Utilidad de los anticuerpos anti-células parietales gástricas y anti-factor intrínseco en el estudio de la deficiencia de vitamina B12 asociada a gastritis autoinmune y anemia perniciosa / Usefulness of anti-gastric parietal cell and anti-intrinsic factor antibodies in the study of vitamin B12 deficiency associated with autoimmune gastritis and pernicious anemia / Utilidade de anticorpos anti-células parietais gástricas e anti-fator intrínseco no estudo da deficiência de vitamina B12 associada à gastrite autoimune e à anemia perniciosa

Resumen La gastritis autoinmune (GAI) es una afección inflamatoria progresiva de la mucosa oxíntica caracterizada por la destrucción de células parietales, pérdida de factor intrínseco, malabsorción de vitamina B12 (cobalamina), hierro y otros micronutrientes y puede progresar hacia un estado avanzado de anemia megaloblástica conocida como anemia perniciosa (AP). El objetivo de este estudio fue determinar la deficiencia de vitamina B12 debida a malabsorción utilizando la detección de anticuerpos anti-células parietales gástricas (ACPG) y anti-factor intrínseco (AFI). Se analizaron 2050 sueros de pacientes con un inmunoanálisis quimioluminiscente para vitamina B12 total y 2,8% de éstos con las pruebas de inmunofluorescencia indirecta para ACPG y enzimoinmunoanálisis para AFI. La deficiencia de vitamina B12 (<200 ng/mL) fue del 13,1%. En la detección de anticuerpos se encontró: 2 doble positivos ACPG/AFI, 17 simple positivos ACPG y 4 simple positivos AFI. Todas las muestras ACPG y/o AFI positivas tuvieron valores de vitamina B12 total <200 ng/mL. En 5 pacientes con ACPG positivos se diagnosticó gastritis crónica confirmada por biopsia. En los 6 pacientes AFI positivos se realizó el diagnóstico de AP y en 2 de ellos se confirmó por histopatología. La positividad de ACPG y/o AFI permitió la clasificación de pacientes con sospecha de GAI en candidatos para la examinación histológica y la aplicación de esquemas terapéuticos adecuados. Se destaca la importancia de las pruebas de laboratorio como parte de una estrategia de diagnóstico temprano y vigilancia endoscópica, para evitar las manifestaciones relacionadas con la deficiencia de hierro y vitamina B12 y las complicaciones de la enfermedad avanzada.

Abstract Autoimmune gastritis (AIG) is a progressive inflammatory condition of the oxyntic mucosa, characterised by gastric parietal cell destruction, loss of intrinsic factor, and malabsorption of vitamin B12 (cobalamin), iron and other micronutrients; conditioning progress to a state of megaloblastic anemia known as pernicious anemia (PA). The aim of this study was to determine vitamin B12 deficiency due to malabsorption utilizing anti-parietal cell (APCA) and anti-intrinsic factor (IFA) antibodies detection. 2050 patient serum samples were analised by chemiluminescent immunoassay for vitamin B12. A total of 2.8% of them were tested for APCA by indirect immunofluorescence and for IFA by enzyme immunoessay. Vitamin B12 deficiency (<200 ng/mL) was 13.1%. Regarding antibody detection: 2 APCA/IFA double positives, 17 APCA simple positives and 4 IFA simple positives were found. APCA and/or IFA positive samples had total vitamin B12 values <200 ng/mL. Chronic gastritis confirmed by biopsy was diagnosed in 5 patients with positive ACPG antibodies. All 6 IFA positive patients were diagnosed with PA, while 2 of them also received histopatologic confirmation. APCA and/or IFA confirmation allowed for the classification of patients with suspicion of AIG as possible candidates for histologic examination and application of appropriate therapeutic schemes. Importance of laboratory testing is to be noted; as part of a strategy that enables early diagnosis and adequate endoscopic surveillance, to avoid manifestations related to iron and vitamin B12 deficiency and the complications of advanced disease.

