DOCSLIB.ORG

©Ferrata Storti Foundation

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
©Ferrata Storti Foundation Red Cell Disorders • Research Paper Role of autoimmune gastritis, Helicobacter pylori and celiac disease in refractory or unexplained iron deficiency anemia Chaim Hershko Background and Objectives. Conventional endoscopic and radiographic methods fail to A. Victor Hoffbrand identify a probable source of gastrointestinal blood loss in about one third of males Dan Keret and post-menopausal females and in most women of reproductive age with iron defi- Moshe Souroujon ciency anemia (IDA). Such patients, as well as subjects refractory to oral iron treat- Itzhak Maschler ment, are often referred for hematologic evaluation. Yehudit Monselise Amnon Lahad Design and Methods. We prospectively studied 150 consecutive IDA patients referred to a hematology outpatient clinic, screened for non-bleeding gastrointestinal conditions including celiac disease (antiendomysial antibodies), autoimmune atrophic gastritis (hypergastrinemia with strongly positive antiparietal cell antibodies) and H. pylori infec- tion (IgG antibodies confirmed by urease breath test). Results. The mean age of all subjects was 39±18 years and 119 of the 150 patients were female. We identified 8 new cases of adult celiac disease (5%). Forty IDA patients (27%) had autoimmune atrophic gastritis of whom 22 had low serum vita- min B12 levels. H. pylori infection was the only finding in 29 patients (19%), but was a common co-existing finding in 77 (51%) of the entire group. Refractoriness to oral iron treatment was found in 100% of patients with celiac disease, 71% with autoimmune atrophic gastritis, 68% with H. pylori infection, but only 11% of subjects with no detect- ed underlying abnormality. H. pylori eradication in previously refractory IDA patients in combination with continued oral iron therapy resulted in a significant increase in hemo- globin from 9.4±1.5 (mean ± 1SD) before treatment to 13.5±1.2 g/ dL (p<0.001 by paired t test) within 3 to 6 months of treatment. Interpretation and Conclusions. The recognition that autoimmune atrophic gastritis and H. pylori infection may have a significant role in the development of unexplained or refractory IDA in a high proportion of patients should have a strong impact on our daily practice of diagnosing and managing IDA. Key words: iron deficiency, celiac disease, Helicobacter pylori, atrophic gastritis, vitamin B12 deficiency. Haematologica 2005; 90:585-595 ©2005 Ferrata Storti Foundation From the Department of pontaneous iron excretion in adult treatment are often referred for hemato- Hematology, Shaare Zedek Medical Center (CH), Department of subjects is minimal and iron deficien- logic evaluation. In recent years, there has Gastroenterology (DK), Central cy anemia (IDA) is generally attrib- been an increasing awareness of subtle, S 1 Clinical Laboratories (MS, IM), uted to abnormal blood loss. This may be non-bleeding gastrointestinal conditions Clinical Immunology Laboratories caused by gastrointestinal bleeding or, in that may result in abnormal iron absorp- Rabin Medical Center (YM), young females of reproductive age, by tion leading to IDA in the absence of gas- Department of Family Medicine, Clalit Health Services, Jerusalem, increased menstrual flow and the trointestinal symptoms. Thus, the impor- and Hebrew University Hadassah increased requirements of pregnancy. tance of celiac disease as a possible cause Med. School, Jerusalem, Israel (AL), However, in adult males and post- of IDA refractory to oral iron treatment, Department of Hematology, Royal menopausal females, major studies evalu- without other apparent manifestations of Free Hospital, London, UK (AVH), ating the gastrointestinal tract for IDA malabsorption syndrome4-10 is increasingly Correspondence: employing