I have been told by a private Dr that I have Pernicious Anaemia causing an autoimmune reaction in my stomach so have been giving regular b12 injections and feeling much improved. Blood tests were negative for parietal cell antibodies but positive for thyroid peroxidase antibodies (advised of being the root cause of malabsorption of B12 and iron) . I am also under a GI Consultant who arranged biopsies for Autoimmune Gastritis for which I am awaiting the results. The private Dr says that the biopsy results for the Autoimmune Gastrtis will be negative, as the parietal cell antibody test was negative.
I would have thought that both the parietal cell antibody test and the biopsies would be positive if I had pernicious anaemia / autoimmune gastritis. Has anyone else been in this situation please??
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Jacklover
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Hi Jacklover. Firstly, let me say that confusion reigns amongst the medical community regarding Pernicious Anemia. There is little covered of this in Med school. Many doctors incorrectly think that all megaloblastic or macrocytic Anemia caused by B12 deficiency must be Pernicious Anemia. This is not true. There are other causes of B12 deficiency such as being vegan, having had gastric surgery, etc. and thus this type of Anemia. Also the symptoms are the same. Pernicious Anemia is solely defined as a late stage manifestation of Autoimmune Gastritis (AIG). It is known through studies that 90% of those with AIG will test positive for Parietal Cell Antibodies. It's possible, if you have I'll call it "autoimmune" PA/AIG that you may fall into the 10% that have it but test negative. My opinion... That does not mean you do not have them but rather they're just not showing up. Your doctor is in error on the gastric biopsies. Gastric biopsies of the Oxyntic Mucosa are the only 100% test to confirm AIG. These biopsies if positive will show damage to the Parietal Cells. This damage is what would and does eventually lead to B12d and PA. It is interesting that AIG only progresses to PA in a subset of those with PA I would add that it is highly probable that you do have AIG/PA since you've already been diagnosed with thyroid antibodies, autoimmune hypothyroid AKA Hashimoto's Thyroiditis. Studies have shown that 40% of those with PA also test positive for Hash. This has something to do with the fact that Thyroid tissue and Parietal Cell tissue both have origins from the same embryonic tissue. It is thought that through biomimicry once your immune system starts attacking one or the other it becomes confused and starts attacking very similar tissue.
If you have PA/AIG look to you pathology report. Get a copy of same if you can so you can make sure where they took the biopsies from. The Parietal Cell containing Oxyntic Mucosa is in only the upper 1/3 of the gastric body and the Fundus, the very top bulbous part of the stomach.
Btw, if you have both Hashimoto's Thyroiditis and AIG/PA then this is called Polyglandular Autoimmune Syndrome (PAS) type 2b.
Is all very confusing but hope this helps some.
Sorry for spelling anemia incorrectly... us silly Yanks! 😂
Thank you so much for the reply. As it has so much detail, I will read it again to try to take the info in. Yes, confusing. I did have biopsies from all around the stomach. I had had biopsies before by a different gastro, but apparently they were done from the wrong locations in the stomach to test for AIG. So will wait and see what the biopsy results are! Btw I didn't even notice that anaemia was spelt differently! 😊
I usually have no idea I'm making any sense at all. Someone once told me when I first started this journey that this disease was "discombobulating!" At the time I had no idea what they meant or what I was in for. 😳
But I do try to make sense of something that makes no sense! 🤣
That's so helpful, thank you! Do I understand that the treatment would not be different if you are diagnosed with PAS? Is it important to have an actual diagnosis of it? I have PA, Hashimotos, coeliac and suspected mild Sjogrens. I know if I ask my GP they'll say it doesn't matter, they would just continue treating everything with replacement. Thank you! Kathie
There is really no test to diagnose PAS. They've just identified a part of the PA and Hashimoto's population that have both. They call it a syndrome because they don't really know or understand, yet, the etiology or cause of this syndrome amongst a subset of the AIG/PA and Hashimotos population. Just that it seems different. Also lumped into that are Sjogren' and type 1 diabetes, another autoimmune condition. So the diagnosis is of each disease individually and they are treated that way also. However, if you have PAS they should place more scrutiny on watching for other endocrine autoimmune conditions. I too have AIG/PA, Hashimoto's, and Sjogren's and being watched closely by endo for type 1 diabetes to rear its ugly head. So it's really hormone replacement and possibly immunosuppressant therapy both of which I've have/had. Oh and yes B12, and iron and learning how to eat again... 😳
Now gastritis is incredibly important to diagnose which type whether it's H-pylori caused or autoimmune caused. These are two entirely different treatments. What they teach in Med school...."if you hear hoofbeats, then look for horses not zebras". This means that 98 to 99% of the time if they look for a horse they'll get it right. Gastritis for example... about 98% of gastritis is caused by H-Pylori infection. Doctors are trained to see Gastritis and prescribe a PPI (Proton Pump Inhibitor) like Omeprazole etc. they never check for an individuals gastric acid levels. They should always test for H-Pylori bacteria but many do not. Then if positive eradicate with antibiotics. Only then will this type of Gastritis begin to heal. This Gastritis primarily is in the antrum or lower part of the stomach.
Treatment for AIG in the other hand should not normally be given PPI. Serum Gastrin should be tested to somewhat determine Hypochlorhydria or achlorhydria. If needed maybe a Betaine HCI and digestive enzymes supplement be added before meals, especially a heavy protein meal. Full iron panels should run periodically, and that other PAS associated conditions should be tested for.
The other thing to consider in multiple autoimmune conditions is that many of the symptoms are overlapping so it difficult to determine which is causing a symptom and which to treat. For example fatigue can be caused by Hypothyroid, B12 deficiency, iron deficiency, and a broader issue is other micronutrient malabsorption due to low or no stomach acid.
OK I've rambled a bit much. I'm not a doctor but I do suggest having these conversations with your doctor although my experience is you may very well see their eyes glaze over! 😂
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