Erosive gastritis and PA. Please advi... - Pernicious Anaemi...

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Erosive gastritis and PA. Please advise re diet and medication!


Hi All,

I have had PA for about 6 years and had a gastroscopy when first diagnosed.

Recent barium swallow showed moderate gastric reflux and recent gastroscopy showed mild erosive gastritis.

My GP prescribed Omeprazole which I have started very reluctantly ( side effects look worrying) but it's necessary as I am taking an anti-coagulant for a heart condition so would be at risk from a bleed if the gastritis deteriorated to ulcers.

I have been looking up all sorts of things to see if I can sort this out by dietary changes as will stop taking the Omeprazole after 4-6 weeks.

I'd be very grateful for suggestions and your experience of dealing with gastritis- and also alternatives to Omeprazole if anyone has found something good without the side effects!!

Many thanks


17 Replies

I too was diagnosed with gastritis, but I had already tried omeprazole and found it made little difference. In my case I am hypothyroidism, and have low, not high stomach acid. So lowering my stomach acid did nothing.

High stomach acid is actually quite a rare condition. It's high levels of acid during digestion that cause the sphincter at the bottom of the oesophagus to close tightly. If your acid is low, it doesn't tighten, and reflux occurs.

It's vital you check whether your stomach acid is high or low first, and there is a simple home test to find out.

If your stomach acid is low you can replace it with a product called Betaine HCL taken with meals.

I also worked to track down the causes of my reflux and for me the number one issue is grains, especially wheat barley Rye and oats, and gluten free bread. Wine is also a problem, but I can drink spirits, and Indian food.

Two years after diagnosis I am symptom free and only take Betaine with large meals. During the early stages of my move away from omeprazole I used gaviscon if I was very uncomfortable with Heartburn, and had the odd omeprazole if the pain of the gastritis got too bad. But it was only a few weeks before diet and Betaine alone were all I needed.

Of course if your stomach acid really is high then none of this will help at all. Which is why testing is essential. And then, of course an acid suppressant might be a good idea. However there are two types, and recent research suggests that the old fashioned ones like tag met are safer than the newer proton pump inhibitors.

rosyG in reply to Ruthi

Thank you for this- very useful. I will take the Omeprazole for the rest of the month and then keep on the vegan diet I have started- I am also trying to lose weight as know that helps acid reflux.

I think taking lemon juice is a good idea for me

clivealiveForum Support

Hi rosyG

I was diagnosed with P.A. 43 years ago following removal of two thirds of my stomach at the age of 17 and put on cyanocobamalin (Cytemen) injections every four weeks.

The only pain killers I avoid are those containing aspirin and have been on Lansoprazole for reflux for more years than I can remember without any side effects.

The best "antacid" in the world is Gaviscon

However having recently been diagnosed with type 2 diabetes I was moved to do a bit of research and found the following:

"Omeprazole or equivalent result in a gastric pH of 3.0, this may affect cobalamin release from food, and causes low cobalamin levels

Metformin may be associated low cobalamin levels".

Of course it depends on the cause of your absorption problems as I believe that if you are having injections of B12 the above may not be relevant to you.

I'm now 74 and still "clivealive".

I wish you well.

Many researchers believe leaky gut or intestinal permeability is the ground zero for autoimmune disease. I had stomach problems for years - gastritis, heartburn, h/pylori, gall bladder pain, IBS, etc.

After researching, I realised I was deficient - probably from the meds I was on (Zantac, antibiotics, etc.) as well as the gastritis and H/pylori. Four of us in the family have Hashimoto's thyroid disease, another autoimmune disease often linked with PA/B12 deficiency and one has severe B12 deficiency.

I eventually found huge relief by avoiding gluten, taking Swedish Bitters for IBS, Cider Vinegar for gall bladder, reflux, heartburn, and now only need to take several spoonfuls of sauerkraut daily for gastritis & H/pylori (more good bacteria than any probiotic ). Hopefully, all of this is healing the villi in my stomach wall and helping absorption of B12.

Thank you- I 'll try sauerkraut- it seems widely used

You say you have PA. Were you actually diagnosed with pernicious anaemia, or are you B12 deficient for unknown reasons?

I ask because PA is caused by Autoimmune Metaplastic Gastric Atrophy (AMGA), which means that your immune system is killing off your Gastric Parietal Cells. These cells do two things - produce Intrinsic Factor (necessary for absorption of B12) and produce hydrochloric acid.

So a diagnosis of PA (presumably from the gastroscopy) would be inconsistent with high levels of stomach acid. Indeed, one would expect the opposite.

Taking Betaine HCl, lemon juice or saurkraut to acidfy the stomch, plus a PPI to destroy stomach acid doesn't seem to make much sense

Polaris in reply to fbirder

It makes sense to me!

All the trillions of good bacteria in sauerkraut are overcoming the H/pylori, often the cause of autoimmune gastritis, and helping villi in the stomach to repair itself, thus allowing better absorption of B12? Not a scientific explanation but it works.

fbirder in reply to Polaris

I don't think H. pylori causes autoimmune gastritis. It does cause gastric atrophy, but not via an autoimmune process.

Is there good bacteria in sauerkraut? I thought the whole aim of the process was to get the pH down to less than 4 to inhibit the growth of any bacteria except the lactobacillus used in the preparation. These are then killed off when the sauerkraut is pasteurised - which is the fate of most sauerkraut in the shops. Only the raw stuff (like my grandma used to make) has all the bacteria left untouched.

