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Pernicious Anaemia Society
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Pernicious aniema diagnosis

Hi i am currently undergoing tests for pa as all levels of iron and b12 are low I have been suffering bowel problems for months like chronic constipation I know it's gross but just wondered if anyone else with bowel problems have lots of mucas in stool abdominal pain sore tongue blurred vision and rapid heartbeat I would be grateful for any info or experiences in a positive diagnosis of pa

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I have had periods in the past when I had a lot of mucus in stools but I would never have thought to think that it might be connected to B12 problems and I did associate it with having a tummy bug because I would also have abdominal cramps but don't think I've had anything like that for a while, since B12 levels got sorted out.

Sore/swollen tongue is a classic symptom of B12 deficiency.

PA in the proper sense is one potential cause of B12 deficiency as it means you aren't able to absorb B12 in the ileum (it's an autoimmune response which kills off either the specialist cells or the binding agent that enables B12 to be absorbed.

The iron deficiency may be related to B12 as B12 plays a big part in health cell reproduction - including healthy red blood cells.

Aside from PA proper, B12 absorption problems also include stomach acid levels getting lower as you get older, surgery affecting the ileum (eg gastric band) and some drug interactions - including some used to treat heartburn and acid reflux eg zantac and omeprazole as well as some anti-convulsives eg gabapentin and NSAIDs.

Unfortunately the tests for PA = IFA and PCA, aren't particularly accurate so not conclusive if you get a negative result.

Whatever the cause of the B12 deficiency - and the symptoms of PA are the result of the B12 deficiency it causes - the treatment is the same - finding some way of getting B12 into you that doesn't involve the ileum - which is generally injections.

I get migraines which manifest in parts as blurred vision - get that still - have days when I know I'm not really going to be able to focus.

Unfortunately the symptoms of B12 have a huge overlap with other conditions, eg Thyroid, MS, daibetes to name a few and as a lot of these are autoimmune conditions - and the chances of having 2 autoimmune conditions + if you have one are high - you can have symptoms because of more than one condition.

I presume you have been tested for thyroid problems (though I believe interpreting tests for that can be a bit more of an art than GPs are generally aware of).

Its also possible that you could have other digestive problems that are contributing to the problems you mention - coeliacs and PA quite often occur together.

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Thanks for your info yes I've been tested for thyroidand presume was ok I ended up in a and e last night due to fainting headaches stomache pain to be honest they didn't dO antanytjing as my go is covering everything my gums are white and I honestly feel like I'm gonna die it's horrible I only asked about the mucas as I know the lining of the stomache becomes thin and wondered if it was part of that or weather there is some infection x


I agree with Gambit that sore tongue and blurred vision are classic B12 def. symptoms but it could be helpful to have a thyroid test, as symptoms often do overlap and autoimmune diseases are interlinked. We have both in our family and I've had digestive problems, IBS, etc. for years before I found avoiding gluten, eating sauerkraut and using Swedish Bitters for bowel problems have helped enormously.

This abridged version of Dr. Marc Ryan's post on Facebook explains things really well..

"Anyone who has lived with Hashimoto's knows that this is so much more than a thyroid problem. The biggest axis of trouble is often found in the thyroid-brain-gut connection. And one common problem that causes this is leaky gut or intestinal permeability. Many researchers believe that this is ground zero for autoimmune disease. It is the place that autoimmune disease is born and the place that makes it get worse and worse. And when things get worse in the gut, problems in the thyroid and brain often follow.

The small intestines are the place where leaky gut often happens. And the walls of the small intestines are lined with tiny little hair like protrusions called microvilli. On a regular microscope they kind of look like a tiny, fuzzy paint brush. This fuzzy appearance is why they came up with the term "brush border" to describe them.

This is the place where absorption happens. And many people with Hashimoto's suffer from deficiencies of important vitamins and nutrients (like vitamin D, vitamin B12 and B6, zinc, selenium, magnesium, iron, etc.). One of the reasons for this is the breakdown of these brush borders. Foods high in lectins or other inflammatory substances (like gluten, and other grains, beans and nightshades) can actually cause these brush borders to get crushed and destroyed.

The microvilli (little hairs) that make up the brush border have enzymes for this final part of digestion anchored into their membrane as membrane proteins. These enzymes are found near to the transporters that will then allow absorption of digested nutrients.

Brush border enzymes amylase, cellulase and invertase can be effective in digesting carbohydrates, proteins, and fats without causing irritation and digestion of the intestinal walls. One problem with using large quantities of pancreatic enzymes (which are commonly found in digestive enzyme formulas) is that they may actually irritate and digest the intestinal walls. The theory about the reason for this is that they help break down proteins and your intestinal walls are made of proteins. If you have leaky gut, which many of us do, these proteins are exposed. And these digestive enzymes don't know which proteins to digest and which ones to not digest. They break down all of them."

Coeliacs and people with low acid are particularly at risk of PA/B12 def. This film and links on the same site are helpful for information, writing to your doctor, etc.



Hi, I can only echo Gambit, you do sound as if you have a thyroid problem going on there - especially the sore tongue, constipation and rapid heartbeat. These are all classic thyroid symptoms. If you have been tested you need to see the thyroid results yourself; doctors' idea of normal is not a good one. If you can get the results you should post them on the thyroid forum and someone there will tell you how normal they really are. Best of luck.


Hi I have similar bowel problems (so far assumed to be IBS) and was diagnosed b12d after borderline / deficient b12 tests then trial set of injections and a year of monitoring b12 until it was deficient again. Cause unknown. I hope you get diagnosed and treated quicker. I also have quite a fast heart beat and with anxiety it quit regularly gets to around 100. My iron tends to look ok but ferritin is low so now on iron tablets until menopause... they dont really help the bowel issues! Good luck


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