiving no further vitamin B12 treatment during the GPCA-negative remission period.. For GPCA-positive OLP patients, treatment modality containing vitamin B12 can effectively reduce the high serum GPCA level to undetectable level. OLP patients with underlying autoimmune atrophic gastritis trait should receive a maintenance vitamin B12 treatment for life.

Topics: Adjuvants, Immunologic; Adult; Aged; Aged, 80 and over; Anemia, Pernicious; Autoantibodies; Case-Control Studies; Female; Gastritis, Atrophic; Humans; Levamisole; Lichen Planus, Oral; Male; Middle Aged; Parietal Cells, Gastric; Reference Values; Vitamin B 12; Vitamin B Complex; Young Adult

To investigate the prevalence of serological markers for chronic atrophic gastritis (AG) and Helicobacter pylori antibodies (HPAb) in an elderly population, and to examine the interrelationship and significance for cobalamin, folic acid and iron status and response to oral vitamin therapy.. The study included community-dwelling subjects (n=209), mean age 76 years, randomized to 4 month of oral daily treatment with 0.5 mg cyanocobalamin, 0.8 mg folic acid and 3 mg vitamin B(6) or placebo (double-blind). Biochemical tests were carried out before and after treatment.. AG, as indicated by a pepsinogen I/II ratio <2.9, occurred in 14% (26/190) and HPAb in 54% (102/190) of the subjects. AG subjects had higher levels of serum methylmalonic acid (MMA) (p<0.001), plasma homocysteine (tHcy) (p<0.05), lower haemoglobin (Hb) (p<0.01) and a higher prevalence of vitamin B(12) deficiency (p<0.01). HPAb was associated with AG, whereas AG subjects without HPAb had higher tHcy and MMA levels. There was no correlation between AG and iron status. Oral vitamin treatment led to greater (albeit non-significant) improvements in MMA, tHcy and total cobalamins in AG subjects compared to non-AG subjects.. AG is a common condition and is a significant determinant of vitamin B(12) status. AG is correlated to HPAB and lower Hb. Elderly AG subjects respond at least as well as non-AG subjects to oral treatment with B-vitamins in the doses employed.

Topics: Administration, Oral; Age Factors; Aged; Aged, 80 and over; Antibodies, Bacterial; Biomarkers; Dose-Response Relationship, Drug; Double-Blind Method; Drug Administration Schedule; Female; Folic Acid; Gastritis, Atrophic; Geriatric Assessment; Helicobacter Infections; Helicobacter pylori; Humans; Iron; Male; Multivariate Analysis; Prevalence; Probability; Reference Values; Regression Analysis; Risk Assessment; Severity of Illness Index; Treatment Outcome; Vitamin B 12; Vitamin B 6

Hyperhomocysteinaemia is an independent risk factor for atherosclerosis. It is often related to low levels of vitamin B12 and/or folate, enzymatic co-factors of methionine metabolism. Atrophic gastritis, often caused by Helicobacter pylori infection, may impair vitamin absorption.. To assess whether the presence of atrophic gastritis is associated with hyperhomocysteinaemia via deficiency of its vitamin co-factors.. Thirty-one patients with atrophic gastritis were recruited. The control group consisted of 28 patients with non-atrophic gastritis, matched with patients for sex, age and body mass index. The presence and degree of gastric atrophy were assessed by histology. H. pylori infection was assessed by histology/serology. Blood samples were collected for the measurement of homocysteine, vitamin B12 and folates.. Multiple logistic regression analysis showed that atrophic gastritis (odds ratio, 5.3; 95% confidence interval, 1.23-25.26; chi2=5.2; P=0.01) and low vitamin B12 (odds ratio, 3.7; 95% confidence interval, 1.03-22.08; chi2=3.6; P<0.05) were both predictors of hyperhomocysteinaemia. None of the other variables considered in the analysis, including H. pylori status, showed a significant association with hyperhomocysteinaemia.. The present study suggests that atrophic gastritis, rather than H. pylori infection per se, may be a contributing factor to hyperhomocysteinaemia, possibly via vitamin B12 malabsorption.

Topics: Female; Folic Acid; Gastritis, Atrophic; Helicobacter Infections; Helicobacter pylori; Humans; Hyperhomocysteinemia; Malabsorption Syndromes; Male; Middle Aged; Odds Ratio; Regression Analysis; Risk Factors; Vitamin B 12

To investigate the effects of hypochlorhydria and acidic drink ingestion on protein-bound vitamin B12 absorption in elderly subjects.. Absorption of protein-bound vitamin B12 was examined in elderly normal subjects (n = 8), and in hypochlorhydric subjects due to omeprazole treatment (n = 8) or with atrophic gastritis (n = 3). Subjects underwent absorption tests of protein-bound vitamin B12 ingested with water, cranberry juice and 0.1 N hydrochloric acid.. Protein-bound vitamin B12 absorption was lower in the omeprazole-treated group (0.50%) compared to the normal group (1.21%; p < 0.001). With cranberry juice ingestion, the omeprazole-treated group showed an increase in absorbed protein-bound vitamin B12 (p = 0.025). With dilute hydrochloric acid ingestion, there was a further increase in vitamin B12 absorption (p < 0.001).. Omeprazole causes protein-bound vitamin B12 malabsorption, and ingestion of an acidic drink improves protein-bound vitamin B12 absorption.

Topics: Absorption; Achlorhydria; Administration, Oral; Aged; Aged, 80 and over; Female; Gastric Acid; Gastric Acidity Determination; Gastritis, Atrophic; Humans; Hydrochloric Acid; Hydrogen-Ion Concentration; Male; Omeprazole; Pepsinogens; Protein Binding; Radioimmunoassay; Vitamin B 12

The role of bacteria in the bioavailability of protein-bound vitamin B12 was examined in eight elderly subjects who had atrophic gastritis and in eight normal controls. On separate days and in random order, vitamin B12 absorption tests were performed using either radiolabeled crystalline or protein-bound vitamin B12. At the same time, bacterial samples were collected from the upper gastrointestinal tract. The tests and gastrointestinal aspirates were performed before and during tetracycline therapy. Crystalline vitamin B12 was absorbed to the same extent in the two study groups. Atrophic gastritis subjects absorbed significantly less protein-bound vitamin B12 than normal controls (mean +/- SEM, 0.7% +/- 0.2% vs. 1.9% +/- 0.5%, respectively). However, protein-bound vitamin B12 absorption in these subjects normalized after antibiotic therapy. These results suggest that the small amounts of vitamin B12 released from the protein binders is readily absorbed (as shown in vitro) and/or metabolized by bacteria.

Topics: Achlorhydria; Aged; Bacterial Infections; Biological Availability; Female; Gastritis, Atrophic; Humans; Intestinal Absorption; Male; Tetracycline; Transcobalamins; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Atrophy; Autoimmune Diseases; Female; Gastritis; Gastritis, Atrophic; Humans; Pregnancy; Vitamin B 12; Vitamin B 12 Deficiency

pernicious anemia is an autoimmune disease characterized by atrophic gastritis due to malabsorption of vitamin B12. Certain oral manifestations, such as Hunter´s glossitis and burning mouth syndrome, may precede the onset of this anemia. The aim of this study is to describe the clinical presentation, para-clinical aspects, the treatment, and the evolution of the pernicious anemia (PA) after treatment.. retrospective study conducted at the Department of Haematology and Internal Medicine B of the Mohammed V Military Training Hospital in Rabat between January 2009 and December 2018. Thirty-four patients were enrolled with vitamin B12 deficiency, non-regenerative macrocytic anemia, a positive anti-intrinsic factor antibody and anti-parietal cell antibody and a histological diagnosis of atrophic gastritis in the presence or not of Helicobacter pylori. The qualitative variables were expressed in numbers and percentages, and the quantitative variables in mean and standard deviation. Multivariate analysis used the Fischer test; it was considered significant for a p < 0.05 value.. thirty-four cases were studied; the population study consists of 56% (n=19) of men and 44% (n=15) of women. The average age was 54.88± 9.14. The clinical manifestations of pernicious anemia are dominated by megaloblastic anemia 85.3% (n=29), followed by digestive 58.8%(n=20) and oral 55.9% (n=19) signs. Neurological manifestations were rarely found in 41% (n=14). Hunter´s glossitis 37% (n=7), stomatodynia 11% (n=2) were the most common oral manifestations accompanying pernicious anemia. The evolution was favorable in 79.4% (n=27) patients under substitution therapy with vitamin B12.. dentists´ involvement in the diagnosis of pernicious anemia is based on changes in oral mucous membranes, which have been reported in 55.9% of all patients. These oral changes may occur in the absence of symptomatic anemia.