endoscopic and radiographic being recognized. In addition, Helicobacter Chaim Hershko M.D., methodologies have only been able to pylori infection has been implicated in sev- Department of Hematology, identify a probable source of upper or eral recent studies as a cause of IDA refrac- Shaare Zedek Med Center, lower gastrointestinal bleeding in about 62 tory to oral iron treatment with a favor- Jerusalem, Israel, PO Box 3235. to 64% of patients.2,3 Similarly, no evi- able response to H. pylori eradication.11-17 E-mail: [email protected] dence of gastrointestinal blood loss can be Likewise, achlorhydric gastric atrophy or found in the vast majority of young, fertile autoimmune atrophic gastritis, a condition females with IDA. Such patients with a associated with chronic idiopathic iron low likelihood of gastrointestinal blood deficiency, has been shown to be respon- loss, and patients refractory to oral iron sible for refractory IDA in over 20% of haematologica/the hematology journal | 2005; 90(5) | 585 | C. Hershko et al. patients with no evidence of gastrointestinal blood healthy subjects of comparable age (see below) and loss.18-20 Although achylia gastrica, a condition indis- gender (9 males and 51 females) referred within the tinguishable from autoimmune atrophic gastritis, same period for evaluation of minor problems such was defined by Faber as a distinct clinical entity as suspected thrombophilia without evidence of responsible for IDA as early as 190921 and extensive- thrombosis (n=44), no disease (n=10) or borderline ly studied subsequently by Wintrobe and others,22-25 white blood cell counts (n=6). this entity was almost completely forgotten and largely ignored in major studies of IDA.2,3 Laboratory methods The recent availability of convenient, non-invasive Complete blood counts (CBC) were performed by screening methods for identifying celiac disease, a SysmexSE-9000 automated analyzer (KOBE, Japan) autoimmune atrophic gastritis and H. pylori gastritis, calibrated daily with standards provided by the man- has greatly facilitated the recognition of patients with ufacturer. Routine biochemical measurements these entities, resulting in an increased awareness of including serum iron (normal range 59-158 mg/dL), these conditions and their possible role in the causa- total iron binding capacity (TIBC; normal range 226- 18,19 tion of IDA. Unlike IDA patients referred for eval- 338 mg/dL) and serum ferritin (normal range males uation of possible gastrointestinal bleeding in whom 40-340, females 14-150 mg/L) were performed by a the causes of anemia are well documented, our Hitachi 747 automated analyzer with quality control knowledge of underlying conditions responsible for assurance by UKNEQAS (Birmingham, UK). Fasting IDA in patients referred for hematologic evaluation serum B12 levels were determined by the ADVIA with no apparent gastrointestinal disease is limited. Centaur VB12 assay which is an automated competi- The objective of the present study was to establish, tive immunoassay using direct chemiluminescent in a systematic and prospective manner, the cause of technology. The lower limit of normal was defined as IDA among patients referred for evaluation to a com- <181 ng/L. Fasting serum gastrin levels were deter- munity hematology clinic over a period of two years mined by GammaDab® Gastrin 125I RIA Kit (DiaSorin, with particular emphasis on non-bleeding gastroin- Stillwater Minnesota, USA) and expressed as pg/mL, testinal causes of IDA, employing non-invasive sero- normal limits < 107. For the detection of IgG anti- logical screening tests supplemented by currently bodies to H. pylori in human serum, the IMMULITE® accepted diagnostic methodologies. 