Autoimmune Gastritis - Low B12 and Pe... - Pernicious Anaemi...

Pernicious Anaemia Society

31,808 members22,935 posts

Autoimmune Gastritis - Low B12 and Pepsin in saliva

iankerudder profile image
14 Replies

I was just diagnosed with AG (from biopsy).

Next they tested my B12 - 339 so on the lower end

Started b12 subling - and now B12 >2000

I also have esophageal symptoms of burning there and in my throat...

Took Pepsin test and they detected Pepsin in my saliva

Gastro says since there was no acid found on my bravo test that the pepsin isn't dangerous without acid.

Has anyone had a similar experience and what's the treatment plan for you? Thank you for any info.

Written by
iankerudder profile image
iankerudder
To view profiles and participate in discussions please or .
Read more about...
14 Replies
fbirder profile image
fbirder

330 isn't at the low end. It's just about average for normal people. The fact that oral B12 shot your level to above the top of the range strongly indicates that you do not have an absorption problem.

Pepsin in the saliva is common. It is found in one-third of normal people and is more common in those with gastro-oesophageal reflux (which would cause your burning).

in reply to fbirder

Hi fbirder, you constantly amaze me with the amount of knowledge you have regarding B12 def. and PA. I, on the other hand am having trouble understanding this. If iankerudder took oral B12 and her levels shot up so high, wouldn't it mean the B12 is not being absorbed and just floating around in the blood? Help! I'm confused again.

fbirder profile image
fbirder in reply to

An absorption problem means there is a problem getting B12 from outside the body into the blood. If you take oral B12 and the amount in the blood rises then there is no absorption problem.

You are describing a functional B12 deficiency whereby there is lots of B12 in the blood, but it's not getting to the right places in the cell. One speculated cause of such a deficiency is a problem with the mechanism that transports B12 from the blood into the cell.

in reply to fbirder

What would cause the B12 to not be able to get into the cell?

fbirder profile image
fbirder in reply to

Getting B12 from the blood into the places in the cell it is supposed to be is a fairly complex operation. The B12 has to bind to a protein called transcobalamin (TC). There are receptors on the outside of the cell that grab hold of the TC and bring it into the cell, where special enzymes remove the TC.

The B12 then has the top ligand (methyl, adenosyl, hydroxo, cyano) removed (by another enzyme) to form cob(II)alamin and transported to the places in the cell it is required (by other proteins), then other enzymes activate it depending on what reaction it is supposed to be taking part in.

Any of those steps can fail. Normally, if they do fail then they do so before birth and produce obvious symptoms. But people are looking into various genetic problems that might cause faults in any of those processes.

in reply to fbirder

Wow, no wonder it is so hard for some to find out why they have B12 deficiency. I think we all want easy answers and treatments. I think this is the most complicated thing I have had to deal with regarding my health. I am so grateful to you, fbirder, You have a way of explaining things so that they are more understandable. God bless you for that my very well informed friend. Just by reading some of your posts I know that you have been through a great deal and you have taken those struggles and used them to help others, the mark of a good soul. May your health be only better and your life be made of only the things you dream of.

helvella profile image
helvella in reply to

Not being absorbed is usually the description of B12 not getting from the gut into the bloodstream.

Any that isn't absorbed through the gut will just pass straight through.

Therefore the blood level will not be (significantly) raised.

However, in this case, the blood B12 level is rising, so it is not a matter of failure to absorb through the gut.

in reply to helvella

Thank you helvella. I think I am starting to get this now, but if you don't have gastritis, what would cause the B12 to not get into the cells?

helvella profile image
helvella in reply to

Why do you think B12 isn't getting into your cells?

My point was really that you are absorbing B12 such that it is rising in your bloodstream. I really know nothing about transfer into cells.

BadHare profile image
BadHare in reply to fbirder

Wouldn’t sublingual B12 bypass gut absorption?

fbirder profile image
fbirder in reply to BadHare

No. The B12 molecule is both too large and too hydrophilic (water-loving, fat-hating) to pass through biological membranes unaided. That is why the body needs IF to get B12 from the gut to the blood. And why transcobalamin is needed to get it from the blood into the cells.

Various studies have shown little difference between the amount of a sublingual dose that is absorbed and the same amount absorbed orally.

If sublingual dosing worked then none of us would need injections.

iankerudder profile image
iankerudder in reply to fbirder

Thanks all! I am taking 1,000 sublingually twice a day...

BadHare profile image
BadHare in reply to fbirder

My levels went from 300 & symptomatic) to top of the range (reduced symptoms) after a month on sublingual 5,000mcg methylcobalamin, the starting level being despite high dietary B12 & daily B complex. I started injecting because it was cheaper rather than sublinguals being ineffective, however, I now need a lower dose of thyroid hormone which is nice.

tcj190 profile image
tcj190

Hi,, I am alka... I have b12 and d3 absorption problem. In july2019 my b12, d3, was low so Dr told me to take supplements and I took and in Nov 2019 it came to 635 and d3 was also 55...but again in feb2020 I had severe fatigue so I tested again it came down to 235 and d3 30.

I am 44 becoz of this absorption I have irregular periods/spotting.

I have milk issues so not taking it.

Please suggest some remedy to improve absorption.

You may also like...

Newly diagnosed possible Autoimmune gastritis and B12 deficiency

folic acid, it goes up then goes down again after a period of months off the high dose folic acid....

Betaine HCl (hydrochloric acid) for autoimmune atrophic gastritis low acid pain (have PA as well)

Sunday to you... I was wondering if any of you use or have used Betaine HCl (with pepsin) for low...

Autoimmune gastritis treatment with corticosteroids

start. I'm told to make control blood tests after the B12 treatment, that include IFA and PC...

Autoimmune Atrophic Gastritis and Pernicious Anemia diagnosis

middle of my breast bone. The GI says I don’t have acid reflux, although I been treated for that...

Just diagnosed with autoimmune atrophic gastritis with intestinal metaplasia

else have this? Any treatment for this? I’m already on EOD (for last two weeks) B12 shots and...