Topics: Anemia, Pernicious; Autoantibodies; Cross-Sectional Studies; Female; Gastritis, Atrophic; Glossitis; Hospitals; Humans; Male; Middle Aged; Military Personnel; Morocco; Retrospective Studies; Vitamin B 12

Nitrous oxide is among the most common drugs used by adolescents and young adults, and its neuropsychiatric sequelae are severe but reversible with timely treatment. The causal mechanism relates to impaired metabolism of vitamin B12, which is necessary for the development and maintenance of the myelin sheath. Individuals most susceptible to neuropsychiatric manifestations are those with a secondary cause of vitamin B12 deficiency, including nutritional deficiency and impaired absorption, or an alternative cause of impaired metaboclism. We describe the case of a man in his thirties who developed subacute combined degeneration of the spinal cord and polyneuropathy in the setting of recreational nitrous oxide use and autoimmune atrophic gastritis. Our case highlights clinical pearls for diagnosis and treatment, differential diagnosis, common concomitant aetiologies and the importance of screening for substance use disorder and psychiatric comorbidities.

Topics: Adolescent; Atrophy; Gastritis; Gastritis, Atrophic; Humans; Male; Nitrous Oxide; Spinal Cord; Subacute Combined Degeneration; Vitamin B 12; Vitamin B 12 Deficiency; Young Adult

Atrophic gastritis (AG) and use of proton pump inhibitors (PPIs) result in gastric acid suppression that can impair the absorption of vitamin B-12 from foods. The crystalline vitamin B-12 form, found in fortified foods, does not require gastric acid for its absorption and could thus be beneficial for older adults with hypochlorhydria, but evidence is lacking.. To investigate associations of AG and PPI use with vitamin B-12 status, and the potential protective role of fortified foods, in older adults.. Eligible participants (n = 3299) not using vitamin B-12 supplements were drawn from the Trinity-Ulster and Department of Agriculture cohort, a study of noninstitutionalized adults aged ≥60 y and recruited in 2008-2012. Vitamin B-12 status was measured using 4 biomarkers, and vitamin B-12 deficiency was defined as a combined indicator value < -0.5. A pepsinogen I:II ratio <3 was considered indicative of AG.. AG was identified in 15% of participants and associated with significantly lower serum total vitamin B-12 (P < 0.001) and plasma holotranscobalamin (holoTC; P < 0.001), and higher prevalence of vitamin B-12 deficiency (38%), compared with PPI users (21%) and controls (without AG and nonusers of PPIs; 15%; P < 0.001). PPI drugs were used (≥6 mo) by 37% of participants and were associated with lower holoTC concentrations, but only in participants taking higher doses (≥30 mg/d). Regular, compared with nonregular, consumption of fortified foods (i.e., ≥5 and 0-4 portions/wk, respectively) was associated with higher vitamin B-12 biomarkers in all participants, but inadequate to restore normal vitamin B-12 status in those with AG.. Older adults who have AG and/or use higher doses of PPIs are more likely to have indicators of vitamin B-12 deficiency. Fortified foods, if consumed regularly, were associated with enhanced vitamin B-12 status, but higher levels of added vitamin B-12 than currently provided could be warranted to optimize status in people with AG.

Topics: Achlorhydria; Aged; Aging; Biomarkers; Female; Food, Fortified; Gastritis, Atrophic; Humans; Male; Nutritional Status; Pepsinogens; Prevalence; Proton Pump Inhibitors; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin B Complex

Topics: Aged; Anemia, Pernicious; Bilirubin; Blood Transfusion; Female; Ferritins; Folic Acid; Gastritis, Atrophic; Humans; L-Lactate Dehydrogenase; Pancytopenia; Parietal Cells, Gastric; Severity of Illness Index; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin B Complex

Topics: Anemia, Pernicious; Female; Folic Acid Deficiency; Gastritis, Atrophic; Homocysteine; Humans; Hydroxocobalamin; Methylmalonic Acid; Middle Aged; Tetrahydrofolates; Vitamin B 12; Vitamin B Complex

Helicobacter pylori (H. pylori) is closely associated with pre-neoplastic lesions such as atrophic gastritis (AG) and gastric intestinal metaplasia (GIM). The relationshionship between inflammation, hyperhomocysteinemia and arterial stiffness is of pathophysiological relevance for the development of cardiovascular disease. This study aimed to investigate the relationship between vitamin B12, folic acid, homocysteine (Hcy) and pulse wave velocity (PWV) levels in patients with GIM, AG and non-atrophic non-metaplastic chronic gastritis.. ninety-seven patients with GIM, 67 patients with AG and 69 patients with chronic gastritis were included in the study. Glucose, creatinine, total cholesterol, triglyceride, low-density lipoprotein, cholesterol, high-density lipoprotein cholesterol, vitamin B12, folic acid and Hcy levels were measured by biochemical methods. PWV and other vascular parameters were measured using the Phsyio-port AS device.. PWV was higher in patients with GIM and AG than in controls (p < 0.05 and p < 0.05, respectively). Vitamin B12 levels were significantly lower in patients with GIM and AG than in controls (p < 0.01 and p < 0.01, respectively). Folic acid levels were significantly lower in patients with GIM than in controls (p < 0.05). Hcy levels were significantly higher in patients with GIM and AG than in controls (p < 0.001 and p < 0.05, respectively). A logistic regression analysis showed that GIM, AG and vitamin B12 deficiency were predictors for arterial stiffness.. PWV values increased in patients with GIM and AG compared to non-atrophic non-metaplastic chronic gastritis, without different conventional cardiovascular risk factors.

Topics: Adult; Aged; Chronic Disease; Female; Folic Acid; Gastritis; Gastritis, Atrophic; Homocysteine; Humans; Intestines; Male; Metaplasia; Middle Aged; Pulse Wave Analysis; Stomach; Vascular Stiffness; Vitamin B 12

This study aimed to report the case of a patient who presented with depression, cognitive impairment, ataxic gait, and urinary incontinence associated with vitamin B12 deficiency.. Serum vitamin B12 level was low in this patient, and anti-intrinsic factor antibody was positive. Neuroimaging revealed abnormal hyperintense signals in the cerebellum and dorsal and lateral columns of the spinal cord, and obstructive hydrocephalus. A biopsy of the stomach revealed chronic gastritis, intestinal metaplasia, and atrophy. After 3 months of initiating methylcobalamin therapy, significant improvement was noticed clinically, and brain magnetic resonance imaging was near to normal.. This study was novel in reporting subacute combined degeneration of the spinal cord and hydrocephalus associated with vitamin B12 deficiency in adults.

Topics: Adult; Gastritis, Atrophic; Humans; Hydrocephalus; Intrinsic Factor; Male; Subacute Combined Degeneration; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin B Complex

Topics: Abortion, Habitual; Adult; Autoimmune Diseases; Female; Gastritis, Atrophic; Humans; Infertility, Female; Pregnancy; Pregnancy Outcome; Vitamin B 12

To explore the correlation between serum vitamin B12 level and peripheral neuropathy in patients with chronic atrophic gastritis (CAG).. A total of 593 patients diagnosed with chronic gastritis by gastroscopy and pathological examination from September 2013 to September 2016 were selected for this study. The age of these patients ranged within 18- to 75-years-old. Blood pressure, height and weight were measured in each patient, and the body mass index value was calculated. Furthermore, gastric acid, serum gastrin, serum vitamin and serum creatinine tests were performed, and peripheral nerve conduction velocity and. Age,. Serum vitamin B12 levels in patients with chronic gastritis significantly decreased, and the occurrence of peripheral neuropathy had a certain correlation. CAG and

Topics: Adult; Aged; China; Female; Folic Acid; Gastritis, Atrophic; Gastroscopy; Helicobacter Infections; Helicobacter pylori; Humans; Male; Middle Aged; Neural Conduction; Peripheral Nervous System Diseases; Risk Factors; Tibial Nerve; Vitamin B 12; Vitamin B 12 Deficiency; Young Adult

Chronic autoimmune atrophic gastritis (CAAG) is an autoimmune disease characterized by hypo/achlorhydria. A role of CAAG in the pathogenesis of nutritional deficiencies has been reported, therefore we hypothesized a possible association between CAAG and 25-OH-Vitamin D [25(OH)D] deficiency. Aim of the present study is to evaluate the prevalence of 25(OH)D deficiency in CAAG patients.. 87 CAAG patients (71 females; mean age 63.5 ± 12.8 years) followed at our Centre from January 2012 to July 2015 were consecutively evaluated. 25(OH)D, vitamin B. Data from the present study showed a significant reduction of 25(OH)D levels in CAAG patients and a possible impairment of vitamin D absorption in CAAG may be postulated. Any implication to the genesis of gastric carcinoids remains to be elucidated.