2000 H. pylori IgG, a solid-phase chemiluminescent immunometric assay (DPC Diagnostics, Los Angeles, CA, USA) with an analytical sensitivity limit of 0.4 Design and Methods U/mL was used; a value < 0.9 U/mL was considered to be negative. Anti-endomysial IgG and IgA anti- Target population bodies and anti-gastric parietal cell IgG antibodies The population for this prospective study consist- (APCA) were determined by an indirect immunoflu- ed of patients with IDA and a low apparent likeli- orescence antibody test for semi-quantitative detec- hood of gastrointestinal disease referred by family tion of antibodies using the ImmuGloTM Anti- physicians to a community hematology clinic. All the Endomysial Antibody Test System (IMMCO® diag- patients had received oral iron treatment prior to nostics, Buffalo, NY, USA). Results were considered referral and many were described as refractory to positive if equal to or greater than 1:40 dilution. oral iron therapy. All newly referred patients with Intrinsic factor antibodies were assayed by enzyme- IDA were included, starting from September 1, 2001, linked immunoassay (ALPHADIA,® Belgium) detect- for a period of 2 years, if their hemoglobin at refer- ing type I and type II antibodies. Results exceeding ral was 11 g/dL or less, and if they fulfilled the fol- 1.1 were considered positive. Anti-gliadin antibodies lowing criteria for iron deficiency anemia: mean cor- were measured by an indirect assay employing per- puscular volume (MCV) less than 80 fL, transferrin oxidase-labeled rabbit anti-human IgG and IgA anti- saturation less than 15%, and serum ferritin less than bodies employing the BINDAZYMETM Human 12 mg/L (143 patients) or two of the above and an Anti-Gliadin IgG and IgA kits (The Binding Site Ltd., increase in hemoglobin > 1.0 g/dL in response to iron Birmingham, UK). Results were considered positive therapy (7 patients). Although patient recruitment if equal to or more than 10 U/mL for IgG and 5 for was terminated in September 2003, follow-up visits IgA antibodies were continued allowing a follow-up period of at The 13C-urease breath test
Load more

Recommended publications
  • Association of Helicobacter Pylori Infection and Chronic Atrophic
    www.impactjournals.com/oncotarget/ Oncotarget, Vol. 7, No. 13 Association of helicobacter pylori infection and chronic atrophic gastritis with risk of colonic, pancreatic and gastric cancer: A ten-year follow-up of the ESTHER cohort study Xin-Zu Chen1,2,*, Ben Schöttker2,*, Felipe Andres Castro2, Hongda Chen2, Yan Zhang2, Bernd Holleczek2,3, Hermann Brenner2,4 1Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China 2Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany 3Saarland Cancer Registry, Saarbrücken, Germany 4German Cancer Consortium (DKTK), Heidelberg, Germany *These authors contributed equally to this work Correspondence to: Hermann Brenner, e-mail: [email protected] Keywords: helicobacter pylori, chronic atrophic gastritis, colon cancer, pancreatic cancer, gastric cancer Received: November 21, 2015 Accepted: February 09, 2016 Published: March 06, 2016 ABSTRACT Objectives: To assess the association of H. pylori and chronic atrophic gastritis (AG) with colonic, pancreatic and gastric cancer in a population-based prospective cohort. Methods: Serum antibodies against H. pylori in general and specific to cytotoxin- associated gene A (CagA), as well as serum pepsinogen I and II were analyzed in 9,506 men and women, aged 50–75 years in a cohort study from Saarland, Germany. Incident cases of colonic, pancreatic and gastric cancer were ascertained by record linkage with data from the Saarland Cancer Registry. Results: During an average follow-up of 10.6 years, 108 colonic, 46 pancreatic and 27 gastric incident cancers were recorded. There was no association between H. pylori infection and colonic cancer (HR = 1.07; 95% CI 0.73–1.56) or pancreatic cancer (HR = 1.32; 0.73–2.39), regardless of either CagA seropositivity or AG status.
