Chronic Autoimmune Gastritis: Modern Diagnostic Principles

This article summarizes and systematizes the available data from the literature on chronic autoimmune gastritis (CAG) in order to increase the awareness of specialists about the modern possibilities for diagnosing the disease, including its early stages. The clinical manifestation of the disease includes possible variants such as gastrointestinal, hematological (first of all, the formation of iron deficiency and B12-deficiency anemia), and neurological variants. Patients with chronic autoimmune gastritis are characterized by comorbidity with other autoimmune diseases. In this paper, data on the most informative serological markers for the diagnosis of CAG, as well as laboratory tests to detect micronutrient deficiencies, information on the characteristic changes in the gastric mucosa, and the prognosis of the disease, are presented. The diagnosis of CAG should be based on a multidisciplinary approach that combines a thorough analysis of a patient’s complaints with a mandatory assessment of nutritional status, as well as the results of serological, endoscopic, and histological research methods.

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Faculty Opinions recommendation of Role of autoimmune gastritis, Helicobacter pylori and celiac disease in refractory or unexplained iron deficiency anemia.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.4034.461526 ◽

2005 ◽

Author(s):

McDonald Horne

Keyword(s):

Helicobacter Pylori ◽

Celiac Disease ◽

Iron Deficiency ◽

Iron Deficiency Anemia ◽

Autoimmune Gastritis ◽

Deficiency Anemia

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Are Countries of the Eastern Mediterranean Region on Track towards Meeting the World Health Assembly Target for Anemia? A Review of Evidence

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18052449 ◽

2021 ◽

Vol 18 (5) ◽

pp. 2449

Author(s):

Ayoub Al-Jawaldeh ◽

Mandy Taktouk ◽

Radhouene Doggui ◽

Zahra Abdollahi ◽

Baseer Achakzai ◽

...

Keyword(s):

Iron Deficiency ◽

Mediterranean Region ◽

Eastern Mediterranean ◽

Eastern Mediterranean Region ◽

Reproductive Age ◽

World Health ◽

Deficiency Anemia ◽

Micronutrient Deficiencies ◽

World Health Assembly ◽

The World

Anemia is a multifactorial condition, with a complex etiology that involves nutritional and non-nutritional factors. The misconception that iron deficiency is equivalent to anemia may mask the need to address other potential causative factors. This review paper aims to (1) assess the burden of anemia vs. iron deficiency anemia (IDA) amongst women of reproductive age (WRA), pregnant women (PW), and children under five years old (underfive children, U5C) in the Eastern Mediterranean region (EMR); (2) evaluate trends in anemia prevalence and whether countries are on track towards meeting the World Health Assembly (WHA) target for 2025; and (3) characterize anemia reduction efforts and provide a road map for future programs. A search of pertinent literature and databases was conducted. Anemia prevalence in the EMR ranged between 22.6% and 63% amongst PW, 27% and 69.6% amongst WRA, and 23.8% and 83.5% amongst U5C. Data showed that the EMR is not on course towards meeting the WHA target. The contribution of IDA to anemia was found to be less than half. Other potential contributors to anemia in the region were identified, including micronutrient deficiencies, parasitic infestations, and poor sanitation. A framework of action was proposed as a roadmap to meet the targets set by the WHA.

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Impact of the WIC Program on the Iron Status of Infants

PEDIATRICS ◽

10.1542/peds.75.1.100 ◽

1985 ◽

Vol 75 (1) ◽

pp. 100-105 ◽

Cited By ~ 2

Author(s):

Virginia Miller ◽

Sheldon Swaney ◽

Amos Deinard

Keyword(s):

Socioeconomic Status ◽

Iron Deficiency ◽

Nutritional Status ◽

Pregnant Women ◽

Iron Status ◽

Deficiency Anemia ◽

Wic Program ◽

Lactating Women ◽

Supplemental Food ◽

Women And Children

The WIC Program (Special Supplemental Food Program for Women, Infants and Children) was initiated in the early 1970s to improve the nutritional status of pregnant women, lactating women, and children from birth to 5 years of age who were at risk for nutritionally related health problems. Better hematologic status of a group of preschool-aged infants who were enrolled in the WIC Program from birth, as compared with another group of similar age and socioeconomic status from the pre-WIC Program era, suggests that participation in the WIC Program will help limit the development of iron depletion or iron deficiency anemia in young children, an important consideration in view of the deleterious hematologic and nonhematologic effects that have been attributed to those conditions.