Topics: 25-Hydroxyvitamin D 2; Aged; Autoimmune Diseases; Calcium; Chronic Disease; Female; Gastritis, Atrophic; Humans; Intestinal Absorption; Male; Middle Aged; Parathyroid Hormone; Prospective Studies; Vitamin B 12; Vitamin D Deficiency

Vitamin B12 deficiency is frequent in older patients, and the main reason is pernicious anemia. However, vitamin B12 deficiency can occur in patients who do not have atrophic gastritis. The aim of the present study was to investigate factors affecting serum vitamin B12 levels in older patients with non-atrophic gastritis.. A total of 1256 out of 1607 patients aged over 60 years who had undergone upper gastrointestinal endoscopy for various reasons, and who had serum vitamin B12 value and were diagnosed as having "non-atrophic gastritis" were analyzed by means of factors affecting low serum vitamin B12 levels.. Non-atrophic gastritis patients were divided into two groups: patients with normal serum vitamin B12 (group I, n = 759) and patients with low serum vitamin B12 (group II, n = 497). The median serum vitamin B12 was 339 pg/mL (range 201-987 pg/mL) in group I and 180 pg/mL (range 50-200 pg/mL) in group II. Helicobacter pylori (n = 154 vs 325, P < 0.001), neutrophil activity (n = 176 vs 367, P < 0.001), intestinal metaplasia (n = 35 vs 14, P < 0.001) and inflammation (n = 230 vs 386, P < 0.001) were present significantly more often in group II compared with group I. A total of 785 patients were both negative for Helicobacter pylori and atrophy. Of these 785 patients, neutrophil activity (n = 56, [32.6%] vs 25, [4.4%], P < 0.001) and inflammation (n = 69, [40.1%] vs 82, [13.4%], P < 0.001) scores were present significantly more often in group II compared with group I.. Helicobacter pylori was present significantly more often in older patients whose serum vitamin B12 levels were ≤200 pg/mL, and Helicobacter pylori density was inversely correlated with serum B12 level. Upper gastrointestinal endoscopic examination should be suggested for elderly patients with serum vitamin B12 level ≤200 pg/mL. Geriatr Gerontol Int 2015; ●●: ●●-●●.

Topics: Age Factors; Aged; Aged, 80 and over; Biopsy, Needle; Case-Control Studies; Female; Gastritis, Atrophic; Gastroscopy; Geriatric Assessment; Helicobacter Infections; Helicobacter pylori; Humans; Immunohistochemistry; Incidence; Male; Middle Aged; Prognosis; Reference Values; Retrospective Studies; Risk Assessment; ROC Curve; Severity of Illness Index; Statistics, Nonparametric; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Gastritis, Atrophic; Helicobacter Infections; Helicobacter pylori; Humans; Vitamin B 12

Several biomarkers have been proposed for the diagnosis of autoimmune atrophic gastritis (AAG), but at the present there is no appropriate testing strategy for the disease.. The aim of this study was to develop and validate a laboratory score able to address the diagnosis of AAG in a general practice setting.. We prospectively evaluated a number of serum biomarkers (vitamin B12, mean corpuscular volume, hemoglobin, gastrin, and chromogranin A levels) in a case-control population and built 2 biochemical scores, the first with all the parameters [Global Score (GS)], and the second as the best statistical combination of them [Simple Score (SS)]. In the second phase we validated the score that proved to be more efficient on a random population referred to our center (Gastroenterology Outpatient Clinic).. Both models turned out to be reliable in detecting patients with suspected AAG, showing excellent accuracy [area under the receiver operating curve (AUC-ROC) 0.94; 95% confidence interval (CI), 0.91-0.97 for GS and AUC-ROC 0.93; 95% CI, 0.89-0.86 for SS]. The SS proved to be more convenient because of its accessibility and availability in a general setting and its low cost. The validation of the SS showed a sensitivity of 85.7% (95% CI, 57.2-98.2) and a specificity of 83.7% (95% CI, 74.2-90.89).. Herein, we describe 2 nonexpensive and reliable score models, particularly the SS, that can be applied in daily medical practice for identifying patients potentially affected by AAG.

Topics: Adult; Aged; Area Under Curve; Autoimmune Diseases; Biomarkers; Case-Control Studies; Chromogranin A; Erythrocyte Indices; Female; Gastrins; Gastritis, Atrophic; Hemoglobins; Humans; Logistic Models; Male; Middle Aged; Prospective Studies; ROC Curve; Vitamin B 12

Topics: Administration, Oral; Dose-Response Relationship, Drug; Female; Gastritis, Atrophic; Graves Disease; Helicobacter Infections; Helicobacter pylori; Hormone Replacement Therapy; Humans; Hypothyroidism; Intestinal Absorption; Iodine Radioisotopes; Middle Aged; Thyrotropin; Thyroxine; Vitamin B 12; Vitamin B 12 Deficiency

Autoimmune gastritis may present as pernicious anaemia arising from vitamin B12 malabsorption, but also with iron deficiency anaemia due to iron malabsorption. These different clinical presentations might have a genetic basis. Single nucleotide polymorphisms associated with vitamin B12 levels have not been investigated in autoimmune gastritis.. To determine the frequency of single nucleotide polymorphisms related to vitamin B12 levels in autoimmune gastritis patients, with or without pernicious anaemia, compared to healthy controls.. 14 single nucleotide polymorphisms associated with vitamin B12 levels were selected from literature. 83 autoimmune gastritis patients (43 with and 40 without pernicious anaemia) and 173 controls were enrolled. Genomic DNA was extracted from peripheral blood leukocytes. Genotyping was performed using Sequenom MALDI-TOF mass spectrometry iPLEX platform.. TCN2 (rs9606756) GG genotype, related with lower vitamin B12 levels, was found in 3 (3.6%) autoimmune gastritis patients (2 with pernicious anaemia), but in none of controls (p = 0.02). FUT6 (rs3760776) AA genotype was present in four (4.8%) autoimmune gastritis patients (all pernicious anaemia) and three (1.7%) controls (p = 0.007).. A genetic variant of TCN2 (rs9606756) related to lower vitamin B12 levels was more frequent in pernicious anaemia patients compared to controls, showing the plausibility of genetic factors determining the possible clinical manifestation of autoimmune gastritis.

Topics: Anemia, Pernicious; Autoimmune Diseases; DNA; Female; Follow-Up Studies; Gastritis, Atrophic; Genotype; Humans; Male; Middle Aged; Polymorphism, Single Nucleotide; Retrospective Studies; Vitamin B 12

Topics: Anemia, Pernicious; Gastric Juice; Gastritis, Atrophic; History, 19th Century; History, 20th Century; Humans; Liver; Vitamin B 12

Topics: Aged; Antipsychotic Agents; Aripiprazole; Female; Gastritis, Atrophic; Humans; Paranoid Disorders; Piperazines; Psychological Tests; Quinolones; Remission Induction; Risperidone; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Pernicious; Gastritis, Atrophic; Humans; Prognosis; Vitamin B 12

We present a case of a 50-year-old female patient with a history of depressive disorder and anaemia (attributed to menorrhagias). She was admitted to the cardiology department with symptoms of fatigue on moderate exertion for several months, with worsening in the month before hospitalisation. Echocardiography revealed a severe mitral stenosis of rheumatic aetiology. Laboratory tests showed microcytic and hypochromic anaemia, reduced iron stores and vitamin B12 levels, and positive serum antiparietal cells autoantibodies. Endoscopy showed focal areas of erythema in the stomach, corresponding histologically to chronic atrophic gastritis. In this context, two distinct clinical entities were diagnosed in the same patient: severe rheumatic mitral stenosis and autoimmune gastritis. The patient was started on vitamin B12 and iron supplementation and underwent surgical correction of the valvular disease. There was symptomatic improvement in her signs of fatigue.