    [Show full text]
  • In Patients with Crohn's Disease Gut: First Published As 10.1136/Gut.38.3.379 on 1 March 1996
    Gut 1996; 38: 379-383 379 High frequency of helicobacter negative gastritis in patients with Crohn's disease Gut: first published as 10.1136/gut.38.3.379 on 1 March 1996. Downloaded from L Halme, P Karkkainen, H Rautelin, T U Kosunen, P Sipponen Abstract In a previous study we described upper gastro- The frequency of gastric Crohn's disease intestinal lesions characteristic of CD in 17% has been considered low. This study was of patients with ileocolonic manifestations of undertaken to determine the prevalence of the disease.10 Furthermore, 40% of these chronic gastritis and Helicobacter pylori patients had chronic, non-specific gastritis. infection in patients with Crohn's disease. This study aimed to determine the prevalence Oesophagogastroduodenoscopy was per- of chronic gastritis and that of H pylori infec- formed on 62 consecutive patients suffer- tion in patients with CD who had undergone ing from ileocolonic Crohn's disease. oesophagogastroduodenoscopy (OGDS) at the Biopsy specimens from the antrum and Fourth Department of Surgery, Helsinki corpus were processed for both histological University Hospital between 1989 and 1994. and bacteriological examinations. Hpylori antibodies of IgG and IgA classes were measured in serum samples by enzyme Patients and methods immunoassay. Six patients (9.70/o) were During a five year period from September 1989 infected with H pylorn, as shown by histo- to August 1994, OGDS was performed on 62 logy, and in five of them the infection consecutive patients with CD to establish the was also verified by serology. Twenty one distribution of their disease. During the study patients (32%) had chronic H pyloni period, the OGDS was repeated (one to seven negative gastritis (negative by both times) - on three patients because of anaemia histology and serology) and one of them and on five patients because of upper gastroin- also had atrophy in the antrum and corpus.
    [Show full text]
  • Autoimmune Diseases in Autoimmune Atrophic Gastritis
    Acta Biomed 2018; Vol. 89, Supplement 8: 100-103 DOI: 10.23750/abm.v89i8-S.7919 © Mattioli 1885 Review Autoimmune diseases in autoimmune atrophic gastritis Kryssia Isabel Rodriguez-Castro1, Marilisa Franceschi1, Chiara Miraglia1, Michele Russo1, Antonio Nouvenne1, Gioacchino Leandro3, Tiziana Meschi1, Gian Luigi de’ Angelis1, Francesco Di Mario1 1 Endoscopy Unit, Department of Surgery, ULSS7-Pedemontana, Santorso Hospital, Santorso (VI), Italy; 2 Department of Me- dicine and Surgery, University of Parma, Parma, Italy; 3 National Institute of Gastroenterology “S. De Bellis” Research Hospital, Castellana Grotte, Italy Summary. Autoimmune diseases, characterized by an alteration of the immune system which results in a loss of tolerance to self antigens often coexist in the same patient. Autoimmune atrophic gastritis, characterized by the development of antibodies agains parietal cells and against intrinsic factor, leads to mucosal destruction that affects primarily the corpus and fundus of the stomach. Autoimmune atrophic gastritis is frequently found in association with thyroid disease, including Hashimoto’s thyroiditis, and with type 1 diabetes mellitus, Other autoimmune conditions that have been described in association with autoimmune atrophic gastritis are Ad- dison’s disease, chronic spontaneous urticaria, myasthenia gravis, vitiligo, and perioral cutaneous autoimmune conditions, especially erosive oral lichen planus. Interestingly, however, celiac disease, another frequent auto- immune condition, seems to play a protective role for
    [Show full text]
  • PDF (Download : 3)
    J Neurogastroenterol Motil, Vol. 27 No. 3 July, 2021 pISSN: 2093-0879 eISSN: 2093-0887 https://doi.org/10.5056/jnm21042 JNM Journal of Neurogastroenterology and Motility Review The Usefulness of Symptom-based Subtypes of Functional Dyspepsia for Predicting Underlying Pathophysiologic Mechanisms and Choosing Appropriate Therapeutic Agents Kwang Jae Lee Department of Gastroenterology, Ajou University School of Medicine, Suwon, Gyeonggi-do, Korea Functional dyspepsia (FD) is considered to be a heterogeneous disorder with different pathophysiological mechanisms or pathogenetic factors. In addition to traditional mechanisms, novel concepts regarding pathophysiologic mechanisms of FD have been proposed. Candidates of therapeutic agents based on novel concepts have also been suggested. FD is a symptom complex and currently diagnosed by symptom-based Rome criteria. In the Rome criteria, symptom-based subtypes of FD including postprandial distress syndrome and epigastric pain syndrome are recommended to be used, based on the assumption that each subtype is more homogenous in terms of underlying pathophysiologic mechanisms than FD as a whole. In this review, the usefulness of symptom- based subtypes of FD for predicting underlying pathophysiologic mechanisms and choosing appropriate therapeutic agents was evaluated. Although several classic pathophysiologic mechanisms are suggested to be associated with individual dyspeptic symptoms, symptom-based subtypes of FD are not specific for a certain pathogenetic factor or pathophysiologic mechanism, and may be frequently associated with multiple pathophysiologic abnormalities. Novel concepts on the pathophysiology of FD show complex interactions between pathophysiologic mechanisms and pathogenetic factors, and prediction of underlying mechanisms of individual patients simply by the symptom pattern or symptom-based subtypes may not be accurate in a considerable proportion of cases.
