PA after appendectomy

[Joecup]

In 2000 I had an appendectomy. Soon after I developed digestion issues. In October/November 2014 I noticed that I would occasionally feel lightheaded, and would become short of breath while walking. I went to the doctor and, after a blood test, was initially told that I had almost zero B12 in my system. Soon after, I was diagnosed with PA.

I was confused initially and started looking up information. I found an old medical document online about a woman who had been admitted to an asylum. What’s interesting is that she had PA. What was even more interesting was that she had an appendectomy prior. I brought the topic up with my doctor. I believed my PA was associated with my appendectomy. The doctor didn’t think so, and she said there wasn’t any medical info linking the two. I won’t forget my conversation with the surgeon before the procedure. He told me that my appendix didn’t do anything. I vehemently told him, “No offense doctor - though YOU may not think it doesn’t do anything, I believe it’s there for a reason.” I sincerely believe that my digestive issues and PA are the result of the appendectomy. Of course, now there’s more info about the appendix and how it’s related to gut health.

[Rexz]

Hi Joecup

It is rare but when having an appendectomy can cause damage to your Terminal Ileum. The Terminal Ileum is the very last part of the small intestine and the appendix is just next to that. The Terminal Ileum is where B12 is absorbed so damage to this can cause B12 malabsorption and thus deficiency. This would not be PA though as PA is a result of autoimmune condition. But the B12 treatment would be the same.

Also inflammation from appendicitis can affect the Terminal Ileum.

Rexz

[Hockey_player]

In the end, the cause of the PA does not need to be known to know how to treat it. You need regular B12 injections. Ideally often enough to keep all symptoms at bay.

[Rexz in reply to Hockey_player]

Hi Hockey_playerA proper diagnosis of PA and it's autoimmune cause is essential to proper treatment. With PA, as I say "it ain't just B12". PA is a late stage manifestation of Autoimmune Gastritis (AIG). It is a progressive disease that destroys the oxyntic mucosa (Parietal Cells). These cell not only produce Intrinsic Factor, but just as importantly, they produce gastric acid. Which by itself causes a while cascade of digestion issues from iron and micronutrient malabsorption, to SIBO, acid reflux, and on...

Additionally, with PA there is anywhere from a 3 to 13 fold increased risk of gastric Adenocarcinoma. Because of this, for those with a diagnosis of PA, the American, British, and European Gastroenterology Guidelines all recommend and initial Endoscopy/Gastroscopy to perform Gastric Mapping and cancer screening. The AMA guidelines are to have this done within six months from diagnosis. So if you have an affirmative diagnosis of PA I would suggest talking to your GI doc and have this done. This could be a life saver as it was for me. This is not to scare but rather inform. Not everyone with PA will progress to cancer so there is some unknown etiology they just don't know about where the medical GI establishments all recommend this screening.

Proper gastric acid is just as critical as B12. Without it...it too is Pernicious. So at some point this will also need supplementation.

Hope this helps some, Rexz

[Hockey_player in reply to Rexz]

I don't have an official diagnosis, but my response to the B12 makes me certain I have PA. My doctor is on side with that. I had a gastroscopy. That is a good point you are making. How often should the gastroscopy be repeated?

[Rexz in reply to Hockey_player]

My suggestion is to get an official diagnosis as it really does matter. Have your IFAB and Parietal Cell antibody test. Also the only 100% affirmative test is a biopsy if your Oxyntic Mucosa and findings by a pathologist of Parietal Cell damage. Surveillance interval depends on the findings of your initial Gastric Mapping gastroscopy. It could be annually or up to every three years. Also depends on if they did a proper gastric mapping in accordance with the Sydney Protocol which is a series of random biopsies from different regions of the stomach. If you can, get a copy of your gastroscopy biopsy pathology report. Resulting from that gastric mapping... If your are determined to be high risk for gastric cancer then annual surveillance, if low risk then every three to five years. The determining factor is the amount of Intestinal Metaplasia that is found and is it contained to just one region a high amount of GIM in all regions then that is a higher risk. My initial Endoscopy found gastric cancer and a boatload of GIM in all regions of my stomach (Pangastritis). The cancer was excised and now I have surveillance endoscopy every 9 months as I'm determined to be high risk for another instance of gastric cancer.

You should also keep an eye on your digestion, how's it working? If you start to have trouble digesting protein or start to get acid reflux then that's indicative of low gastric acid. Keep an eye on Ferritin too. Start having full iron panel tests. See my post on Iron Deficiency Without Anemia (IDWA). Just start surveiling these things as PA is a progressive condition.

Best wishes for a very best New Year!

Rexz

[Annamaudebug]

I feel the appendix must do something as well and obviously not identified. It does not surprise me you developed problems with your B12 levels. Good luck.