Resumo A gastrite autoimune (GAI) é uma doença inflamatória progressiva da mucosa oxíntica, caracterizada pela destruição das células parietais gástricas, perda do fator intrínseco, má absorção de vitamina B12 (cobalamina), ferro e outros micronutrientes pode progredir para um estado avançado de anemia megaloblástica conhecida como anemia perniciosa (AP). O objetivo deste estudo foi determinar a deficiência de vitamina B12 por má absorção usando a detecção de anticorpos anti-células parietais gástricas (ACPG) e anti-fator intrínseco (AFI). Foram analisados 2050 soros de pacientes com um imunoensaio quimioluminiscente para vitamina B12 total, 2,8% deles com testes de imunofluorescência indireta para ACPG e enzimaimunoensaio para AFI. A deficiência de vitamina B12 (<200 ng/mL) foi de 13,1%. Na detecção de anticorpos foram encontrados: 2 duplo positivos ACPG/AFI, 17 simples positivos ACPG e 4 simples positivos AFI. Todas as amostras ACPG e/ou AFI positivas apresentaram valores de vitamina B12 total <200 ng/mL. Gastrite crônica confirmada por biópsia foi diagnosticada em 5 pacientes positivos para ACPG. Nos 6 pacientes AFI positivos o diagnóstico de AP foi feito e em 2 deles foi confirmado por histopatologia. A positividade para ACPG e/ou AFI permitiu a classificação de pacientes com suspeita de GAI em candidatos para exame histológico e a aplicação de esquemas terapêuticos adequados. Destaca-se a importancia dos testes laboratoriais, como parte de uma estratégia de diagnóstico precoce e vigilância endoscópica, para evitar manifestações relacionadas à deficiência de ferro e vitamina B12 e complicações da doença avançada.

A mother's deficiency, a baby's challenge: vitamin B12 deficiency-related seizures and pancytopenia in an infant

Anemia is prevalent in pediatric age and it stems from diverse factors. While iron deficiency is a common cause above six months of age, other nutritional deficits contribute to the disease burden. During pregnancy, anemia due to nutritional deficits is associated with adverse outcomes for the newborn. Precise diagnosis of dietary deficits in the pediatric population is vital to avert negative health consequences. We describe the case of a six-month-old exclusively breastfed infant with a mother having unspecified anemia under folic acid supplementation. The infant presented with neurological symptoms, including paroxysmal events and developmental regression. Laboratory analysis revealed pancytopenia and severe vitamin B12 deficiency. The patient’s mother's serum level of vitamin B12 was also low and ant parietal cell antibodies were positive, suggesting maternal autoimmune gastritis. Treatment with hydroxocobalamin led to clinical and analytical improvement. Maternal deficiency is the major cause of cobalamin deficiency in infants. It is paramount to raise awareness to this issue to prevent its avoidable repercussions.

Deficiencia de vitamina B12 en gastritis autoinmune y anemia perniciosa. Pruebas bioquímicas y mecanismos inmunológicos implicados / Vitamin B12 deficiency in autoimmune gastritis and pernicious anemia. Biochemical tests and immunological mechanisms involved / Deficiência de vitamina B12 em gastrite autoimune e anemia perniciosa. Testes bioquímicos e mecanismos imunológicos envueltos

Resumen La deficiencia funcional de vitamina B12 o cobalamina puede ser causada por defectos adquiridos en su absorción, metabolismo y transporte; el origen de la misma puede deberse a la presencia de una enfermedad autoinmune primaria como la gastritis autoinmune o la anemia perniciosa. Es importante destacar que el metabolismo de la cobalamina puede verse afectado por diversas condiciones, como la deficiencia de factor intrínseco, enfermedad celíaca, enfermedad de Crohn, gastritis autoinmune, cirugía gástrica y el abuso de alcohol, entre otras. El diagnóstico oportuno de la deficiencia y diferencial de su etiología es crítico para evitar los síntomas neurológicos que pueden ser irreversibles. El objetivo de esta revisión fue considerar la deficiencia de vitamina B12 asociada a gastritis autoinmune y a otras enfermedades autoinmunes. Primero, se revisó el metabolismo de la cobalamina, proteínas transportadoras y derivados biológicamente activos y se continuó con las diferentes pruebas de laboratorio disponibles para el estudio de la deficiencia de vitamina B12. Al mismo tiempo, es de interés comprender los mecanismos inmunológicos implicados en la patogénesis de la gastritis autoinmune y anemia perniciosa. Del mismo modo, se hizo referencia a otras enfermedades autoinmunes, las que por presentarse con deficiencia de cobalamina deberían ser consideradas para su estudio.