    [Show full text]
  • Gastric PDX-1 Expression in Pancreatic Metaplasia and Endocrine Cell Hyperplasia in Atrophic Corpus Gastritis
    Modern Pathology (2004) 17, 56–61 & 2004 USCAP, Inc All rights reserved 0893-3952/04 $25.00 www.modernpathology.org Gastric PDX-1 expression in pancreatic metaplasia and endocrine cell hyperplasia in atrophic corpus gastritis Maike Buettner1, Arno Dimmler1, Achim Magener1, Thomas Brabletz1, Manfred Stolte2, Thomas Kirchner1 and Gerhard Faller1 1Institute of Pathology, University of Erlangen-Nuremberg, Erlangen, Germany and 2Institute of Pathology, Bayreuth, Germany The homeodomain transcription factor PDX-1 plays a key role in endocrine and exocrine differentiation processes of the pancreas. PDX-1 is also essential for differentiation of endocrine cells in the gastric antrum. The role of PDX-1 in the pathogenesis of endocrine cell hyperplasia and pancreatic metaplasia in corpus and fundus gastritis has not been evaluated. By immunohistochemistry and double-immunofluorescence, we investigated the expression of PDX-1 in 10 tissue specimens with normal human gastric mucosa, nonatrophic and atrophic gastritis and in pancreatic metaplasia, respectively. In normal corpus mucosa and in nonatrophic corpus gastritis, PDX-1 was mainly absent. In pancreatic metaplasia, PDX-1 was found in metaplastic cells and in adjacent gastric glands. In contrast to normal gastric corpus mucosa, PDX-1 could be strongly detected in the cytoplasm of the parietal cells surrounding metaplastic areas. Furthermore, PDX-1 expression was found in hyperplastic endocrine cells and in the surrounding gastric glands in chronic atrophic gastritis. Hyperplastic endocrine cells coexpressed the b-subunit of the gastric H,K-ATPase. We conclude that PDX-1 represents a candidate switch factor for glandular exocrine and endocrine transdifferentiation in chronic gastritis and that an impaired parietal cell differentiation might play a key role in disturbed gastric morphogenic processes.