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Annual Prevalence, Health Expenditures, and Co-Morbidities Trend of Iron Deficiency Anemia in Korea: National Health Insurance Service Data from 2002 to 2013

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17124433 ◽

2020 ◽

Vol 17 (12) ◽

pp. 4433

Author(s):

Yoo-Jin Park ◽

Hee-Sook Lim ◽

Tae-Hee Kim

Keyword(s):

Iron Deficiency ◽

Nutritional Status ◽

Iron Deficiency Anemia ◽

National Health ◽

Health Expenditures ◽

Medical Costs ◽

Deficiency Anemia ◽

Prevalence Rates ◽

Annual Prevalence ◽

Hospitalization Costs

Despite improvements in nutritional status, iron deficiency anemia (IDA) remains a debilitating nutritional problem worldwide. We estimate annual IDA prevalence rates by sex and age and the trends therein in Korea. We also calculate the health expenditures of IDA and its co-morbidities by analyzing claims data in the National Health Information Database from 2002 to 2013. All analyses were performed based on diagnosis codes of IDA (D50, D50.0, D50.8, and D50.9) regardless of whether IDA was the principal or a coexisting disease. Trends in IDA prevalence rates were evaluated by calculating annual percent changes (APCs) in prevalence. The health expenditures of IDA were calculated based on the direct medical costs (outpatient and hospitalization costs, pharmaceutical costs) and direct non-medical costs (travel costs). The overall IDA prevalence in both sexes increased approximately 2.3-fold from 2002 to 2013; the APC was +7.6%. In females, the prevalence of IDA was highest in aged 30–39 and 40–49 years. The APC was highest in those aged <10 years (+18.2%), followed by those aged ≥80 (+14.7%) and 70–79 (+9.8%) years. In males, the prevalence rates were highest in aged <10 years, followed by those aged ≥60 years. The APC was highest in those aged <10 years (+19.1%), followed by those aged ≥80 years (+10.5%). The total health expenditures increased 2.8-fold during 12 years. Diseases of the respiratory or gastrointestinal tract were the most prevalent co-morbidities in both males and females. The annual prevalence of IDA continues to rise in association with adverse health expenditures and co-morbidities in spite of improvements in nutritional status. Most importantly, infants and young children, the elderly, and females aged 30–49 years are at highest risk of IDA. A national, prospective, and well-organized effort to improve iron status and to manage IDA is required.

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Iron deficiency anemia and megaloblastic anemia in obese patients

Romanian Journal of Internal Medicine ◽

10.1515/rjim-2016-0046 ◽

2017 ◽

Vol 55 (1) ◽

pp. 3-7 ◽

Cited By ~ 2

Author(s):

Mahmoud Arshad ◽

Sara Jaberian ◽

Abdolreza Pazouki ◽

Sajedeh Riazi ◽

Maryam Aghababa Rangraz ◽

...

Keyword(s):

Body Mass Index ◽

Morbid Obesity ◽

Iron Deficiency ◽

Vitamin B12 ◽

Iron Deficiency Anemia ◽

Megaloblastic Anemia ◽

Vitamin B12 Deficiency ◽

Deficiency Anemia ◽

Obese Patients ◽

B12 Deficiency

Abstract Background. The association between obesity and different types of anemia remained uncertain. The present study aimed to assess the relation between obesity parameters and the occurrence of iron deficiency anemia and also megaloblastic anemia among Iranian population. Methods and Materials. This cross-sectional study was performed on 1252 patients with morbid obesity that randomly selected from all patients referred to Clinic of obesity at Rasoul-e-Akram Hospital in 2014. The morbid obesity was defined according to the guideline as body mass index (BMI) equal to or higher than 40 kg/m2. Various laboratory parameters including serum levels of hemoglobin, iron, ferritin, folic acid, and vitamin B12 were assessed using the standard laboratory techniques. Results. BMI was adversely associated with serum vitamin B12, but not associated with other hematologic parameters. The overall prevalence of iron deficiency anemia was 9.8%. The prevalence of iron deficiency anemia was independent to patients’ age and also to body mass index. The prevalence of vitamin B12 deficiency was totally 20.9%. According to the multivariable logistic regression model, no association was revealed between BMI and the occurrence of iron deficiency anemia adjusting gender and age. A similar regression model showed that higher BMI could predict occurrence of vitamin B12 deficiency in morbid obese patients. Conclusion. Although iron deficiency is a common finding among obese patients, vitamin B12 deficiency is more frequent so about one-fifth of these patients suffer vitamin B12 deficiency. In fact, the exacerbation of obesity can result in exacerbation of vitamin B12 deficiency.

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Reticulocyte size in nutritional anemias

Blood ◽

10.1182/blood.v48.5.669.669 ◽

1976 ◽

Vol 48 (5) ◽

pp. 669-677 ◽

Cited By ~ 15

Author(s):

DR Clarkson ◽

EM Moore

Keyword(s):