Topics: Anemia; Anemia, Iron-Deficiency; Autoantibodies; Autoimmune Diseases; Echocardiography; Fatigue; Female; Gastritis, Atrophic; Humans; Iron Deficiencies; Iron, Dietary; Middle Aged; Mitral Valve; Mitral Valve Stenosis; Parietal Cells, Gastric; Rheumatic Heart Disease; Stomach; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adult; Gastritis, Atrophic; Humans; Male; Paraplegia; Vitamin B 12; Vitamin B 12 Deficiency

Autoimmune atrophic gastritis (AIG) is characterized by immune-mediated chronic inflammation of the gastric body and fundus, leading to hypo-achlorhydria and vitamin B12 deficiency. We analyzed the clinical features of AIG and sought to identify factors that might be used in diagnosis.. We collected and analyzed clinical data from 99 consecutive patients (age, 59 ± 17 y) who were diagnosed with AIG, based on histologic factors and the presence of autoantibodies against gastric parietal cells.. Clinical factors that led to a diagnosis of AIG included hematologic findings related to vitamin B12 deficiency (n = 37), incidental histologic evidence in gastric biopsy specimens (n = 34), immune disorders (n = 18; 9 were celiac disease), neurologic symptoms (n = 6), and a family history of AIG (n = 4).. Based on an analysis of 99 consecutive patients with AIG, this disorder is not solely a condition of the elderly. Other features to look for in making a diagnosis of AIG include vitamin B12 deficiency, histologic factors, and immune disorders.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Autoantibodies; Autoimmune Diseases; Biopsy; Gastritis, Atrophic; Histocytochemistry; Humans; Male; Middle Aged; Parietal Cells, Gastric; Vitamin B 12; Vitamin B 12 Deficiency; Young Adult

A previously healthy 66-year-old women presented with onset of general weakness, shortness of breath and significant weight loss. Due to appearance of jaundice, biliary obstruction had been ruled out by a CAT scan previous to the patients presentation in our practice.. The laboratory tests already arranged by the patients general practitioner showed a pronounced pancytopenia with megaloblastic anemia and hyperbilirubinemia. The bone marrow aspiration revealed a hypercellular bone marrow with megaloblastic erythropoiesis. The diagnosis of pernicious anemia was confirmed by the low cobalamin (vitamin B12) serum level and the presence of atrophic gastritis.. Pernicious anemia was treated with intramuscular injection of Cyanocobalamin (1000 µg) which resulted in an immediate reticulocytosis and a widely normalized blood cell count and bilirubin level four weeks after initiation of treatment.. The differential diagnosis of megaloblastic anemia covers a wide spectrum of diseases with different etiology. This case report demonstrates an example of a pernicious anemia with atypical and foudroyant clinical course.

Topics: Aged; Anemia, Macrocytic; Autoimmune Diseases; Biopsy; Bone Marrow; Diagnosis, Differential; Erythrocyte Indices; Female; Gastritis, Atrophic; Gastroscopy; Humans; Infusions, Intravenous; Jaundice; Megaloblasts; Pancytopenia; Ultrasonography; Vitamin B 12

A 6-month-old infant with severe hyporegenerative anaemia, muscular hypotonia and developmental delay is reported, and the metabolic, diagnostic and therapeutic implications of this case are discussed.. Diagnostic work-up disclosed vitamin B12 depletion with an elevated excretion of methylmalonic acid (MMA), but a normal plasma total homocysteine. MRI showed fronto-temporal atrophy and a delay in myelinization. The boy's disease was attributable to a maternal atrophic gastritis. After initiation of vitamin B12 supplementation, he quickly recovered regarding haematopoiesis and MMA excretion. His neurological development completely normalized during 18 months of follow-up including assessment by Bayley scores.. As the majority of reported patients with this acquired form of methylmalonic aciduria show a persistent neurological deficit, early diagnosis of this condition is mandatory and should include sensitive markers of vitamin B12 depletion, namely MMA formation and plasma homocysteine.

Topics: Amino Acid Metabolism, Inborn Errors; Dietary Supplements; Female; Gastritis, Atrophic; Humans; Infant; Maternal Welfare; Methylmalonic Acid; Pregnancy; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin B Complex

Topics: Anemia, Megaloblastic; Anemia, Pernicious; Autoantibodies; Autoimmune Diseases; Folic Acid Deficiency; Gastritis, Atrophic; Humans; Intrinsic Factor; Parietal Cells, Gastric; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Aged; Aged, 80 and over; Aging; Cognition Disorders; Dementia; Folic Acid Deficiency; Gastritis, Atrophic; Helicobacter Infections; Helicobacter pylori; Homocysteine; Humans; Risk Factors; Vitamin B 12; Vitamin B 12 Deficiency

Previous studies have shown inconsistent associations of folate intake and polymorphisms of the methylenetetrahydrofolate reductase (MTHFR) gene with gastric cancer risk. Our nested case-control study within the European Prospective Investigation into Cancer and Nutrition cohort is the first prospective study of blood folate levels and gastric cancer. Gastric cancer cases (n=247) and controls (n=631) were matched for study center, age, sex, and time of blood donation. Two common single nucleotide polymorphisms of the MTHFR gene were determined, as were plasma concentrations of folate, cobalamin (vitamin B12), total homocysteine, and methylmalonic acid (cobalamin deficiency marker) in prediagnostic plasma. Risk measures were calculated with conditional logistic regression. Although no relations were observed between plasma folate or total homocysteine concentrations and gastric cancer, we observed a trend toward lower risk of gastric cancer with increasing cobalamin concentrations (odds ratio, 0.79 per SD increase in cobalamin; P=0.01). Further analyses showed that the inverse association between cobalamin and gastric cancer was confined to cancer cases with low pepsinogen A levels (marker of severe chronic atrophic gastritis) at the time of blood sampling. The 677 C-->T MTHFR polymorphism was not associated with gastric cancer, but we observed an increased risk with the variant genotype of the 1298 A-->C polymorphism (odds ratio, 1.47 for CC versus AA; P=0.04). In conclusion, we found no evidence of a role of folate in gastric cancer etiology. However, we observed increased gastric cancer risk at low cobalamin levels that was most likely due to compromised cobalamin status in atrophic gastritis preceding gastric cancer.

Topics: Adult; Aged; Case-Control Studies; Cohort Studies; Europe; Female; Folic Acid; Gastritis, Atrophic; Homocysteine; Humans; Male; Methylenetetrahydrofolate Reductase (NADPH2); Methylmalonic Acid; Middle Aged; Polymorphism, Single Nucleotide; Prospective Studies; Risk Factors; Stomach Neoplasms; Vitamin B 12

A teenager was admitted with an iron-deficiency anemia. The gastroscopy found an atrophic body gastritis, which revealed a pernicious anemia. This diagnosis is rare in paediatric patients, the frequency of pernicious anemia increasing with age. Iron-deficiency anemia is mainly described in young people.

