González-Martínez KI, Farell-Rivas J, Bautista-Piña V

Language: Spanish
References: 7
Page: 359-363
PDF size: 405.27 Kb.

ABSTRACT

We present the case report of a 48-year-old male with no relevant past medical history, which presented with chronic fatigue and paresthesias; after a full medical evaluation he was diagnosed with megaloblastic anemia associated with vitamin B₁₂ deficiency, sensitive polineuropathy and gastric atrophy. He was treated with vitamin B₁₂, folic acid and erradication of H. pylori infection; after two months of treatment symptoms disappeared. Megaloblastic anemias are macrocytic anemias in which the progenitors of red cells from bone marrow have alterations of DNA synthesis. The most frequent cause of megaloblastic anemia is the lack of vitamin B₁₂ and/or folic acid. Cobalamin or vitamin B₁₂ is synthesized by intestinal bacteria, the major cause of vitamin B₁₂ deficiency is pernicious anemia (PA), which is presented as the final stage of autoimmune atrophic gastritis; however, environmental chronic atrophic gastritis associated with H. pylori can cause deficit of vitamin B₁₂ absorption and consequently lead to megaloblastic anemia. Chronic atrophic gastritis is considered by some authors a preneoplastic disease, as it has been demonstrated the evolution from gastric atrophy intestinal metaplasia to gastric dysplasia and consequently to adenocarcinoma in a small groupp of patients. Upper endoscopy with biopsy is essential to identify the presence and type of gastric atrophy, typical endoscopic findings are: the absence of gastric folds, pale mucosa and submucosal vessels display, these findings must be confirmed via histopathological study and then to determine the presence or absence of autoimmune gastritis with serological markers to have a proper following, diagnosis and treatment.

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