07-11-2008, 12:36 AM
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This patient's clinical findings are due to atrophic gastritis, probably as a result of lifelong Helicobacter pylori infection. In patients with atrophic gastritis, vitamin B12 cannot be released from dietary protein because of the absence of gastric acid and pepsin. In addition, deficient gastric secretion of intrinsic factor (caused by atrophy of the parietal cells that produce this factor) reduces vitamin B12 absorption. This patient will most likely have an elevated serum gastrin level and gastric polyps, as a consequence of gastric achlorhydria.
Autoimmune gastritis with pernicious anemia is uncommon in black persons. In addition, patients with this disorder would most likely have positive anti-parietal cell antibodies and anti-intrinsic factor antibodies. There is no history of or any reason to suspect the presence of ileal disease. Although pancreatic insufficiency can impair vitamin B12 absorption by impairing release of this vitamin from R proteins, vitamin B12 deficiency is rare in patients with pancreatic disease, and there is nothing in this patient's presentation to suggest pancreatic disease. Alendronate can lead to esophageal and gastric damage, but would not be expected to cause macrocytic anemia and her other clinical findings.
This patient's clinical findings are due to atrophic gastritis, probably as a result of lifelong Helicobacter pylori infection. In patients with atrophic gastritis, vitamin B12 cannot be released from dietary protein because of the absence of gastric acid and pepsin. In addition, deficient gastric secretion of intrinsic factor (caused by atrophy of the parietal cells that produce this factor) reduces vitamin B12 absorption. This patient will most likely have an elevated serum gastrin level and gastric polyps, as a consequence of gastric achlorhydria.
Autoimmune gastritis with pernicious anemia is uncommon in black persons. In addition, patients with this disorder would most likely have positive anti-parietal cell antibodies and anti-intrinsic factor antibodies. There is no history of or any reason to suspect the presence of ileal disease. Although pancreatic insufficiency can impair vitamin B12 absorption by impairing release of this vitamin from R proteins, vitamin B12 deficiency is rare in patients with pancreatic disease, and there is nothing in this patient's presentation to suggest pancreatic disease. Alendronate can lead to esophageal and gastric damage, but would not be expected to cause macrocytic anemia and her other clinical findings.