    [Show full text]
  • The Gastrointestinal Tract Frank A
    91731_ch13 12/8/06 8:55 PM Page 549 13 The Gastrointestinal Tract Frank A. Mitros Emanuel Rubin THE ESOPHAGUS Bezoars Anatomy THE SMALL INTESTINE Congenital Disorders Anatomy Tracheoesophageal Fistula Congenital Disorders Rings and Webs Atresia and Stenosis Esophageal Diverticula Duplications (Enteric Cysts) Motor Disorders Meckel Diverticulum Achalasia Malrotation Scleroderma Meconium Ileus Hiatal Hernia Infections of the Small Intestine Esophagitis Bacterial Diarrhea Reflux Esophagitis Viral Gastroenteritis Barrett Esophagus Intestinal Tuberculosis Eosinophilic Esophagitis Intestinal Fungi Infective Esophagitis Parasites Chemical Esophagitis Vascular Diseases of the Small Intestine Esophagitis of Systemic Illness Acute Intestinal Ischemia Iatrogenic Cancer of Esophagitis Chronic Intestinal Ischemia Esophageal Varices Malabsorption Lacerations and Perforations Luminal-Phase Malabsorption Neoplasms of the Esophagus Intestinal-Phase Malabsorption Benign tumors Laboratory Evaluation Carcinoma Lactase Deficiency Adenocarcinoma Celiac Disease THE STOMACH Whipple Disease Anatomy AbetalipoproteinemiaHypogammaglobulinemia Congenital Disorders Congenital Lymphangiectasia Pyloric Stenosis Tropical Sprue Diaphragmatic Hernia Radiation Enteritis Rare Abnormalities Mechanical Obstruction Gastritis Neoplasms Acute Hemorrhagic Gastritis Benign Tumors Chronic Gastritis Malignant Tumors MénétrierDisease Pneumatosis Cystoides Intestinalis Peptic Ulcer Disease THE LARGE INTESTINE Benign Neoplasms Anatomy Stromal Tumors Congenital Disorders Epithelial Polyps
    [Show full text]
  • Symptomatic Non-Acidic Reflux in a Patient with Chronic Autoimmune Atrophic Gastritis Successfully Treated with Anti-Reflux Surgery
    J Neurogastroenterol Motil, Vol. 24 No. 1 January, 2018 pISSN: 2093-0879 eISSN: 2093-0887 https://doi.org/10.5056/jnm17083 JNM Journal of Neurogastroenterology and Motility Letter to the Editor Symptomatic Non-acidic Reflux in a Patient With Chronic Autoimmune Atrophic Gastritis Successfully Treated With Anti-reflux Surgery TO THE EDITOR: We present the case of a patient with chronic and symptomatic index were positive (> 95% and > 50% respec- autoimmune atrophic gastritis (CAAG) with non-acidic gastro- tively) for all 3 symptoms. esophageal reflux disease (GERD) demonstrated with 24-hour The patient was offered surgery, which she accepted, and un- multichannel intraluminal impedance-pH (MII-pH) monitoring derwent laparoscopic Nissen fundoplication with associated hiatal who was successfully treated with laparoscopic antireflux surgery. repair. She experienced great improvement, with remission of all Written and oral informed consent was obtained from the patient symptoms (regurgitation, cough, dysphagia, and belching). Post- for the communication of this case. surgical manometry and MII-pH monitoring revealed objective A 56-year-old woman with no relevant medical history was re- improvement: lower esophageal sphincter mean resting pressure of ferred to our Motility Unit because of refractory gastroesophageal 11 mmHg, 79 non-acidic refluxes, and bolus exposure time of 1.2%. reflux. She complained of a 2-year history of daily alimentary non- This case report represents, to our knowledge, the first com- acidic regurgitation that occurred mainly in the recumbent position munication of a patient with objectively proven GERD due to non- and interfered with her sleep. She had also frequent heartburn, acidic reflux in the context of CAAG who was satisfactorily treated belching, and chronic dry cough, also predominant in the recum- with fundoplication, with improvement in symptoms and in objec- bent position.
    [Show full text]
  • Chronic Gastritis and Gastroduodenal Ulcer: a Case Control Study on Risk of Coexisting Duodenal Or Gastric Ulcer in Patients with Gastritis
    Gut: first published as 10.1136/gut.30.7.922 on 1 July 1989. Downloaded from Gut, 1989, 30, 922-929 Chronic gastritis and gastroduodenal ulcer: a case control study on risk of coexisting duodenal or gastric ulcer in patients with gastritis P SIPPONEN, K SEPPALA, M AARYNEN, T HELSKE, AND P KETTUNEN From the Department ofPathology and Internal Medicine, Jorvi Hospital, Espoo, District Hospital of Kuusankoski, Kuusankoski, and Second Department of Medicine, University ofHelsinki, Helsinki, Finland SUMMARY Chronic (atrophic) gastritis (AG) is common in active duodenal (DU) and gastric ulcer (GU) disease. In this case control study in consecutive prospective outpatients (571 cases and 1074 controls) who had undergone diagnostic upper gastrointestinal endoscopy and routine biopsies from both antral and body mucosa, we calculated the risk of coexisting active DU and/or GU in different gastritis ofthe antrum or body and according to grade (superficial gastritis, mild, moderate or severe atrophic gastritis). The risk of coexisting active gastroduodenal ulcer (ulcer in duodenum and/or stomach), as well as the risk of DU or GU, was dependent upon the presence and grade of gastritis in antrum and body mucosa. The risk of coexisting ulcer, as expressed as an age adjusted relative risk (RR) and calculated as odds ratio of gastritis in cases and controls, was significantly increased in the presence of superficial antral and body gastritis (RR=8.5 (7'0-20 0) in men; RR=5.8 (33-10.2) in women), as compared with the risk of ulcer in subjects with histologically normal mucosa (RR=1). The risk of ulcer, and the risk of GU in particular, increased further with increasing severity of antral gastritis.