Abstract Functional deficiency of vitamin B12 or cobalamin can be caused by acquired defects in its absorption, metabolism, and transport, with its cause possibly linked to the presence of a primary autoimmune disease such as autoimmune gastritis or pernicious anemia. It is important to note that cobalamin metabolism can be affected by various conditions, including intrinsic factor deficiency, celiac disease, Crohn's disease, autoimmune gastritis, gastric surgery, and alcohol abuse, among others. Timely diagnosis of deficiency and distinguishing its etiology is critical to prevent potentially irreversible neurological symptoms. The aim of this review was to consider vitamin B12 deficiency associated with autoimmune gastritis and other autoimmune diseases. Cobalamin metabolism, transport proteins, and biologically active derivatives were reviewed, followed by a consideration of different laboratory tests available to study vitamin B12 deficiency. At the same time, understanding the immunological mechanisms involved in the pathogenesis of autoimmune gastritis and pernicious anemia is of interest. Likewise, reference was made to other autoimmune diseases, which, when presenting with cobalamin deficiency, should be considered for study.

Resumo A deficiência funcional de vitamina B12 ou cobalamina pode ser causada por defeitos adquiridos na sua absorção, metabolismo e transporte; sua origem pode ser devido à presença de uma doença autoimune primária, como gastrite autoimune ou anemia perniciosa. É importante ressaltar que o metabolismo da cobalamina pode se ver afetado por diversas condições, como a deficiência de fator intrínseco, doença celíaca, doença de Crohn, gastrite autoimune, cirurgia gástrica e o abuso de álcool, entre outras. O diagnóstico oportuno da deficiência e a diferenciação da sua etiologia é fundamental para evitar sintomas neurológicos que podem ser irreversíveis. O objetivo desta revisão foi considerar a deficiência de vitamina B12 associada à gastrite autoimune e a outras doenças autoimunes. Primeiramente, foi revisto o metabolismo da cobalamina, as proteínas transportadoras e os derivados biologicamente ativos, seguidos pelos diferentes testes laboratoriais disponíveis para o estudo da deficiência de vitamina B12 . Ao mesmo tempo, é interessante compreender os mecanismos imunológicos envolvidos na patogênese da gastrite autoimune e da anemia perniciosa. Da mesma forma, foi feita referência a outras doenças autoimunes que, por apresentarem deficiência de cobalamina, devem ser consideradas para estudo.

Síndrome tirogástrico autoinmune en mujer joven

RESUMEN El síndrome tirogástrico autoinmune es la asociación entre dos patologías de origen autoinmune: la anemia perniciosa y la tiroiditis autoinmune, generalmente de presentación en adultos mayores. Se presenta caso de una mujer de 34 años que acude por derrame pericárdico asociado a una pancitopenia por déficit de vitamina B12 debida a una gastritis atrófica de origen autoinmunitaria. Se diagnostica una tiroiditis autoinmune. Recibe tratamiento con complejo B y levotiroxina, con mejoría del derrame. Es importante que ante patologías autoinmunitarias se realice la búsqueda sistemática de otras enfermedades de la misma estirpe para el mejor manejo clínico.

ABSTRACT Autoimmune thyrogastric syndrome is the association between two pathologies of autoimmune origin: pernicious anemia and autoimmune thyroiditis, which usually presents in older adults. We present the case of a 34-year-old woman who consult about pericardial effusion associated with pancytopenia caused by vitamin B12 deficiency due to autoimmune atrophic gastritis. Autoimmune thyroiditis is diagnosed. She receives treatment with complex B and levothyroxine, with improvement of the effusion. It is important that in the case of autoimmune pathologies, a systematic search for other diseases of the same lineage is carried out for the best clinical management.