Topics: Adolescent; Anemia, Iron-Deficiency; Anemia, Pernicious; Gastric Fundus; Gastritis, Atrophic; Humans; Intrinsic Factor; Male; Parietal Cells, Gastric; Vitamin B 12; Vitamin B Complex

To determine the serum vitamin B(12) status of older New Zealanders and to assess the impact of atrophic gastritis on vitamin B(12) status.. A cross-sectional nationally representative population-based survey.. Serum vitamin B(12) concentrations were used to assess vitamin B(12) status. The presence and severity of atrophic gastritis was classified using serum pepsinogen I and II.. A total of 466 noninstitutionalized urban and rural dwelling New Zealanders aged 65 y or older who participated in the 1997 National Nutrition Survey.. The prevalence of deficient (<148 pmol/l) and marginal (148-221 pmol/l) serum vitamin B(12) concentrations was 12 and 28%, respectively. The prevalence of atrophic gastritis was 6.7% (severe 3.1%, mild-moderate 3.6%). While atrophic gastritis increased the relative risk (RR, 95% CI) of having a deficient or marginal serum vitamin B(12) concentration by 21-fold (6-67) and five-fold (1-17), respectively, those who had atrophic gastritis made up only 33 and 6% of the participants with deficient or marginal serum vitamin B(12) concentrations. An intake of vitamin B(12) from food that exceeded the recommended dietary allowance (2.4 mug/day) did not protect against deficient (RR 0.5; 95% CI: 0.2, 1.2) or marginal (RR 0.9; 95% CI: 0.5, 1.7) serum vitamin B(12) status. Vitamin B(12) supplement users had a reduced risk of having deficient and marginal vitamin B(12) status (RR 0.3; 95% CI: 0.1, 0.8).. There is a relatively high prevalence of deficient and marginal serum vitamin B(12) concentrations among older New Zealanders. However, the prevalence of atrophic gastritis was low in the New Zealand elderly compared with other surveys. Although atrophic gastritis was a risk factor for low vitamin B(12) status, it did not fully explain the prevalence of low serum vitamin B(12).

Topics: Aged; Confidence Intervals; Cross-Sectional Studies; Female; Gastritis, Atrophic; Humans; Male; New Zealand; Nutrition Surveys; Risk; Rural Population; Seroepidemiologic Studies; Urban Population; Vitamin B 12; Vitamin B 12 Deficiency

Approximately 15% of people aged more than 60 years old have a cobalamin (vitamin B12) deficiency, mainly in relation with food-cobalamin malabsorption (FCM). To date, no study has documented this disorder in the elderly. There is also little information on clinical consequences.. We studied 92 elderly patients with well-established FCM who were extracted from an observational cohort study (1995-2004) of 172 consecutive elderly patients with documented cobalamin deficiency.. The median patient age was 76 +/- 8 years; 60 patients were women. The most common clinical manifestations were neurologic or psychologic: mild sensory polyneuropathy (44.6%), confusion or impaired mental functioning (22.8%), and physical asthenia (20.7%). Hematologic abnormalities were reported in at least one third of the patients: anemia (21%), leukopenia (10.9%), thrombopenia (8.7%), and pancytopenia (6.5%). All patients had low serum vitamin B12 levels (<200 pg/mL), with a mean value (+/- standard deviation) of 131 +/- 38 pg/mL and total serum homocysteine level of 22.1 +/- 9.3 micromol/L. The mean hemoglobin level was 10.9 +/- 2.5 g/dL and the mean erythrocyte cell volume 95.7 +/- 12.7 fL. Correction of the serum vitamin B12 levels and hematologic abnormalities was achieved equally well in patients treated with either intramuscular or oral crystalline cyanocobalamin.. This study suggests that in elderly patients, FCM may be associated with significant neurologic, psychologic, and hematologic abnormalities, which seem to respond equally well to either oral or parenteral vitamin B12 therapy.

Topics: Aged; Aged, 80 and over; Asthenia; Cognition Disorders; Cohort Studies; Confusion; Edema; Erythrocyte Indices; Female; Follow-Up Studies; Gastritis, Atrophic; Hematologic Diseases; Hemoglobins; Homocysteine; Humans; Jaundice; Malabsorption Syndromes; Male; Paresthesia; Polyneuropathies; Reflex, Abnormal; Retrospective Studies; Vitamin B 12; Vitamin B 12 Deficiency

In this study, we have aimed to show the possible relation between atrophic gastritis and premature atherosclerosis via hyperhomocysteinemia.. Thirty-four patients with atrophic gastritis were enrolled to the study. The control group consisted of 35 patients with non-atrophic gastritis. Classical cardiovascular disease risk factors did not significantly differ between atrophic gastritis and control subjects. The presence and degree of atrophic gastritis were assessed histologically and Helicobacter pylori infection was determined by both histologic and serologic methods. Body mass index was measured by standard technique blood fasting glucose, serum creatinine, total cholesterol, triglyceride, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, vitamin B12, folic acid, and homocysteine levels were measured by biochemical methods. Carotid intima-media thickness was measured by B-mode ultrasonography to examine the premature atherosclerosis.. Plasma vitamin B12 levels were significantly lower (p = .00) and homocysteine levels were significantly higher (p = .01) in the atrophic gastritis group. There was no statistically significant difference in plasma folic acid levels between the two groups (p = .728). Carotid intima-media thickness was higher in the atrophic gastritis group than in the control group (0.516 mm versus 0.465 mm), but this difference did not show any statistical significance (p = .062).. Our results showed that atrophic gastritis may cause hyperhomocysteinemia, which is an independent risk factor for atherosclerosis and cardiovascular diseases. However, when compared with controls, carotid intima-media thickness of the atrophic gastritis patients was found to be higher but did not reach statistically significant levels.

Topics: Atherosclerosis; Carotid Arteries; Female; Gastritis, Atrophic; Helicobacter Infections; Helicobacter pylori; Humans; Hyperhomocysteinemia; Male; Middle Aged; Prevalence; Ultrasonography; Vitamin B 12

Topics: Anemia, Pernicious; Autoimmune Diseases; Female; Folic Acid; Gastritis, Atrophic; Humans; Middle Aged; Vitamin B 12; Vitiligo

Topics: Aged; Aged, 80 and over; Cohort Studies; Female; France; Gastritis, Atrophic; Humans; Injections, Intramuscular; Malabsorption Syndromes; Male; Prospective Studies; Risk Factors; Vitamin B 12; Vitamin B 12 Deficiency

Cobalamin (vitamin B12) deficiency is associated with Helicobacter pylori infection. This study examined how serum vitamin B12 levels relate to gastric mucosa H. pylori density and histology, and to hematological findings in patients with minimal or no gastric atrophy. A second aim was to confirm that H. pylori eradication therapy increases serum B12.. Biopsies of the gastric mucosa from a population of dyspeptic patients were graded for level of chronic inflammation, neutrophil activity, atrophy, and H. pylori density. A total of 145 H. pylori-infected patients with minimal or no atrophy were included in the study. Serum cobalamin level, hemoglobin level, and mean corpuscular volume were measured in the 145 patients before eradication therapy, and in 65 of the subjects after treatment. The hematologic findings before and after eradication therapy and correlations between serum vitamin B12 level and histologic parameters, hematologic findings, and patient age were statistically analyzed.. There was no significant correlation between serum cobalamin level and patient age. Before treatment all the histopathological scores were inversely correlated with serum vitamin B12 level (p <.01) on univariate analysis. Only H. pylori density was significantly associated with B12 level on multivariate analysis. Serum hemoglobin and cobalamin levels were significantly increased after treatment, regardless of H. pylori eradication status (p <.001).. The findings provide strong evidence that H. pylori infection is associated with cobalamin deficiency, and show that this is true even in patients with non-ulcer dyspepsia and minimal or no gastric atrophy.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Dyspepsia; Erythrocyte Indices; Female; Gastric Mucosa; Gastritis, Atrophic; Helicobacter Infections; Helicobacter pylori; Hemoglobins; Humans; Male; Middle Aged; Vitamin B 12; Vitamin B 12 Deficiency

Cobalamin deficiency is common in the elderly. However, most of the patients are asymptomatic or present with few symptoms. A subacute combined degeneration of the spinal cord accounts for only 10% of the neurological complications. Revealing forms of this myelopathy are exceptional, and were rarely documented by magnetic resonance imaging (MRI) study.. We report a case of subacute combined degeneration of spinal cord in an 81-year-old woman evaluated by a spinal cord MRI. We discuss the role of the spinal cord radiographic study in the diagnosis, the etiopathogeny of cobalamin deficiency and the benefit of vitamin supplementation even at a late stage of the disease in geriatrics patients.. The spinal cord MRI is useful in the diagnosis of late-form combined spinal cord degeneration. The high frequency of atrophic gastritis in elderly prevents the identification of a deficiency of the cobalamin etiology. The treatment relies on vitamin therapy even in the late stages. The severe disability of cobalamin deficiency neurological complications must encourage an earlier diagnosis in elderly patients.

