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atrophic gastritis
Etiology:
- autoimmune gastritis: pernicious anemia
- vitamin B12 deficiency
- persistent Helicobacter pylori infection
Pathology:
- chronic inflammation of the gastric mucosa
- loss of gastric glandular cells & their eventual replacement by intestinal and fibrous tissue
- impaired secretion of hydrochloric acid, pepsin, & intrinsic factor
- vitamin B12 deficiency (pernicious anemia)
- iron deficiency anemia
- small intestinal bacterial overgrowth [3]
- gastric carcinoid
Clinical manifestations:
- macrocytic anemia due to vitamin B12 deficiency
- macrocytosis may be blunted by concurrent iron deficiency
- bloating, foul-smelling stools due to small intestinal bacterial overgrowth weight loss may occur
Laboratory:
- serology for Helicobacter pylori
- rapid urease test from gastric biopsy tissue
- histology for H pylori
- anti-parietal cell antibody
- anti-intrinsic factor antibody
- serum vitamin B12
- serum iron
- serum gastrin (hypergastrinemia)
Special laboratory:
- upper gastrointestinal endoscopy for gastric biopsy
Complications:
- increased risk of gastric cancer (adenocarcinoma)
Management:
- treat Helicobacter pylori
- autoimmune atrophic gastritis
- vitamin B12 supplementation
- iron supplementation
- surveillance for gastric carcinoid [3]
Specific
pernicious anemia; autoimmune gastritis
General
gastritis
atrophy
References
- Wikipedia: Atrophic gastritis
http://en.wikipedia.org/wiki/Atrophic_gastritis
- Sepulveda AR and Katz J
eMedicine: Atrophic Gastritis
http://emedicine.medscape.com/article/176036-overview
- Medical Knowledge Self Assessment Program (MKSAP) 18, 19.
American College of Physicians, Philadelphia 2018, 2021
- Medical Knowledge Self Assessment Program (MKSAP) 20
American College of Physicians, Philadelphia 2025
- Minalyan A, Benhammou JN, Artashesyan A, Lewis MS, Pisegna JR
Autoimmune atrophic gastritis: current perspectives.
Clin Exp Gastroenterol. 2017 Feb 7;10:19-27. Review.
PMID: 28223833 Free PMC Article
- Shah SC, Piazuelo MB, Kuipers EJ, et al.
AGA clinical practice update on the diagnosis and management of
atrophic gastritis: expert review.
Gastroenterology. 2021;161:1325-1332.e7.
PMID: 34454714