Refractory iron deficiency anemia as an early manifestation of autoimmune gastritis in a teenager / Anemia ferropénica refractaria como presentación temprana de gastritis autoinmune en un adolescente

Abstract Autoimmune gastritis is an underdiagnosed disease in the pediatric population due to the absence of specific signs and symptoms and late clinical manifestations. Iron deficiency anemia has recently been identified as an early hematological manifestation, allowing an early diagnostic approach. We present the case of a Colombian teenager, with no history of autoimmunity, with refractory iron deficiency. He underwent extension studies; biopsies and serology compatible with autoimmune gastritis were documented, requiring parenteral iron in its evolution. This pathology is underdiagnosed in our context since early diagnosis requires a high index of suspicion to prevent associated complications.

Resumen La gastritis autoinmune es una enfermedad subdiagnosticada en la población pediátrica. Lo anterior se debe a la ausencia de signos y síntomas específicos y manifestaciones clínicas tardías. Recientemente se ha identificado la anemia ferropénica como una manifestación hematológica precoz, lo que permite un enfoque diagnóstico temprano. Se presenta el caso de un adolescente colombiano, sin antecedentes de autoinmunidad, con ferropenia refractaria, en el que se realizaron estudios de extensión y se documentaron biopsias y serología compatible con gastritis autoinmune, con requerimiento de hierro parenteral en su evolución. Esta patología es subdiagnosticada en nuestro medio, ya que el diagnóstico temprano requiere un alto índice de sospecha, lo que permite la prevención de las complicaciones asociadas.

Study to assess the etiology of vitamin b12 deficiency in patients of North Karnataka

Background: Vitamin B12 deficiency related anemia is a common form of anemia noted in our patients. Due to rising clinical awareness, the deficiency is recognized with increasing frequency. B12 deficiency is also known to have varied clinical spectrum than previously recognized. Prognosis of B12 deficiency is variable and its outcome may vary from complete recovery to permanent neurological deficits. Aim and objectives: To assess the etiology of Vitamin B12 deficiency in patients with B12 deficiency related anemia. Materials and methods: 75 patients diagnosed with vitamin B12 deficiency were assessed to study the etiology. Data collected was analyzed and different levels of vitamin B12 and different age groups were correlated with sex, diet pattern, etiology, anti-intrinsic factor antibody (AIFA) and levels of B12 deficiency. Results: Of the 75 patients analyzed, 44 (58.7%) were males and 31(41.3%) were females. The mean age was 35.8 year with majority of patients (33.3%) in the age group 21-30 years. 57 (76%) patients were strict vegetarians while 18 (25 %) were on mixed diet. Patients presented with general weakness (66.7%), severe anorexia (60%), dyspnoea on exertion (40%), giddiness, tingling and numbness (33.3%), jaundice (20%), and ataxia (9.3%). Mean Hb was 6.14 g% (range 1.7-11.2 g%) with MCV of 111.37 fL (64.9-134 fL). The mean serum vitamin B12 level was 125.94 pg/ml, range 30-120 pg/ml. Inadequate dietary intake (nutrition) was the most common etiology seen in 48 patients (64%), followed by alcohol in 14 (18.7%) and pernicious anemia in 9 (12%) patients. Conclusion: We observed that vitamin B12 deficiency is commonly seen in our region, which might be due to insufficient dietary intake of vitamin B12 and can be described as a treatable disease with Nagaraj Kotli, Sagar Sourabh. Study to assess the etiology of vitamin b12 deficiency in patients of North Karnataka. IAIM, 2019; 6(5): 104-111. Page 105 good short and long term outcomes. Clinical signs and symptoms, etiology, in this study were similar to those of other studies.

Gastritis autoinmune: diagnóstico y manejo de una entidad subdiagnosticada / Autoimmune gastritis: diagnosis and management of an underdiagnosed disease

