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Pernicious anemia: new insights from a gastroenterological point of view.
World J Gastroenterol 2009; 15(41):5121-8WJ

Abstract

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.

Authors

No affiliation info availableNo affiliation info available

Pub Type(s)

Editorial
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

19891010

Citation

Lahner, Edith, and Bruno Annibale. "Pernicious Anemia: New Insights From a Gastroenterological Point of View." World Journal of Gastroenterology, vol. 15, no. 41, 2009, pp. 5121-8.
Lahner E, Annibale B. Pernicious anemia: new insights from a gastroenterological point of view. World J Gastroenterol. 2009;15(41):5121-8.
Lahner, E., & Annibale, B. (2009). Pernicious anemia: new insights from a gastroenterological point of view. World Journal of Gastroenterology, 15(41), pp. 5121-8.
Lahner E, Annibale B. Pernicious Anemia: New Insights From a Gastroenterological Point of View. World J Gastroenterol. 2009 Nov 7;15(41):5121-8. PubMed PMID: 19891010.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Pernicious anemia: new insights from a gastroenterological point of view. AU - Lahner,Edith, AU - Annibale,Bruno, PY - 2009/11/6/entrez PY - 2009/11/6/pubmed PY - 2010/2/24/medline SP - 5121 EP - 8 JF - World journal of gastroenterology JO - World J. Gastroenterol. VL - 15 IS - 41 N2 - 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. SN - 2219-2840 UR - https://www.unboundmedicine.com/medline/citation/19891010/Pernicious_anemia:_new_insights_from_a_gastroenterological_point_of_view_ L2 - http://www.wjgnet.com/1007-9327/full/v15/i41/5121.htm DB - PRIME DP - Unbound Medicine ER -