    [Show full text]
  • Risk for Irritable Bowel Syndrome in Patients with Helicobacter Pylori Infection: a Nationwide Population-Based Study Cohort Study in Taiwan
    International Journal of Environmental Research and Public Health Article Risk for Irritable Bowel Syndrome in Patients with Helicobacter Pylori Infection: A Nationwide Population-Based Study Cohort Study in Taiwan Chia-Ming Liang 1, Chih-Hsiung Hsu 2,3, Chi-Hsiang Chung 4,5,6, Chao-Yang Chen 7, Lin-Yin Wang 8, Sheng-Der Hsu 1, Pi-Kai Chang 2,7, Zhi-Jie Hong 1, Wu-Chien Chien 4,5,9,* and Je-Ming Hu 2,5,7,10,* 1 Division of General Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan; [email protected] (C.-M.L.); [email protected] (S.-D.H.); [email protected] (Z.-J.H.) 2 Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei 11490, Taiwan; [email protected] (C.-H.H.); [email protected] (P.-K.C.) 3 Teaching Office, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan 4 School of Public Health, National Defense Medical Center, Taipei 11490, Taiwan; [email protected] 5 Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan 6 Taiwanese Injury Prevention and Safety Promotion Association, Taipei 11490, Taiwan 7 Division of Colorectal Surgery, Department of surgery, Tri-service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan; [email protected] 8 Department of Surgery, Taoyuan Armed Forces General Hospital, Taoyuan 32551, Taiwan; [email protected] 9 Graduate Institute of Life Sciences, National Defense Medical Center, Taipei 11490, Taiwan 10 School of Medicine, National Defense Medical Center, Taipei 11490, Taiwan * Correspondence: [email protected] (W.-C.C.); [email protected] (J.-M.H.) Received: 21 April 2020; Accepted: 21 May 2020; Published: 25 May 2020 Abstract: Background: The association between Helicobacter pylori (H.
    [Show full text]
  • The Diagnosis and Management of Achlorhydria
    The Diagnosis and Management of Achlorhydria Dicky Febrianto, Iswan Abbas Nusi, Poernomo Boedi Setiawan, Herry Purbayu, Titong Sugihartono, Ummi Maimunah, Ulfa Kholili, Budi Widodo, Amie Vidyani, Muhammad Miftahussurur and Husin Thamrin 1Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo Teaching Hospital, Surabaya, Indonesia [email protected] Keywords: Achlorhydria, kobalamin, vitamin, calcium Abstract: Achlorhydria is defined as a decrease in secretion quantity or decrease in the acidity of gastric acid. Gastric acid has several functions including activating other digestive enzymes, deciphering the food particles in the digestive process, essential vitamins and minerals absorption, and eliminating most of the microorganisms that enter with the food. There is no specific management for achlorhydria. Patients with achlorhydria in addition to experiencing disorders of HCl formation generally also suffer from pepsin deficiency. Therefore, pepsin is usually given to support the provision of betaine HCl. Patients with achlorhydria should be periodically monitored for early diagnosis of anemia due to iron deficiency and/or cobalamin. Calcium and vitamin D deficiency can be monitored through serum 25 hydroxyvitamin D level as well as bone density examination. 1 INTRODUCTION The signs that often arise include being weak, weary, lethargic due to anemia, the occurrence of Achlorhydria is a condition of decrease in the undigested food in the feces, neurological disorders, quantity or the absence of gastric acid (Schubert et and bone fractures (Fujita, 2014). al., 2013). The most common risk factor of The gold standard of achlorhydria diagnosis is achlorhydria is Helicobacter pylori infection. H. established by Heidelberg's gastric analysis pylori infection causes chronic atrophic gastritis technique to measure the acidity of gastric acid.