Autoimmune gastritis (AIG) or chronic atrophic gastritis type A, is a chronic inflammatory disease that affects the body and fundus mucosa of the stomach. It is an underdiagnosed entity, whose clinical presentation has a broad spectrum, which may include asymptomatic patients; hematological manifestations such as iron deficiency anemia, vitamin B12 deficiency anemia (so called pernicious); non-specific digestive symptoms like dyspepsia; neurological and psychiatric manifestations. AIG is associated with other autoimmune diseases, mainly hypothyroidism ("Tyrogastric Syndrome") and type 1 diabetes. It is characterized by the development of anti-parietal cell and anti-intrinsic factor antibodies, decrease in pepsinogen I (PGI) level with low PGI/PGII ratio (< 3), and high level of gastrin. Endoscopic findings are not sufficient for the diagnosis of gastric atrophy. The use of the Sydney pathological report protocol and the OLGA/OLGIM system to evaluate the severity of gastritis have improved their diagnosis and the possibility to establish the risk of developing gastric neoplasms. The importance of its diagnosis and surveillance is based on the development of type 1 neuroendocrine gastric neoplasms, in addition to an increased risk of the incidence of gastric adenocarcinoma. Currently, an individualized endoscopic surveillance seems reasonable, with a minimum interval of 3 years.

La gastritis autoinmune (GAI) o gastritis crónica atrófica tipo A, es una enfermedad inflamatoria crónica que afecta la mucosa del cuerpo y fondo del estómago. La GAI es una entidad subdiagnosticada, cuya presentación clínica es de amplio espectro, puede incluir pacientes asintomáticos; manifestaciones hematológicas, tales como anemia ferropriva, anemia por déficit de vitamina B12 (anemia perniciosa); digestivas inespecíficas tipo dispepsia; neurológicas y psiquiátricas. La GAI está asociada a otras enfermedades autoinmunes, principalmente hipotiroidismo ("síndrome tirogástrico") y diabetes tipo 1. Se caracteriza por el desarrollo de anticuerpos anti células parietales y anti factor intrínseco, bajo nivel de pepsinógeno I (PGI) con una baja relación PGI/PGII (< 3), e hipergastrinemia. Los hallazgos endoscópicos no son suficientes para el diagnóstico de atrofia gástrica. El uso de protocolo de Sydney de reporte patológico y sistema OLGA/OLGIM para evaluar la severidad de gastritis han mejorado su diagnóstico y objetivado su riesgo de desarrollar neoplasias gástricas. La importancia de su diagnóstico y seguimiento está basada en el desarrollo de neoplasias gástricas neuroendocrinas tipo 1, además de un riesgo incrementado de la incidencia de adenocarcinoma gástrico, entre otros. Actualmente, parece razonable un seguimiento endoscópico individualizado, siendo un intervalo mínimo de 3 años.

Anemia perniciosa en una paciente con artritis reumatoide y vitíligo / Pernicious anemia in a female patient with rheumatoid arthritis and vitiligo

Resumen: Comunicamos el caso de una mujer en la cuarta década de la vida con antecedentes personales de artritis reumatoide y vitíligo, quien acudió a consulta por síndrome anémico. En su abordaje diagnóstico encontramos concentraciones bajas de vitamina B12 y anticuerpos contra factor intrínseco positivos con lo que llegamos al diagnóstico de anemia perniciosa. Este caso apoya la definición del término de síndrome de poliautoinmunidad en el que existe asociación entre diferentes enfermedades autoinmunitarias sin relación comprobada previamente.

Abstract: We report the case of a woman in the fourth decade of life with previous medical history of rheumatoid arthritis and vitiligo who presented with anemic syndrome. In the diagnostic workup we found low levels of vitamin B12 and positive intrinsic factor antibodies that corroborate the diagnosis of pernicious anemia. This clinical case supports the definition of polyautoimmune syndrome in which there is a link between different autoimmune diseases without a previous known relation.

Demencia reversible por déficit de vitamina B12 en un adulto mayor / Reversible dementia caused by vitamin B12 deficiency in an older adult

Se presenta el caso de un paciente adulto mayor con antecedente de haber presentado úlcera gástrica hace 40 años, cuyos familiares observaron desde hace dos meses cambios en el comportamiento, los cuales incluyeron progresivamente desorientación, agitación psicomotriz, negativismo, delirio de persecución, lo que motivó ser traído al servicio de emergencia. Así mismo presentó palidez marcada y equimosis múltiple, por lo cual fue admitido posteriormente en nuestro servicio y diagnosticado de demencia reversible por anemia perniciosa. También se le detectó pancitopenia y cambios neurológicos. El paciente respondió favorablemente a la administración de vitamina B12.

