atrophic gastritis

Etiology

• autoimmune gastritis: pernicious anemia
  • vitamin B12 deficiency
• persistent Helicobacter pylori infection

Pathology

• chronic inflammation of the gastric mucosa
• loss of gastric glandular cells & their eventual replacement by intestinal and fibrous tissue
• impaired secretion of hydrochloric acid, pepsin, & intrinsic factor
  • vitamin B12 deficiency (pernicious anemia)
  • iron deficiency anemia
  • small intestinal bacterial overgrowth
• gastric carcinoid

Clinical manifestations

• macrocytic anemia due to vitamin B12 deficiency
  • macrocytosis may be blunted by concurrent iron deficiency
• bloating, foul-smelling stools due to small intestinal bacterial overgrowth weight loss may occur

Laboratory

• serology for Helicobacter pylori
• rapid urease test from gastric biopsy tissue
• histology for H pylori
• anti-parietal cell antibody
• anti-intrinsic factor antibody
• serum vitamin B12
• serum iron
• serum gastrin (hypergastrinemia)

Diagnostic procedures

• upper gastrointestinal endoscopy for gastric biopsy

Complications

• increased risk of gastric cancer (adenocarcinoma)

Management

• treat Helicobacter pylori
• autoimmune atrophic gastritis
  • vitamin B12 supplementation
  • iron supplementation
  • surveillance for gastric carcinoid

More general terms

• gastritis
• atrophy

More specific terms

• pernicious anemia; autoimmune gastritis