Topics: Age Factors; Aged; Aged, 80 and over; Female; Follow-Up Studies; Gastritis, Atrophic; Humans; Injections, Intramuscular; Magnetic Resonance Imaging; Sclerosis; Spinal Cord; Spinal Cord Diseases; Spinal Puncture; Time Factors; Vitamin B 12; Vitamin B 12 Deficiency

The aim of this study was to test the hypothesis that chronic atrophic gastritis induced by Helicobacter pylori (H. pylori) causes malabsorption of vitamin B12 and folate in food, leading ultimately to an increase in circulating homocysteine levels.. We performed endoscopy with stomach biopsy and measured fasting plasma homocysteine, vitamin B12, and folate levels in 93 patients who underwent diagnostic coronary arteriography. The patients were divided into two groups according to the presence (n = 57) or absence (n = 36) of H. pylori infection. Positive H. pylori infection was defined as positive H. pylori histology of biopsy specimens from the stomach. The extent of atrophic gastritis was endoscopically graded from 0 to 6.. There were no differences in age, sex, or traditional coronary risk factors between the two groups. Atrophy scores of the stomach were greater in patients with H. pylori infection than in patients without (3.9 +/- 1.4 vs 2.2 +/- 1.8, p < 0.0001). Patients with H. pylori infection had lower levels of vitamin B12 (630 +/- 222 vs 747 +/- 259 pg/ml, p = 0.02) and folate (6.2 +/- 2.1 vs 7.4 +/- 2.8, p = 0.046), as well as higher levels of homocysteine (11 +/- 4.9 vs 8.3 +/- 2.1 nmol/ml, p = 0.01), than did patients without H. pylori infection. Plasma homocysteine levels correlated inversely with plasma vitamin B12 and folate levels and positively with atrophic scores.. This study suggests that H. pylori-induced chronic atrophic gastritis decreases plasma vitamin B12 and folic acid levels, thereby increasing homocysteine levels. However, this effect does not seem to be strong.

Topics: Aged; Coronary Angiography; Coronary Artery Disease; Female; Folic Acid; Gastritis, Atrophic; Helicobacter Infections; Helicobacter pylori; Homocysteine; Humans; Malabsorption Syndromes; Male; Middle Aged; Risk Factors; Vitamin B 12

Topics: Adolescent; Anemia, Pernicious; Diabetes Mellitus, Type 1; Female; Gastritis, Atrophic; Gastroparesis; Humans; Thyrotoxicosis; Vitamin B 12

We have previously demonstrated that vitamin B12 (cobalamin)-deficient central neuropathy in the rat is associated with local overexpression of neurotoxic tumour necrosis factor (TNF)-alpha combined with locally decreased synthesis of neurotrophic epidermal growth factor (EGF). The aims of this study were to investigate whether a similar imbalance also occurs in the serum of adult patients with clinically confirmed cobalamin deficiency and whether it can be corrected by vitamin B12 replacement therapy.. We studied 34 adult patients with severe cobalamin deficiency, 12 patients with pure iron deficiency anaemia and 34 control subjects. Haematological markers of cobalamin deficiency and serum TNF-alpha and EGF levels were measured using commercial kits. Thirteen cobalamin-deficient patients were re-evaluated after 3 and 6 months of parenteral vitamin B12 treatment.. TNF-alpha was significantly higher (p < 0.01) and EGF significantly lower (p < 0.01) in the patients with cobalamin deficiency, but both were unchanged in patients with pure iron deficiency anaemia. In cobalamin-deficient patients the serum TNF-alpha levels correlated significantly with plasma total homocysteine levels (r = 0.425; p < 0.02). In the treated patients TNF-alpha and EGF levels normalised concomitantly with clinical and haematological disease remission.. In humans, as in rats, cobalamin concentration appears to be correlated with the synthesis and release of TNF-alpha and EGF in a reciprocal manner, because cobalamin deficiency is accompanied by overproduction of TNF-alpha and underproduction of EGF.

Topics: Adult; Aged; Aged, 80 and over; Anemia, Hypochromic; Anemia, Megaloblastic; Animals; Bone Marrow; Epidermal Growth Factor; Female; Folic Acid; Follow-Up Studies; Gastritis, Atrophic; Homocysteine; Humans; Iron; Iron Deficiencies; Male; Middle Aged; Peripheral Nervous System Diseases; Rats; Species Specificity; Tumor Necrosis Factor-alpha; Vitamin B 12; Vitamin B 12 Deficiency

We experienced a female case with asymptomatic primary biliary cirrhosis that was associated with pernicious anemia after 16 years from the onset. She was 52 years old when she first visited a clinic in 1981 for liver dysfunction treatment. Antimitochondrial antibody was negative and antipyruvate dehydrogenase complex antibody was positive in a low titer in its immunoglobulin (Ig)M type. Histological examination of her liver revealed a presence of definite chronic non-suppurative destructive cholangitis with numerous epithelioid cell granuloma. She had been given 600 mg of the oral daily dose of ursodeoxycholic acid since 1992. Macrocytic anemia incidiously appeared in September 1999. An immunological examination detected negative antiparietal cell antibodies and positive anti-intrinsic factor antibodies. Her bone marrow smear showed numerous megaloblasts and serum vitamin B12 in her blood was low at 99 pg/mL. Severe reversed atrophic-type gastritis (type A gastritis) was demonstrated by the use of dye-endoscopy with Congo red. Her macrocytic anemia dramatically improved after intramuscular administration of vitamin B12. In conclusion, attention should be given to the association of pernicious anemia during the follow up of primary biliary cirrhosis.

Topics: Anemia, Pernicious; Autoantibodies; Biopsy; Cholagogues and Choleretics; Female; Gastritis, Atrophic; Humans; Liver Cirrhosis, Biliary; Middle Aged; Transaminases; Ursodeoxycholic Acid; Vitamin B 12; Vitamin B Complex

It is still a commonly held belief that many of the frequently found low cobalamin (Cbl, vitamin B12) levels in older people do not represent deficiency and are therefore without clinical significance and should not be treated. In this study this notion will be challenged.. In this prospective observational cohort design we studied 28 patients aged 65 years and older with low plasma Cbl (< or =150 pmol/l). A number of haematological (Hb, MCV, five- and six-lobed granulocytes), metabolic (plasma levels of methylmalonic acid and homocysteine), and gastrointestinal (plasma pepsinogen A and C and protein-bound and free Cbl absorption) parameters, and the response to Cbl treatment, were measured. Cbl deficiency was considered to be present when at least one of the following three criteria was fulfilled: (1) haematological or metabolic abnormalities compatible with Cbl deficiency; (2) Cbl malabsorption or atrophic gastritis; (3) a response to Cbl supplementation.. Haematological or metabolic abnormalities were identified in 27 patients. Atrophic gastritis and Cbl malabsorption were identified in, respectively, 15 and 23 patients. Each treated patient showed a haematological or metabolic response to Cbl supplementation. All patients were considered Cbl deficient: 18 patients (64%) fulfilled three criteria of Cbl deficiency, eight (29%) fulfilled two criteria and two (7%) fulfilled one criterion.. According to the generally accepted and a wide variety of criteria, we found that older patients with low Cbl levels were cobalamin deficient. Therefore, these patients should receive Cbl supplementation.

Topics: Aged; Aged, 80 and over; Anemia, Pernicious; Diagnosis, Differential; Female; Gastritis, Atrophic; Hospitals; Humans; Inpatients; Malabsorption Syndromes; Male; Netherlands; Prospective Studies; Psychiatric Status Rating Scales; Treatment Outcome; Vitamin B 12; Vitamin B 12 Deficiency

In the great majority of cases vitamin B12 deficiency is caused by chronic atrophic gastritis. This study has compared several different tests for the identification of patients for whom substitution therapy is needed or warranted. It is concluded that serum tests reflecting the state of the gastric body mucosa (serum pepsinogen A combined with serum gastrin or serum pepsinogen C) appear to be the logical first step in the workup of these patients in terms of high sensitivity and superior specificity as compared with other tests.