This is the case of an elderly patient with a 40-year history of stomach ulcer, whose relatives perceived behavioral changes for the last two months. Those changes progressively included disorientation, psychomotor agitation, negativism and delirium of persecution, which caused him to be brought to the emergency room. He also showed marked pallor and multiple ecchymosis, due to which he was hospitalized in our service and diagnosed with reversible dementia caused by pernicious anemia. Pancytopenia and neurological changes were also found. The patient responded favorably to the administration of vitamin B12.

Clinical and Epidemiological Features of 14 Cases of Pernicious Anemia on Tokunoshima Island / 日本プライマリ・ケア連合学会誌

<p><b>Objective: </b>To identify the clinical and epidemiological characteristics of pernicious anemia (PA) in patients treated at Miyagami hospital on Tokunoshima Island.</p><p><b>Methods: </b>We evaluated 14 patients with PA who were enrolled and treated from March 2009 to May 2014.</p><p><b>Results: </b>The majority of patients were older than 50 years of age and primarily consisted of elderly women. Routine medical examinations revealed macrocytic anemia in 6 of the 14 patients (43%), although they were clinically asymptomatic and subsequently diagnosed with PA. The average number of patients per year was reported to be 3 (95% confidence interval [CI]: 1.25-3.42).</p><p><b>Conclusions: </b>The annual incidence of PA per 100,000 individuals on Tokunoshima Island is possibly much higher than that previously reported in Japan. An increase in the elderly population, a negligence of the disease, and an ethnic and regional diversity may explain this discrepancy. As the annual incidence of PA may be higher than that previously reported, anemia must be carefully evaluated in the differential diagnosis of PA.</p>

Central Nervous System Complication due to Pernicious Anemia in a Patient with Rheumatoid Arthritis

Pernicious anemia (PA) is an autoimmune disease characterized by atrophic gastritis and deficiency in intrinsic factor leading to impairment of vitamin B12 absorption in the ileum. Anemia is commonly found in rheumatoid arthritis (RA); however, PA is rarely found in RA. There are few reports describing patients with both conditions; none in Korea to date. We report on a case of a 46-year-old female who presented with hypesthesia and general weakness. She was previously diagnosed as seropositive RA with myelodysplastic syndrome. She had severely impaired sensation, especially for vibration and proprioception in all limbs. Subacute combined degeneration was observed on her magnetic resonance imaging and serum vitamin B12 level was very low. Further exam results were consistent with PA and her symptoms improved with cobalamin injection. This case demonstrates that PA should be considered in RA patients presenting with both central nervous system manifestations and anemia.

La anemia como manifestación de la infección por Helicobacter pylori / Anemia as a manifestation of helicobacter pylori infection

Helicobacter pylori es el agente causal de infección más frecuente de la especie humana, con una marcada desventaja entre los países desarrollados y los países en vía de desarrollo, donde es mucho más frecuente. Si bien la infección por Helicobacter pylori cursa asintomática en la mayoría de los individuos infectados también es claro que está íntimamente relacionada con enfermedades malignas del estómago como el cáncer gástrico y el linfoma MALT; y enfermedades benignas como la gastritis crónica y la úlcera péptica duodenal y gástrica. A partir del momento en que se conoció que la mucosa gástrica podía ser colonizada por una bacteria, en la literatura médica mundial indexada (PubMed) se han informado alrededor de una centena de manifestaciones extragástricas que involucran a especialidadesmédicas tan disímiles como la cardiología, la dermatología, la endocrinología, la ginecoobstetricia, la hematología, la neumología, la neurología, la odontología, la oftalmología, la otorrinolaringología, la pediatría, la siquiatría y vascular periférico, algunas de ellas con mayor o menor acervo probatorio de la relación entre la infección por Helicobacter pylori y el desarrollo de la enfermedad. Esta revisión de la literatura médica mundial se centra en el análisis de la relación de la infección por Helicobacter pylori con las deficiencias de hierro y de vitamina B12, con o sin anemia. Se presentan para ambas formas de anemia, una visión general del problema, las evidencias de la asociación de cada una de ellas con la infección por Helicobacter pylori, la fisiopatología y el manejo en la era poshelicobacter.

