The Level of Serum Pepsinogen in Diagnosing and Evaluating the Severity of Subacute Combined Degeneration Due to Vitamin B12 Deficiency

[WiscGuy]

It's well known that B12 deficiency results in gastrointestinal symptoms, but this is a new twist for me:

frontiersin.org/articles/10...

[Technoid]

"the serum cobalamin level would be normal or even elevated (3, 4), perhaps due to interference of anti-intrinsic factor antibodies in measuring cobalamin (5), overgrowth of intestinal bacteria which produced cobalamin analogs (6), or cobalamin administration before diagnosis"

Nice find WiscGuy . I was aware of B12 serum level interference from anti IF antibodies and supplementation but bacterial overgrowth causing falsely elevated B12 from cobalamin analogs was new to me. Reinforces the unreliability of using simple serum B12 as a diagnostic marker.

[WiscGuy in reply to Technoid]

Thanks for the note. I am happy to hear the article is helpful.

[jade_s]

You might like this recent paper as well nature.com/articles/s41598-... Relevance of pepsinogen, gastrin, and endoscopic atrophy in the diagnosis of autoimmune gastritis - I can't remember all the details but I found it in my files

There is a test bundle marketed by some company and for the life of me I cannot remember or find it back - but it measures all the pepsinogens and gastrin - and it is useful in differentiating AMAG/AIG from H pylori and other causes, but it is only available in a few countries. I tried in Belgium and France and they looked at me like I had two heads when I mentioned pepsinogen. I WILL remember the name and post back when I do.

Edit: It's called Gastropanel 🤦‍♀️ gastropanel.com/healthcare-... "The assays measure concentrations of pepsinogen I (PGI), pepsinogen II (PGII), gastrin-17 (G17) and helicobacter IgG antibodies (Hp IgG) in a fasting blood sample."

[jade_s in reply to jade_s]

And thank you for this paper! I had not seen it before. How the heck did they find 65 - SIXTY FIVE! - people with SACD. Talk about undertreating 😥 those poor people!

[WiscGuy in reply to jade_s]

Very interesting, Jade! I very slowly am gaining the vocabulary to understand some of these papers, and the diagnostics could quite possibly be useful. Think how many people with B12 deficiency dangle forever with no diagnosis, many of them, seemingly, with autoimmune gastritis. (It wasn't very long ago - weeks - that I first learned that something called autoimmune gastritis even existed!)