    [Show full text]
  • Acid Suppression and Gastric Atrophy: Sifting Fact
    Gut 1998;43(suppl 1):S35–S38 S35 Acid suppression and gastric atrophy: sifting fact from fiction Gut: first published as 10.1136/gut.43.2008.S35 on 1 July 1998. Downloaded from R M Genta Summary tuted with either intestinal metaplastic epithe- Prolonged pharmacological acid suppression is lium or fibroblasts and extracellular matrix, or associated with various histological changes in a combination of the two. In such cases the the gastric mucosa, particularly in Helicobacter glands are invisible for the obvious reason that pylori infected patients. In a number of subjects they are not there—that is, they are truly “lost”. these changes include a shift in the gastric Most definitions of gastric atrophy, including inflammation from the antrum to the corpus. Whitehead’s,1 Correa’s,2 the original Sydney This finding has been interpreted as gastric System,3 and the updated Sydney System4 have atrophy, and the possibility that acid suppres- emphasised gland loss without specifying what sion accelerates the progress of lesions that may replaces the missing glands. Therefore, mucosa lead to gastric cancer has been considered. Two showing the histopathological features de- recent studies on the relation between treat- picted in figure 1B would be considered ment with proton pump inhibitors and atrophic by many observers, but not by those atrophic gastritis have yielded apparently con- who would want to know whether the missing tradictory results. These studies are reviewed in glands are really lost or just displaced by the detail here and some of the possible reasons for inflammation. Functional studies do not help the discrepant conclusions are explored.
    [Show full text]
  • Patterns of GI Tract Injury
    Adapted/inspired by: Atlas of Gastrointestinal Pathology. Arnold et al. 2015 Prepared by Kurt Schaberg Last updated: 4/2/2020 Patterns of GI Tract Injury Esophagus Non-keratinizing stratified Normal Esophagus squamous mucosa Benign Incidental Findings: Gastric “Inlet Patch”- Heterotopic Muscularis mucosae gastric mucosa in esophagus Esophageal duct Pancreatic Heterotopia/Metaplasia Glycogenic Acanthosis – Epithelial Submucosal glands hyperplasia with abundant, enlarged superficial glycogenated cells; clinically appears white (Muscularis propria: distal = smooth muscle; proximal = skeletal muscle) Acute Esophagitis Intraepithelial Neutrophils with Erosion/Ulceration GERD Often scattered Eos (usu. < 15/HPF), Intercellular edema, Basal cell hyperplasia, Elongation of vascular papilla. Worse distally (near GEJ). Ulcer! Infections Candida - Look for fungal hyphae, Get PAS-D/GMS HSV - Look for Molding, Multinucleation, Margination in epithelial cells. CMV – Look for inclusions in mesenchymal cells. Medications (“Pill esophagitis”) Look for crystals, resins, and pill fragments; Polarize to help looking for foreign material. Eosinophilic Esophagitis Increased intraepithelial Eosinophils (report per HPF) GERD Eos typically < 15/HPF, Intraepithelial T lymphocytes (“squiggle cells”), Intercellular edema, Basal cell hyperplasia, Elongation of vascular papilla. Worse distally (near GEJ). Eosinophilic Esophagitis Typically >20 Eos/HPF. Often eosinophilic microabscesses with degranulation. Often diffuse or worse proximally. Associated with “Atopic Triad”
    [Show full text]