Helicobacter pylori is the most common causative agent of human infection, with a marked disadvantage between developed and developing countries. Although Helicobacter pylori infection is asymptomatic in majority of individuals infected, it is also clear their close relation with malignant diseases of the stomach as gastric cancer and gastric MALT lymphoma; and benign diseases such as chronic gastritis and duodenal and gastric peptic ulcer. Since the moment that was known that the gastric mucosa can be colonized by bacteria, it has been informed about a hundred extragastric events in the indexed world medical literature (PubMed), that involves medical specialties as diverse as cardiology,dermatology, endocrinology, obstetrics and gynecology, hematology, pulmonology, neurology, dentistry, ophthalmology, otolaryngology, pediatrics, psychiatry, and peripheral vascular. Some of these with varying proofs of relation between Helicobacter pylori infection and disease development. This review was focuses on the analysis of the relationship between Helicobacter pylori infection with the iron and vitamin B12 deficiencies, with or without anemia. The information is presented for both forms of anemia, the problem overview, evidence of the association with Helicobacter pylori infection, the pathophysiology and management in poshelicobacter era.

Diagnóstico tardio da imunodeficiência comum variável / Late diagnosis of common variable immunodeficiency

A imunodeficiência comum variável (ICV) é uma doença primária do sistema imunológico associada a infecções recorrentes, principalmente no trato respiratório, fenômenos autoimunes e neoplasias. Sua incidência é relativamente baixa, mas é considerada entre as imunodeficiências primárias sintomáticas a mais comum; mesmo assim o atraso no seu diagnóstico costuma ser muito frequente. Os autores apresentam um caso de um paciente com diagnóstico prévio de anemia perniciosa que apresentava infecções respiratórias de repetição quando o diagnóstico de ICV foi suspeitado

Common variable immunodeficiency (CVID) is a primary disease of the immune system, associated with recurrent infections, mainly in the respiratory tract, autoimmune phenomena and malignancies. Although its incidence is relatively low, it is considered the most common among symptomatic primary immunodeficiencies. Still, the delay in diagnosis is very frequent. The authors present a case of a patient with previous diagnosis of pernicious anemia who presented with recurrent respiratory infections when the diagnosis of CVID was suspected

Niveles de vitamina B12 en pacientes colombianos con gastritis crónica atrófica / Levels of vitamin B12 in colombian patients with chronic atrophic gastritis

Se presenta un grupo de 75 pacientes adultos colombianos, con diagnóstico de gastritis crónica atrófica de acuerdo a los criterios de Sydney, de los cuales el 28% presentó deficiencia de vitamina B12 y al 9% se le diagnóstico anemia perniciosa.Las cifras de hemoglobina, volumen corpuscular medio no se correlacionaron con el déficit de vitamina B12. No se encontró una asociación estadística del déficit de la vitamina B12 con el género, edad mayor de 60 años de los pacientes o con la presencia del Helicobacter pylori (H. pylori).La edad promedio de los pacientes con déficit de vitamina B12 o con anemia perniciosa es menor a la que tradicionalmente se reporta para estas enfermedades.

We present a group of 75 Colombian adults who were diagnosed with chronic atrophic gastritis in accordance with the Sydney criteria. 28% of the group had vitamin B12 deficiencies: 9% were diagnosed with Pernicious anemia. Hemoglobin and mean corpuscular volume were not correlated with vitamin B12 deficiency. We found no statistical association of vitamin B12 deficiency with gender, patients over 60 years of age, or the presence of Helicobacter pylori (H. pylori). The average age of patients with vitamin B12 deficiency or pernicious anemia is less than that traditionally reported for these diseases.

