Pernicious Anaemia Society
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No atrophy but anti-intrinsic antobody?

I am 46 years old diagnosed 6 years ago with autoimmune pernicious anemia by virtue of symptoms, low serum B12 (was 85) plus anti-intrinsic factor antibody being positive. I am negative for H Pylori.

I had my first endoscopy last week and the gastroenterologist told me my stomach had no evidence at all of any stomach atrophy which greatly surprised him as typically a person with my profile has atrophy.

He wants to do further tests looking at my blood fasting gastrin levels, and for anti-parietal cell antibodies and perhaps another endoscopy looking at acid stomach secretions. This is due to an increased risk of carcinoids if there is no stomach acid or I have achlorohydria.

Has anyone had an endoscopy with similar results? What does this all mean? Thought the stomach atrophy is the cause of low B12? I am very confused.

1 Reply

B12 deficiency can be caused by (not listed in any particular order)

a) autoimmune responses that either kill of the cells that absorb B12, or destroy the binding agent (IF) that allows the cells in the ileum to absorb B12

b) changes in level of acidity in the stomach as you get older - which also affects the ability of parietal cells to absorb B12

c) drug interactions (eg metformin, some anti-acid treatments, NSAIDs)

d) gastric surgery that compromises the ileum.

The mechanism for absorbing B12 is very delicate and specialised so lots of things can upset it resulting in malabsorption and subsequent deficiency. It can take decades for deficiency to really become manifest because of the way the body stores some B12 in the liver.

I have no idea what actually caused me to develop a B12 deficiency, just know that my absorption has been compromised somehow. Generally speaking (aside from some problems with acid reflux before I managed to get my B12 levels under control - ie treatment with the levels of B12 I needed not the levels the text books said) I don't have any problems with digestion.

Hope this helps a bit


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