Autoimmune gastritis may present as pernicious anaemia arising from vitamin B12 malabsorption, but also with iron deficiency anaemia due to iron malabsorption. These different clinical presentations might have a genetic basis. Single nucleotide polymorphisms associated with vitamin B12 levels have not been investigated in autoimmune gastritis.Pernicious anemia is more likely to be diagnosed in younger patients in the setting of autoimmune disease, especially primary Sjogren syndrome, elements of APS, and in those with H. pylori infection. In older patients fracture, neuropathy, and plasma cell dyscrasia are more likely clinical scenarios. The correlation found among pernicious anemia patients between H. pylori infection and underlying autoimmune disease supports the hypothesis that H. pylori can act as a trigger of an autoimmune response in a genetically predisposed host.

Pernicious anemia (PA) is defined as having anemia (hemoglobin concentration < 13 g/dL for men and <12 g/dL for women), an mean corpuscular volume (MCV) ≥ 100 fL, a serum vitamin B12 level < 200 pg/mL, and the presence of serum gastric parietal cell antibody (GPCA) and/or anti-intrinsic factor antibody positivities. Our previous studies found PA in 22 (2.1%) of 1064 atrophic glossitis patients, in 15 (1.7%) of 884 burning mouth syndrome patients, in 6 (1.7%) of 352 oral lichen planus patients, and in 4 (1.1%) of 355 recurrent aphthous stomatitis patients. Patients with PA usually have complete or partial atrophic glossitis and concomitant sensitivity to spicy or hot food, burning and numbness of the tongue, and loss of taste sensation that finally result in difficulty in eating or swallowing of food. In our experience, atrophic glossitis was trouble for PA patients, but it could be treated to normal in two weeks by intramuscular injection of vitamin B12 . The oral symptoms and signs usually disappeared after 2-week treatment of vitamin B12 injection and this in turn allowed patients to have a comfortable feeling when eating. In addition, for PA patients with a permanent decrease in the ability to absorb dietary vitamin B12, lifelong treatment with intramuscular injection of vitamin B12 once per month is necessary. Although it is not an established treatment, recently it has been reported that oral treatment is also effective, because 1%–5% of vitamin B12 absorption in the terminal ileum is by passive diffusion, which does not involve intrinsic factor. However, PA patients are at high risk of developing gastric adenocarcinoma and carcinoid tumors. Thus, periodic stomach examinations are recommended for PA patients.

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Mishita
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Journal of  Autoimmune Disorders