Diet changes with Pernicious Anemia that led to mild gastritis???

[Nanc72]

Has anyone with PA had an endoscopy that showed mild or severe gastritis? I just had mine done and am finishing up a 7 day dose of carafate that I guess coates and will heal my stomach lining. My understanding is that the PA caused this inflammation so I am wondering if I should follow a low inflammation diet? Has anyone else heard of or done this? I don’t have a gluten allergy or sensitivity (was tested), but that’s one of the things they say to remove along with caffeine, tomatoes, dairy...so before I go in full force I was wondering your thoughts?????

[fbirder]

If you have PA then it is caused by Autoimmune Metaplastic Gastric Atrophy. With AMGA the immune system attacks the gastric parietal cells. These have two jobs - making stomach acid and making Intrinsic Factor. IF is required to escort the B12 molecule across the gut wall (it is too big to get across unaided).

If your gastric atrophy was due to an autoimmune attack of GPCs then the inflammation would be restricted to the areas where those cells are found - the fundus (top) and body (middle) of the stomach, not the antrum (bottom). This should have been found when they did the endoscopy. Also, if they took biopsy samples then they should have shown signs of metaplasia under the microscope.

Did anybody tell you why you have gastritis? Normally it is due to AMGA, infection with H. pylori, overuse of NSAID painkillers or too much gastric acid. The carafate suggests they have decided it is the last of those. If so they're just painting over the cracks in your stomach without treating the cause.

I would go and see the gastroenterologist and ask - What is the cause of my gastritis? Why do you think it's that? Has it anything to do with my PA?

[Nanc72 in reply to fbirder]

It was very mild and it was in the antrum. All my biopsies were normal. No H pylori, nothing. I do take medication for migraines but it doesn’t contain aspirin. I also don’t drink. He didn’t know what the cause was. Every other part of my stomach and esophagus were normal.

[fbirder in reply to Nanc72]

It doesn't sound like it's anything to do with PA. Definitely not something I would change my diet over.

[Nanc72 in reply to fbirder]

Can you have weakened stomach lining with PA and NOT have Atrophic gastritis? I see him next month. Going to have to narrow this down. I have no symptoms except occasional nausea and not wanting to eat a lot at times. No heartburn, reflux, nothing! Weird. Thanks for the info though

[topher2018 in reply to Nanc72]

I am not following your questions. Do you have PA? If yes your stomach/digestive issues are likely to be related - either due to your immune system attacking your parietal cells or the lack of stomach acid or both. You might have other things going on as well but those two things will cause issues.

Many would recommend a low inflammation diet regardless of PA. I am on a low inflammation diet to try to dampen the damage from my PA.

My endoscopy showed no visual indication of AMAG but it showed up in the biopsy. I think the biopsy I had five years prior came back clean. So I think the ability to detect it through biopsy takes a while.

[Hidden]

I had mild gastritis in the antrum and I have a confirmed PA diagnosis. One of the best things you can do in following a non inflammatory diet is to reduce or eliminate gluten (regardless of coeliac status) reduce or eliminate dairy and totsllly eliminate processed foods. I’m currently doing that and it does help. Google Mediterranean Diet and try something like that and see how you go.

[GastritisB12]

I too was diagnosed with mild gastritis first, no H Pylori after 3 different tests, then eventually they found low B12 and mild anti-parietal antibodies. Definitely get tested for parietal antibodies if you have no H Pylori, it could mean autoimmune gastritis. My understanding is autoimmune gastritis causes pernicious anemia not the other way round?

[Nanc72 in reply to GastritisB12]

Thank you for all the information. I am going to switch to a low inflammation diet, and yes I already was confirmed with PA through antibody testing. I am concerned because my understanding of AMGA is that you need more frequent endoscopys due to an increase in stomach cancer? My biopsies showed nothing. H pylori was negative. I just want to ask the right questions when I follow up. This has been going on for 3 years and I just got a diagnosis on February 25. I really appreciate all the help from all of you😊

[GastritisB12 in reply to Nanc72]

Yes, my gastroenterologist said follow up every two years. I am at the intestinal metaplasia stage. They need to monitor if it progresses. I read that the next bad stage is dysplasia. If you haven't been for a endoscopy for 3 years definitely go back for another one.

[Nanc72 in reply to GastritisB12]

I just had mine done a week ago. The one from 9 years ago showed nothing. That was way before I knew anything about all of this. I will definitely make sure he explains to me why I don’t need to come back in a few years if he says I don’t need to. Thank you

[GastritisB12 in reply to Nanc72]

If the gastroenterologist says you don't have to come back that must be a good thing. I am sure they know what follow up you need/dont need based on biopsies.

[topher2018 in reply to GastritisB12]

That sound right. I should have said I am trying to dampen the damage from my AMAG with PA being part of the damage. Although it is still unclear to me if the immune system could just be attacking the intrinsic factor but not the parietal cells - in which case you could have PA with autoimmune intrinsic factor destruction (AIFD - an acronym I just made up) but no AMAG. Sounds like that might be the case with Nanc72.

[topher2018]

Yes. That would be great news. It could mean that your immune system is only attacking the intrinsic factor but not the parietal cells. I tried to research whether this was possible several months ago and the impression I got was that it was unlikely but not definitively ruled out. In any event I would try to keep it that way if it were me. Again I don’t think there is any definitive scientific evidence that diet has any impact on this but I figured I needed to change what I was doing. Because what I had been doing ended up with me having PA (not saying it caused it but it definitely didn’t stop it). Based on what I read here the message I got was to not sweat the increased stomach cancer risk too much because it is still very rare. And mostly they discover easily removed nodules (not the proper medical term). And in your case your stomach seems to be fine. Have you looked into any tests of your stomach acid production? You might consider monitoring it. My theory (not that I invented it, just that I think it may be true) is that once acid production drops and digestion is impaired it increases likelihood of developing new autoimmune problems or exacerbating existing ones due to leaky gut, off balance gut biome or something like that.

[Nanc72 in reply to topher2018]

When I brought up low stomach acid and if it need to be treated, my GI Dr., blew that off. I don’t even know if I have low stomach acid or not. I am going to ask when I go for follow up. I am just so overwhelmed with all of this and the need to get better. I thought since I wasn’t anemic I may have low iron, because I have some tell tale signs. Just got my labs back from the hematologist and now I have a low Hemaglobin and Hematocrit along with some other indicators, but the iron stuff was normal. 3 weeks ago exactly my Hemaglobin and Hematocrit were normal! Ugh....does it ever end?....

[topher2018]

My GI doc blew off the acid too. And the diet. And he said the digestive problems and pain were from stress. But he’s the same doctor that missed the PA 5-6 years ago. Second GI doc said the same thing. Can you evacuate your bowels and are you bleeding internally? If yes to first and no to second why are you here? Ha. So I decided they were for endoscopy procedures and that I would consult with others to try to feel better.

[Nanc72 in reply to topher2018]

I did have tiny, almost pin point like blood in my antrum that he couldn’t give a reason for. I don’t have an ulcer, nor am I bleeding in the stomach. It was on the lining and very small. I am also a very type “A” person. I wouldn’t be surprised if my gastritis was from stress, LOL. He said something about even a person with low acid could take the paint off a car if they got sick on it. These Dr’s just amaze me. I may end up switching to someone else after my follow up.