Gastric as well as Duodenal Biopsies May Be Useful in the Investigation of Iron Deficiency Anaemia

Abstract

As well as confirming the importance of seeking coeliac disease in patients with iron deficiency anaemia, our results suggest that achlorhydric gastric atrophy is also a common association. Gastric biopsies should be taken in patients with no other explanation for anaemia. The finding of Giardia organisms in two achlorhydric patients, with a possible contributory role, suggests that duodenal biopsies should be obtained even if serum coeliac-related antibodies are absent.

How I treat unexplained refractory iron deficiency anemia

“…38,39 Autoimmune atrophic gastritis Achylia gastrica as a cause of IDA has first been described as a clinical entity by Faber in 1909 40 ; achlorhydric gastric atrophy, a synonym for the same entity, has long been recognized as a major cause of IDA 41 but has been completely ignored in subsequent major surveys of gastrointestinal causes of IDA. More recently, achlorhydric gastric atrophy was rediscovered by Dickey et al, 14 and implicated in 20% of IDA patients with no evidence of gastrointestinal blood loss. This observation was confirmed and greatly extended in a series of important studies by Annibale et al 13 who found 27% of patients with refractory IDA without gastrointestinal symptoms to have atrophic body gastritis, a percentage identical with the proportion of subjects with autoimmune atrophic body gastritis found subsequently in our own studies.…”

“…11,12 Likewise, autoimmune atrophic gastritis, a condition associated with chronic idiopathic iron deficiency, has been shown to be responsible for refractory IDA in over 20% of patients with no evidence of gastrointestinal blood loss. 13,14 The availability of convenient, noninvasive screening methods for identifying celiac disease (anti-tissue transglutaminase [TTG] antibodies), autoimmune atrophic gastritis (serum gastrin, parietal cell, or intrinsic factor antibodies), and H pylori infection (antibody screening or fecal antigen and urease breath test), and the recent recognition of rare inherited forms of iron deficiency greatly facilitated the diagnosis of these entities, resulting in an increased awareness of these conditions and their possible role in the causation of IDA. The aim of the present communication is to focus on the role of the above entities in the pathogenesis of refractory IDA, but it is not intended to represent a detailed general strategy for the diagnosis and management of iron deficiency.…”

Soluble transferrin receptor level: a new marker of iron deficiency anemia, a common manifestation of gastric autoimmunity in type 1 diabetes.

“…Moreover, PCAs target the gastric proton pump (7), which results in decreased gastric acid secretion and decreased iron absorption. This may cause iron deficiency anemia, which is a common (although frequently overlooked) manifestation of autoimmune gastritis (8)(9)(10)(11)(12). On the other hand, iron deficiency anemia can also arise by malignant or inflammatory diseases, especially from the gastrointestinal tract (13,14), and atrophic gastritis predisposes patients to gastric carcinoma and carcinoid tumors (15,16).…”

Déficit de hierro sin pérdidas hemorrágicas evidentes: ¿un "reto" para la práctica clínica?

“…La gastritis atrófica aclorhídrica puede ser la causa del estado ferropénico hasta en un 20% de pacientes con anemia ferropénica sin síntomas gastrointestinales, una prueba de sangre oculta en heces negativa y ausencia de una lesión sangrante en procedimientos de endoscopia gastrointestinal y colónica (determinada la aclorhidria por unos niveles plasmáticos de gastrina superiores a 200 ng/l estando el paciente en ayunas); la atrofia vellosa de duodeno puede ser la causa en otro 10% (11). La gastritis atrófica, en algún trabajo reciente, constituye incluso la primera causa de anemia ferropénica en pacientes asintomáticos desde un punto de vista gastrointestinal, incluidas tanto las causas asociadas a pérdidas como las que no se asocian a sangrado, una vez recogido un diagnóstico final (3).…”

“…La biopsia de intestino delgado, ya bien sea duodenal o yeyunal, puede también poner de manifiesto la presencia de una infección por Giardia lamblia, parásito implicado en estados ferropénicos, asociado o no a aclorhidria (11). La gastritis asociada a infección por Helicobacter pylori se ha relacionado con déficit de hierro en una comunidad de nativos de Alaska (12).…”