Demência e neuropatia periférica reversíveis com reposição parenteral de vitamina B 12 / Improvement of dementia and peripheral neuropathy with parenteralvitamin B 12

A anemia perniciosa é a anemia por deficiência de vitami­na B 12 secundária a gastrite atrófica. Complicações incluem neuropatia periférica e lesões cerebrais que podem ou não ser reversíveis com a reposição da cobalamina. Apresentamos o caso de uma mulher de 80 anos com parestesias e piora cogni­tiva progressiva que evoluiu com paraparesia crural, deixando de deambular. Apresentava anemia megaloblástica, dosagem diminuída de vitamina B 12 e gastrite atrófica. Após o diagnós­tico de anemia perniciosa e a reposição vitamínica, a paciente evoluiu com melhora significativa. A importância deste relato de caso consiste em alertar os clínicos que o diagnóstico de anemia perniciosa deve ser considerado em idosos com neu­ropatia periférica e demência, pois a intervenção precoce pode evitar sequelas.

Gastric Adenocarcinoma in Patient with Pernicious Anemia: A Case Report

Increased risk of gastric cancer has been reported in patients with chronic atrophic gastritis that develops in conjunction with pernicious anemia. We report here a case of a gastric adenocarcinoma associated with pernicious anemia. A 40-year-old female patient had been diagnosed with anemia 6 years earlier at a local hospital. One month ago, she visited our hospital for aggravated dizziness and newly developed epigastric soreness. Her blood hemoglobin level was 4.2 g/dl, and a gastroscopic work-up for anemia discovered a 2.5-cm-sized, slightly elevated mucosal lesion at the anterior wall of the high body in the stomach. The biopsy of this lesion revealed a moderately-differentiated adenocarcinoma. She underwent a total gastrectomy with a Roux en Y esophagojejunostomy with D2 lymph node dissection. The final stage of the gastric carcinoma was identified as T1N0M0. Based on this experience, we recommend that a follow-up gastroscopy be performed in patients with pernicious anemia with atrophic gastritis because of the increased risk of gastric cancer in patients with pernicious anemia.

Deficiency Anemia

Iron deficiency anemia (IDA) and megaloblastic anemia due to vitamin B12 deficiency are well-characterized prototypes of anemia. There is no doubt that IDA is the most common hematologic disorder in Korea and worldwide as well. The diagnosis and treatment of IDA is not a difficult practice usually, however, a caution is required in detecting early-stage iron deficiency and in distinguishing IDA from anemia of chronic disorders such as chronic inflammatory disease, malignancies, chronic liver disease, and chronic renal disease. Administration of a standard iron preparation at a proper dosage over an adequate period is a prerequisite for the successful treatment of IDA, which is sometimes overlooked by both physicians and patients. Early detection and treatment as well as prevention of iron deficiency per se are also required. Pernicious anemia is the most common cause of vitamin B12 deficiency in Western populations. By contrast, the disorder is rare in Korea, although the number of cases seems to be increasing these days. The majority of patients with megaloblastic anemia reveal a history of gastrectomy. Thus, it should be reminded that vitamin B12 supplementation is important to prevent the development of overt deficiency or anemia in these susceptible individuals, since a delay in the treatment of vitamin B12 deficiency may result in an irreversible neurologic deficit.

Treatment of pernicious anemia / 대한내과학회지

No abstract available.

A Case of Mercury Intoxication Associated with Pernicious Anemia / 영남의대학술지

Pernicious anemia is the frequent cause of megaloblastic anemia, and it is the result of a vitamin B12 deficiency due to the decrease or absence of intrinsic factor (IF) because of gastric mucosa atrophy or autoimmune destruction of IF-producing parietal cells. With the existence of a severe gastric atrophy, there is a decreased in acid and IF production and a further change in vitamin B12 absorption. Mercury is ubiquitous in nature and exists in 3 forms, elemental mercury, inorganic salts and organic compounds. Organic forms, specifically methyl mercury, are the most toxic of the 3 classes of mercurials. Methyl mercury exerts its most devastating effect on the central nervous system by causing psychiatric disturbances, ataxia, visual loss, hearing loss, and neuropathy. We report a case of mercury intoxication associated with pernicious anemia. The 77 years old patient was referred to Yeungnam University Hospital for tongue pain, somatitis, headache and aggressive behavior. He had taken an unevaluated medicine for a long time. After clinical evaluation, this case was diagnosed as a pernicious anemia and the unevaluated medicine was made up of mercury. After the administration of D-penicillamine and intramuscular injection of BAL and cobalamine, clinical symptoms and aggressive behavior were improved as well as laboratory findings.