Iron Deficiency ◽

Vitamin B12 ◽

Mean Corpuscular Volume ◽

Vitamin B12 Deficiency ◽

Deficiency Anemia ◽

Initial Development ◽

Abrupt Decrease ◽

Iron Saturation ◽

Iron Deficient ◽

B12 Deficiency

Abstract Alterations in reticulocyte size occur 2–3 days after the onset of iron deficient or megaloblastic erythropoiesis and precede, by several weeks, changes in mean corpuscular volume (MCV). Iron-deficiency anemia induced in a normal subject by repeated phlebotomies was characterized by the initial development of larger than normal reticulocytes followed by an abrupt decrease in reticulocyte size. Microreticulocytes appeared 3 days after the fall in per cent iron saturation and antedated the decrease in MCV to below normal by 6 wk. Mean reticulocyte size was disproportionately smaller than normal in patients presenting with iron deficiency. In contrast, reticulocyte size increased abruptly in a patient (and rats) 2–3 days after administration of methotrexate. Mean reticulocyte size was disproportionately larger than normal in patients presenting with folate or vitamin B12 deficiency. Specific replacement therapy with iron, folate, or vitamin B12 was quickly followed by normalization of reticulocyte size.

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Serum Transferrin Receptor and Its Ratio to Serum Ferritin in the Diagnosis of Iron Deficiency

Blood ◽

10.1182/blood.v89.3.1052 ◽

1997 ◽

Vol 89 (3) ◽

pp. 1052-1057 ◽

Cited By ~ 533

Author(s):

Kari Punnonen ◽

Kerttu Irjala ◽

Allan Rajamäki

Keyword(s):

Bone Marrow ◽

Iron Deficiency ◽

Transferrin Receptor ◽

Laboratory Tests ◽

Bone Marrow Examination ◽

Deficiency Anemia ◽

Serum Transferrin ◽

Iron Stores ◽

Serum Transferrin Receptor ◽

Reference Limits

Abstract The objective of the study was to evaluate the diagnostic efficiency of laboratory tests, including serum transferrin receptor (TfR) measurements, in the diagnosis of iron depletion. The patient population consisted of 129 consecutive anemic patients at the University Hospital of Turku who were given a bone marrow examination. Of these patients, 48 had iron deficiency anemia (IDA), 64 anemia of chronic disease (ACD), and 17 patients had depleted iron stores and an infectious or an inflammatory condition (COMBI). Depletion of iron stores was defined as a complete absence of stainable iron in the bone marrow examination. Serum TfR concentrations were elevated in the vast majority of the IDA and COMBI patients, while in the ACD patients, the levels were within the reference limits reported earlier for healthy subjects. TfR measurement thus provided a reliable diagnosis of iron deficiency anemia (AUCROC 0.98). Serum ferritin measurement also distinguished between IDA patients and ACD patients. However, the optimal decision limit for evaluation of ferritin measurements was considerably above the conventional lower reference limits, complicating the interpretation of this parameter. Calculation of the ratio TfR/log ferritin (TfR-F Index) is a way of combining TfR and ferritin results. This ratio provided an outstanding parameter for the identification of patients with depleted iron stores (AUCROC 1.00). In anemic patients, TfR measurement is a valuable noninvasive tool for the diagnosis of iron depletion, and offers an attractive alternative to more conventional laboratory tests in the detection of depleted iron stores.

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Multifactorial Etiology of Anemia in Celiac Disease and Effect of Gluten-Free Diet: A Comprehensive Review

Nutrients ◽

10.3390/nu11112557 ◽

2019 ◽

Vol 11 (11) ◽

pp. 2557 ◽

Cited By ~ 8

Author(s):

Martín-Masot ◽

Nestares ◽

Diaz-Castro ◽

López-Aliaga ◽

Alférez ◽

...

Keyword(s):

Celiac Disease ◽

Iron Deficiency ◽

Vitamin B12 ◽

Clinical Manifestations ◽

Vitamin B12 Deficiency ◽

Deficiency Anemia ◽

Intestinal Biopsy ◽

B12 Deficiency ◽

Endomysial Antibodies ◽

Inflammatory Bowel

Celiac disease (CD) is a multisystemic disorder with different clinical expressions, from malabsorption with diarrhea, anemia, and nutritional compromise to extraintestinal manifestations. Anemia might be the only clinical expression of the disease, and iron deficiency anemia is considered one of the most frequent extraintestinal clinical manifestations of CD. Therefore, CD should be suspected in the presence of anemia without a known etiology. Assessment of tissue anti-transglutaminase and anti-endomysial antibodies are indicated in these cases and, if positive, digestive endoscopy and intestinal biopsy should be performed. Anemia in CD has a multifactorial pathogenesis and, although it is frequently a consequence of iron deficiency, it can be caused by deficiencies of folate or vitamin B12, or by blood loss or by its association with inflammatory bowel disease (IBD) or other associated diseases. The association between CD and IBD should be considered during anemia treatment in patients with IBD, because the similarity of symptoms could delay the diagnosis. Vitamin B12 deficiency is common in CD and may be responsible for anemia and peripheral myeloneuropathy. Folate deficiency is a well-known cause of anemia in adults, but there is little information in children with CD; it is still unknown if anemia is a symptom of the most typical CD in adult patients either by predisposition due to the fact of age or because biochemical and clinical manifestations take longer to appear.

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