Is Pernicious Anemia Caused by Campylobacter pylori Gastritis?

Gastroduodenal Dyspepsia: A Personal View Integrating Clinical, Endoscopic, Histological and Management Criteria

“…(2) As indicated [29], it is inter esting to speculate that this spread of II. pylori infection from the antrum to the fundus may result in total corpus atrophy with achlorhyd ria, and, thus, II.…”

“…The severe phases of cor pus atrophy, however, do have clinical signifi cance and histologically are characterized by almost total loss of parietal and chief cells, intestinal metaplasia, and other degenerative changes such as cystic dilatation, as described by Barwick et al [28]. Thus, if a diagnosis of severe gastric atrophy is made, then only the clinician can actually determine whether the patient has total corpus atrophy, i.e., from a clinical point of view, nonfunctioning chief and parietal cells, on the basis of the presence or absence of gastric secretory failure [27], The histological specimens may miss parietal/ chief cells because of sampling error, or, if present, they may be nonfunctioning [29], Thus, it is the clinician who must assess secre Gaslroduodenal Dyspepsia: The Spiro Syndrome tory failure by determining whether achlor hydria is present by gastric analysis using pentagastrin stimulation or by measuring serum pepsinogen I or gastrin levels. It was shown in a recent study [30] that gastrin levels >200 pg are consistent with gastric atrophy and achlor hydria.…”

“…Requiring this strict defini tion of total corpus atrophy with secretory failure for the final stage of gastric atrophy will be more meaningful to the clinician be cause of its clinical implication. Namely, with achlorhydria the patient can no longer devel op peptic ulcer disease and may now be sub ject to other complications such as pernicious anemia or cancer [27,29].…”

“…The atrophic changes in antrum and duodenum are not always in parallel with corpus atrophy and can vary from normal to abnormal [29,31].…”

“…pylori infection from the antrum to the fundus may result in total corpus atrophy with achlorhyd ria, and, thus, II. pylori may eventually selfdestruct [29] by eliminating the acid-peptic milieu that appears to be necessary for its sur vival. Support for this hypothesis has been the demonstration that although gastric tissue staining fails to reveal II.…”