Topics: Biomarkers; Gastric Mucosa; Gastritis, Atrophic; Gastrointestinal Diseases; Gastroscopy; Homocysteine; Humans; Intestinal Mucosa; Methylmalonic Acid; Pepsinogen C; Practice Guidelines as Topic; Sensitivity and Specificity; Vitamin B 12; Vitamin B 12 Deficiency

Omeprazole maintenance therapy for gastro-oesophageal reflux disease (GERD) has been associated with an increased incidence of atrophic gastritis in H. pylori-infected patients and with a decreased absorption of protein-bound, but not of unbound cobalamin.. : To test the hypothesis that the combination of decreased cobalamin absorption and atrophic gastritis decreases serum cobalamin levels during omeprazole therapy.. Forty-nine H. pylori-positive GERD patients were treated with omeprazole for a mean (+/- s.d.) period of 61 (25) months. At the start of omeprazole treatment (T0) and at the latest follow-up visit (T1), serum was obtained for measurement of cobalamin. Corpus biopsy specimens were obtained at entry and follow-up for histopathological scoring according to the updated Sydney classification.. At inclusion, none of the 49 patients had signs of atrophic gastritis. During follow-up, 15 patients (33%) developed atrophic gastritis, nine of whom had moderate to severe atrophy. These 15 patients did not differ from the other 34 patients with respect to age, serum cobalamin at T0 or the duration of follow-up. During follow-up, no change was observed in the median serum cobalamin level in the 34 patients without atrophy; (T0) 312 (136-716) vs. (T1) 341 (136-839) pmol/L (P=0.1). In the 15 patients who developed atrophy, a decrease in cobalamin was seen from 340 (171 to 787) at baseline to 285 (156-716) at latest follow-up (P < 0.01).. The development of atrophic gastritis during omeprazole treatment in H. pylori-positive GERD patients is associated with a decrease of serum vitamin B12 levels.

Topics: Absorption; Anti-Ulcer Agents; Cohort Studies; Drug Administration Schedule; Female; Gastritis, Atrophic; Gastroesophageal Reflux; Humans; Longitudinal Studies; Male; Middle Aged; Omeprazole; Prospective Studies; Vitamin B 12

The reason for the high prevalence of mild cobalamin (vitamin B-12) deficiency in the elderly is poorly understood.. We aimed to determine the reason for this high prevalence.. We examined cobalamin intake, the presence and severity of atrophic gastritis, the presence of Helicobacter pylori infection, and plasma cobalamin and methylmalonic acid (MMA) concentrations in 105 healthy, free-living, older subjects aged 74-80 y.. Mild cobalamin deficiency, ie, low to low-normal plasma cobalamin concentrations (< 260 pmol/L) and elevated plasma MMA concentrations (> 0.32 micromol/L), were found in 23.8% of subjects; 25.7% of subjects were not cobalamin deficient (plasma cobalamin > or = 260 pmol/L and plasma MMA < or = 0.32 micromol/L). Six subjects (5.8%), including 1 with mild cobalamin deficiency, had dietary cobalamin intakes below the Dutch recommended dietary intake of 2.5 microg/d. Mildly cobalamin-deficient subjects had lower total (diet plus supplements) cobalamin intakes (median: 4.9 microg/d; 25th and 75th percentiles: 3.9, 6.4) than did non-cobalamin-deficient subjects (median: 6.3 microg/d; 25th and 75th percentiles: 5.4, 7.9) (P = 0.0336), mainly because of less frequent use of cobalamin supplements (8% compared with 29.6%; chi2 = 3.9, P = 0.048). Atrophic gastritis was found in 32.4% of the total study group: mild to moderate in 19.6% and severe in 12.7%. The prevalence of severe atrophic gastritis, but not mild-to-moderate atrophic gastritis, was higher in mildly cobalamin-deficient subjects (25%) than in non-cobalamin-deficient subjects (3.7%) (chi2 = 4.6, P = 0.032). The prevalence of immunoglobulin G antibodies to H. pylori was similar in mildly cobalamin-deficient subjects (54.2%) and in non-cobalamin-deficient subjects (44.4%) (chi2 = 0.5, P = 0.5).. The high prevalence of mild cobalamin deficiency in healthy, free-living, older Dutch subjects could be explained by inadequate cobalamin intake or severe atrophic gastritis in only 28% of the study population. Other mechanisms explaining mild cobalamin deficiency in older people must be sought.

Topics: Aged; Aged, 80 and over; Female; Gastritis, Atrophic; Helicobacter Infections; Helicobacter pylori; Humans; Male; Methylmalonic Acid; Prevalence; Vitamin B 12; Vitamin B 12 Deficiency

To compare the diagnostic performance of serum antibodies to H+,K+-ATPase (EC 3.6.1.36), serum pepsinogen A (EC 3.4.23.1) and the Schilling test in diagnosing chronic atrophic body gastritis; to study the interrelationships between H+,K+-ATPase antibodies, serology for Helicobacter pylori, and gastric morphology.. Patients with suspected cobalamin deficiency and serum cobalamin < 200 micromol/l were investigated using upper gastrointestinal endoscopy, the Schilling test and serum tests for H+,K+-ATPase antibodies, pepsinogen A, and H. pylori.. The Department of Internal Medicine, Sahlgrenska University Hospital, Göteborg, Sweden.. Ninety seven consecutively referred patients.. Sensitivity and specificity of assays for serum H+,K+-ATPase antibodies, serum pepsinogen A, and the Schilling test.. Assays of serum antibodies to H+,K+-ATPase and of serum pepsinogen A displayed equal diagnostic sensitivity for atrophic gastritis (around 0.90 for the severe forms) and higher than that for the Schilling test (0.65). The diagnostic specificity for pepsinogen A (1.0) was higher than for H+,K+-ATPase antibodies (about 0.80). The prevalence of antral gastritis and positivity for H. pylori antibodies declined with the transition of body gastritis into severe atrophy, while the prevalence of H+,K+-ATPase antibodies increased.. Pepsinogen A is preferable to serum H+,K+-ATPase antibodies in the diagnosis of gastric body mucosal atrophy. The formation of H+,K+-ATPase antibodies does not seem to be a primary event in the development of gastric body muscosal atrophy.

Topics: Adult; Aged; Antibodies, Bacterial; Chronic Disease; Gastric Mucosa; Gastritis, Atrophic; H(+)-K(+)-Exchanging ATPase; Helicobacter pylori; Humans; Middle Aged; Pepsinogen A; Reference Values; Schilling Test; Sensitivity and Specificity; Serologic Tests; Vitamin B 12

Iron absorption is known to be impaired in the setting of gastric achlorhydria, yet gastric atrophy is not usually considered an aetiological factor for iron deficiency anaemia. We aimed to determine the prevalence of achlorhydric gastric atrophy in patients with iron deficiency and no identifiable source of gastrointestinal blood loss, and to assess whether gastric, as well as duodenal, biopsies should be routinely performed in these patients.. Forty-one consecutive patients with iron deficiency anaemia and no specific gastrointestinal symptoms or evidence of a bleeding lesion on faecal occult blood testing or upper gastrointestinal or colonic endoscopy.. As well as routine duodenal biopsies, samples were taken from gastric corpus and antrum for evidence of gastric atrophy. Achlorhydria was considered to be present if plasma gastrin measured on a sample obtained with the patient fasting was over 200 ng/l. Serum was tested for intrinsic factor and gastric parietal cell antibodies.. Haemoglobin concentrations ranged from 4.1 to 10.9 g/dl. Eight (20%) of the 41 patients had corpus-predominant or generalized atrophy and high plasma gastrin levels, of whom six had serum intrinsic factor and/or gastric parietal cell antibodies: two also had Giardia lamblia organisms in duodenal biopsies. Four other patients (10%) had villous atrophy of the duodenum.. As well as confirming the importance of seeking coeliac disease in patients with iron deficiency anaemia, our results suggest that achlorhydric gastric atrophy is also a common association. Gastric biopsies should be taken in patients with no other explanation for anaemia. The finding of Giardia organisms in two achlorhydric patients, with a possible contributory role, suggests that duodenal biopsies should be obtained even if serum coeliac-related antibodies are absent.