Polaris in reply to fbirder

It has to be the health food shop sauerkraut, not from the supermarket - many people make their own.

rosyG in reply to fbirder

Thank you for your reply- I was diagnosed with PA after a gastroscopy a few years ago which took biopsy of parietal cells and blood tests for anti bodies- can't remember the exact details and am getting my GP to give me copies of old notes about this as have a follow up appt after the recent gastroscopy which showed 'mild erosive gastritis' I feel the PA hasn't been taken into account and the Omeprazole, given for gastric reflux, may well be the wrong medication, although may allow time for gastritis to heal. I am considering having private appointment if I can find a consultant near me (Epsom)who specialises in PA- rang the society today but just ansaphone and no-one has rung back .

None of the other reasons for gastritis relate to me- alcohol, NSAIDs etc, and I was negative for H Pylori so I think you are on the right lines re cause.

I thought if I take a short course of Omeprazole ( 4 weeks) and then start lemon juice etc, but am floundering really !!

I need to be careful I don't get real ulcers etc as am on an anti-coagulant so would have possibly serious bleeding.

I have spent hours researching how erosive gastritis may worsen/ heal itself etc but very little information so far and so thought someone with good knowledge of PA might have the answers- any more advice very welcome please!!

CarrieD2018 in reply to fbirder

Hi Fbirder, what would you suggest for low to no stomach acid? I have parietal cell antibodies and recently had an endocrine tumour removed. I know this is not reversible but I would like to know more about the disease. The doc said I'm producing too much gastric which encourages tumour growth. Is there any artificial acid that would stop my stomach from producing too much acid? There is so little info on this disease. Irony is I would say I have very good digestion! Thanks a million Carrie

fbirder in reply to CarrieD2018

See my reply to your other thread for what to do about low stomach acid (achlorhydria).

I'm surprised they removed your NET. Normal procedure is to leave them alone unless they're big (about 1 cm or bigger). Mine have been sitting quietly since they were first detected four years ago. My gastroenterologist is still happy to just look in on them once a year.

The NETs are caused by too much gastrin. In the normal body food entering the stomach switches on gastrin production and secretion of stomach acid. The acid lowers stomach pH which switches off gastrin production.

In people with achlorhydria there is no acid, no lowering of pH and no switching off of gastrin, leading to high levels in the blood - hypergastrinaemia.

When my gastroenterologist found my NETs I went off for various scans to ensure they hadn't spread elsewhere. It might be worth asking about the same - a DOTATATE PET/MRI scan is the most thorough, although you may have to travel to London to get it done.

Any other questions about NETs, feel free to send a message.

CarrieD2018 in reply to fbirder

Hi fbirder, mine was 1cm. Gastroenterologist said it's gone now. He found something else very small which he's doing a biopsy on. I'm only 42. He said he'd do a scope in five years.. but I think I should push for an annual endoscopy. What do you think? He did do an MRI of my pancreas. I had one b12 shot and my levels went from 195 to over 1000 (one month post shot). I've been taking a b12 under tongue spray as well. My iron and folate levels are seemingly fine. I'm seeing a neurologist next week as I've been experiencing numbness in my hands the last six months, this for very bad in the new year where for two weeks my hands were numb every night and all day New Year's Day. The last week this has just gone away. Palpitations have gone too. I've gone from hardly ever going to doctor to being a regular in the last two months. Doctor will give me loading shots after the neurologist (do I even need them if my b12 levels are over 1000). It's all a bit overwhelming! Thanks for your advice Carrie

I also have P.A., and did have a lot of tummy problems. After going to 2 gastroenterologists,and getting no help at all. a professor of Gastroenterology told me that P.A. sufferers can take it as read that they suffer from either LOW or NO stomach acid(which is Hydrochloric acid.) This means that your food ferments and produces bad bacteria instead of being digested. This leads to tummy problems. pain and bloating. There is no treatment for this in the NHS. I have more or less solved this by taking pro and pre biotics.and avoiding white processed wheat flour. Sauerkraut also helps, and organic raw cider vinegar(diluted) So, I would say that as you have P.A. any antacid or PPI (omeprazole)) is the worst thing that you can take!

Some people take Hydrochloric Acid capsules with Pepsin for low stomach acid. I hope that this has helped. All the best!

fbirder in reply to wedgewood

Yup, I take capsules that contain Betaine hydrochloride and pepsin. The former releases hydrochloric acid when wet, the latter helps digest proteins.

What pre/probiotics do you take, and in which format? I used to have yoghurt (with little beasties in it) with my breakfast cereal, but I seem to have developed an intolerance to dairy stuff.

wedgewood in reply to fbirder

Quite by chance I discovered a marvellous water-based probiotic called SYMPROVE.. It has been researched at Kings College. It has worked extremely well for me. After 4 months, I could halve the dose. This could suit you because there is no lactose in it at all. Only draw back---it has to be refridgerated. I have some of those capsules but am afraid to take them! Symprose is quite expensive, but has been a life-saver for me. Best wishes.

fbirder in reply to wedgewood

Ah, yes, I recall you mentioning that before. ''Twas the price that put me off. Maybe I'll have to give it a go.

There's an article in New Scientist this week that mentions several studies on how gut microflora can influence our food preferences.

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