I'm new here and had a couple questions. A little history.. I had the parietal cell antibody test done (3 times) and each time my test has come back abnormal with a reading of 113.5 or higher. My intrinsic factor was negative about a year ago and hasn't been tested since. My B12 levels have run on the lower side in the past (200s-300s range). I have a history of iron deficiency, my ferritin levels have been as low as 3 before and my vitamin D levels are low too. I've done my own experiments with starting and stopping supplements over the years and noticed that I simply do not absorb these nutrients at all without them. I have a healthy diet and keep track of my food intake to make sure I get enough of these nutrients. I do have a long history of stomach problems, recently I was diagnosed with Barrett's Esophagus and the doctor says he thinks I have pernicious anemia along with atrophic gastritis because I have intestinal metaplasia and inflammation. My main symptoms over the years have been tingling in upper left leg, weakness, upper stomach pain/heartburn symptoms, constipation, undigested food in stool, and lots of nausea. What I wanted to know is pernicious anemia related to atrophic gastritis or autoimmune AG? Is one caused by the other? Is there any specific tests I should have done to get a definite diagnosis?
Thanks so much for reading!
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yogamom1
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From what I've read, pernicious anemia is very much related to (caused by) autoimmune AG. emedicine.medscape.com/arti... (if the link asks you to log in, you can just google "autoimmune gastritis" and click on the Medscape link and you can bypass the login). But I'm just a newbie here so am curious what others have to say about this.
My last endoscopy also showed intestinal metaplasia as well as inflammation, various lesions and ulcers in the stomach. Negative for H-pylori. Erosive esophagitis. My father had barrett's that turned into esophageal cancer (but he never once had a single endoscopy so it was way too late once they caught it. I'm wondering now if he had PA). I haven't had any of the antibodies tested yet; no PA diagnosis (yet?). Same symptoms as you! Also have difficulty keeping vitamin levels up unless I supplement heavily. Previous GI doc told me I just had IBS and to exercise 2 hours every day. Um, yeah....
I've found Betaine HCl to help quite a bit with the reflux and slow digestion, but I didn't find that digestive enzymes helped, though. Avoiding mixing high fat and high sugar foods helps. I recently figured out tomato paste/sauce gives me bad reflux. Not being hypo helps my digestion too. Sleep apnea can also cause silent nighttime reflux. Anyway, my 2 cents!
I can't answeryour question specifically, but l also have absorption problems as well as neurological symptoms from low b12. My test results showed my b12 to be 290.
I was also low in iron and vitamin D.
Are you getting B12 injections? Are you in the U.K. or the U.S.?
I'm in the U.S. And my normal GP agreed to injections but after a year on Cyanocobalami-monthly injections- there was no change in my symptoms. That's when I decided to go to a naturopath who prescribed more frequent injections of methylcobalamin, which has helped a lot. I also took iron supplements and take sublingual D drops as I don't absorb the kind you swallow.
I never had any testing done for ag or pa but based on my low b12 & both GP and naturopath agreed to B12 injections.
I was also diagnosed with IBS a few years ago.
Based on your symptoms and low B12 levels, it would be beneficial for you to have B12 injections, in mho.
I am not a medical professional, just a person who can't absorb nutrients!
Yes , they are related . I had awful tummy problems with PA . Gastroenterologist told me that PA patients have no or low stomach acid (Achlorhydria and Hypochlorhydria respectively) The NHS has no treatment for this . The stomach flora is upset. . I found taking a probiotic has helped me completely (,I took Symprove initially . Now I make my own organic sauerkraut using red or white cabbage . I eat a small portion every day--- truly marvellous, natural and cheap. . It should be eaten raw . Cooking kills the probiotic content to a certain extent) I do not take the Betaine hydrochloric acid with pepsin capsules as I did in the beginning . Getting your stomach flora in better shape should help enormously . And of course your doctor should be treating you withB12 injections as he "thinks" that you have PA !You should be tested with the Intrinsic Factor antibody test ? Positive means that you have PA , negative means you could have PA . !!!!! If he only thinks that , and has no proof he should be treating you ! My very best wishes to you .
This presentation looks at autoimmune atrophic gastritis from the carcinoid side of things. But it is a fairly good explanation as to what the problem is.
Thank you all for your helpful and supportive replies. I haven't been treated with b12 injections yet but I do supplement very heavily. I struggle to stay in the 500 range doing this. I am going to ask about the injections at my next doctor visit. Does anyone know how often I should be getting them? My doctor said he was going to test intrinsic factor next time but that won't be until December. The last time it was negative.
One thing I have been concerned and confused about is that I have Barrett's esophagus so my doctor has prescribed me acid reducer omeprazole 40mg daily thinking I have an over production of acid. With the other issue of pernicious anemia/atrophic gastritis I've read multiple sources saying that low stomach acid is a complication. I haven't started my omeprazole because of this and am unsure how to treat both conditions simultaneously. I've researched everywhere but can't really find anyone with both diagnosis'.
Thanks again everyone!!
***edit: I also forgot to mention that I have been told I do not have h pylori (tested thru biopsy) and blood test as well a few times. This is why I think my atrophic gastritis is probably autoimmune.
page 8 of the "BCSH Cobalamin and Folate Guidelines" gives details of UK B12 recommended treatment. If you have neuro symptoms the treatment is more intensive but be warned that a lot of people struggle to get the more intensive treatment if they have neuro symptoms.
Page 29 gives details of the process doctors should follow with someone they suspect has B12 deficiency. It also mentions Antibody Negative Pernicious Anaemia meaning PA where the IFA test comes back negative.
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IF & Parietal Cell antibodies 
Homocysteine and Anti-parietal cell antibody tests if supplementing with Folic acid 
Low B12 but Negative Parietal Cell Autoantibodies
Intrinsic Factor and Gastric Parietal Cells Negative