Topics: Adolescent; Aged; Aged, 80 and over; Anemia, Iron-Deficiency; Biopsy; Duodenum; Endoscopy, Gastrointestinal; Female; Folic Acid; Follow-Up Studies; Gastrins; Gastritis, Atrophic; Hemoglobins; Humans; Male; Middle Aged; Prevalence; Prospective Studies; Stomach; Vitamin B 12

Topics: Achlorhydria; Adenosine Deaminase; Anemia, Pernicious; Gastric Mucosa; Gastritis, Atrophic; Humans; Vitamin B 12

Healthy people can have low levels of cobalamin (vitamin B12) without symptoms or signs of cobalamin deficiency. Early detection of deficiency is imperative for treatment to be effective. Development of radioimmunoassay tests has greatly improved accurate determination of cobalamin (Cbl) levels. Nevertheless, results of studies of Cbl deficiency vary widely because of the variety of populations studied.. In a prospective study, we tested 100 consecutive, unselected geriatric outpatients in a primary care setting to determine the prevalence of cobalamin deficiency. All patients, 65 years of age or older, who visited the office of one of the authors during a period of 11 consecutive working days, had their serum Cbl level checked. If the level was 299 pg/mL or lower, serum intrinsic factor and parietal cell antibodies, serum gastrin, part 1 Schilling test, serum methylmalonic acid, and total homocysteine were done, when possible, for the diagnosis of type A gastritis and intracellular Cbl deficiency.. Sixteen percent of geriatric outpatients had serum Cbl levels of 200 pg/mL or below, and 21% had levels between 201 and 299 pg/mL. Among the 16 patients with levels < or = 200 pg/mL, 2 patients had macrocytic anemia, 3 patients had peripheral neuropathy, and 8 patients had type A gastritis. Among the 21 patients with levels of 201 to 299 pg/mL, 2 patients had peripheral neuropathy, 9 patients had type A gastritis, and none of the patients had macrocytic anemia. Among the patients whose methylmalonic acid and total homocysteine levels were determined, the results were high in 80% of those with Cbl levels < or = 200 pg/mL and in 33% of those with levels from 201 to 299 pg/mL.. The prevalence of Cbl deficiency in geriatric outpatients was found to be higher than in any recent report. The lower limit of the normal range for Cbl level should be increased to 300 pg/mL.

Topics: Aged; Aged, 80 and over; Female; Gastritis, Atrophic; Homocysteine; Humans; Male; Methylmalonic Acid; New York; Outpatients; Peripheral Nervous System Diseases; Prevalence; Prospective Studies; Vitamin B 12; Vitamin B 12 Deficiency

Serum concentrations of group I pepsinogens (pepsinogen-I) and gastrin were determined in patients with dementia disorders in order to assess the relationship, if any, between these indices of gastric mucosal function and serum cobalamin (vitamin B12) levels. A significant positive correlation between pepsinogen-I and B12 and, as expected, an inverse relationship between gastrin and pepsinogen-I concentrations was found, indicating that vitamin B12 deficiency was mainly determined by gastric mucosal atrophy (atrophic gastritis) in this West-Swedish sample of patients with dementia disorders. Patients with low B12 but normal gastrin and pepsinogen-I concentrations should, therefore, be further evaluated for possible nutritional deficiency, as well as nongastric causes of poor B12 assimilation from the diet.

Topics: Aged; Aged, 80 and over; Dementia; Female; Gastric Mucosa; Gastrins; Gastritis, Atrophic; Humans; Intestinal Absorption; Male; Pepsinogens; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Aged; Aged, 80 and over; Female; Gastritis; Gastritis, Atrophic; Health Status Indicators; Humans; Male; Vitamin B 12

Serum vitamin B12 concentrations were determined in 129 patients and a pentagastrin test performed in 116 patients with dermatitis herpetiformis (DH). Low serum vitamin B12 levels were found in 27 patients (21%) and achlorhydria in 30. Forty-two patients with achlorhydria and/or vitamin B12 deficiency were subjected to further haematological and gastrointestinal investigations. Functional or morphological involvement of the small intestine was seen in almost all patients with vitamin B12 deficiency but, in addition, atrophic gastritis resulting in defective secretion of intrinsic factor (pernicious anaemia) was found in 8 cases (7% of all DH patients). Thus, a low vitamin B12 level in DH patients should result in a careful gastrointestinal examination as both an atrophic gastritis and a coeliac-like enteropathy have further clinical implications.

Topics: Achlorhydria; Adult; Aged; Anemia, Pernicious; Dermatitis Herpetiformis; Female; Gastritis, Atrophic; Humans; Intestines; Male; Middle Aged; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adult; Cobalt Radioisotopes; Female; Gastritis; Gastritis, Atrophic; Humans; Intestinal Absorption; Male; Middle Aged; Vitamin B 12

Topics: Adolescent; Anemia, Pernicious; Gastric Acid; Gastric Mucosa; Gastritis; Gastritis, Atrophic; Humans; Intestinal Absorption; Male; Vitamin B 12

Topics: Adult; Age Factors; Duodenal Ulcer; Gastric Mucosa; Gastritis, Atrophic; Gastroenterostomy; Humans; Intestinal Polyps; Iron; Male; Middle Aged; Postoperative Complications; Precancerous Conditions; Stomach Neoplasms; Time Factors; Vitamin B 12

Serum vitamin B12 concentration, parietal cell antibodies (PCA), peak acid output vitamin B12 resorption capacity were determined in 76 patients (age 23 to 82 years). Gastroscopy was performed on all of these patients; guided biopsy was taken from 70 of them. No influence of the inflammatory changes in the gastric mucosa, sex or the presence of PCA on the serum vitamin B12 concentration were demonstrable in our patients, who all revealed a vitamin B12 resorption in the normal range. In particular we were unable to confirm the observation of Döscherholmen et al. (5) of a fall in serum vitamin B12 concentration with increasing age or decreasing PAO. Hence the estimation of the serum vitamin B12 concentration cannot be used as a screening test for selecting those patients suffering from chronic atrophic gastritis and achlorhydria, who should be monitored by gastroscopy and biopsy because of an increased risk of gastric cancer.

Topics: Achlorhydria; Adult; Aged; Aging; Female; Gastric Juice; Gastritis; Gastritis, Atrophic; Humans; Male; Middle Aged; Regression Analysis; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia; Anemia, Hypochromic; Autoantibodies; Autoimmune Diseases; Biological Assay; Biopsy; Cobalt Isotopes; Complement Fixation Tests; Fluorescent Antibody Technique; Folic Acid; Gastric Acidity Determination; Gastritis; Gastritis, Atrophic; Humans; Intestinal Absorption; Pathology; Thyroid Gland; Vitamin B 12

Topics: Achlorhydria; Anemia; Anemia, Pernicious; Blood; Carbachol; Gastric Juice; Gastritis; Gastritis, Atrophic; Geriatrics; Histamine; Humans; Hydrochloric Acid; Intrinsic Factor; Pathology; Pharmacology; Vitamin B 12

Topics: Anemia; Anemia, Pernicious; Atrophy; Bodily Secretions; Cathepsins; Cobalt Isotopes; Gastric Juice; Gastric Mucosa; Gastritis; Gastritis, Atrophic; Histamine Release; Humans; Pepsin A; Urine; Vitamin B 12

Topics: Atrophy; Duodenal Ulcer; Gastritis; Gastritis, Atrophic; Humans; Intrinsic Factor; Polyps; Stomach Diseases; Stomach Neoplasms; Stomach Ulcer; Vitamin B 12

Topics: Atrophy; Biopsy; Gastric Juice; Gastric Mucosa; Gastritis; Gastritis, Atrophic; Humans; Intestinal Absorption; Intestines; Stomach Diseases; Suction; Vitamin B 12

Topics: Corrinoids; Gastritis; Gastritis, Atrophic; Humans; Vitamin B 12

Topics: Biochemical Phenomena; Gastritis; Gastritis, Atrophic; Vitamin B 12