Last reviewed: November 2017
Last updated: September  2017

Summary

Definition

History and exam

Other diagnostic factors

  • age >60 years
  • female sex
  • autoimmune disorders
  • weakness
  • lethargy
  • decreased exercise tolerance
  • skin and conjunctival pallor
  • paraesthesias and difficulty ambulating
  • nutritional deficiency (cobalamin, iron, calcium, vitamin D)
  • enteric infection
  • memory loss, irritability, depression, and dementia
  • ataxia, shuffling gait, decreased position sense, decreased vibration sense
  • pale, smooth, and glossy tongue
  • koilonychia

Risk factors

  • autoimmune disorders
  • age >60 years
  • Helicobacter pylori infection
  • prior gastric surgery
  • hypergastrinaemia
  • gastric carcinoid

Diagnostic investigations

1st investigations to order

  • haemoglobin
  • biopsy of corpus and/or fundus of stomach
  • intragastric pH
Full details

Investigations to consider

  • serum gastrin
  • gastric acid secretory test (gastric analysis)
  • parietal cell antibodies
  • intrinsic factor antibodies
  • urea breath test: Helicobacter pylori infection
  • histology: Helicobacter pylori infection
  • rapid urease test on biopsy samples: Helicobacter pylori infection
  • stool antigen test: Helicobacter pylori infection
  • serology: Helicobacter pylori infection
  • polymerase chain reaction (PCR): Helicobacter pylori infection
  • fluorescence in situ hybridisation: Helicobacter pylori infection
Full details

Emerging tests

  • serum pepsinogen I and II (PGI and PGII)
  • serum ghrelin
Full details

Treatment algorithm

ACUTE

Contributors

Authors VIEW ALL

Mitchell L. Schubert

Professor of Medicine and Physiology

Virginia Commonwealth University Health System

Chief of Gastroenterology

McGuire VAMC

Richmond

VA

Disclosures

MLS is an author of several studies referenced in this monograph.

Dr Mitchell L. Schubert would like to gratefully acknowledge Dr Juan Diego Baltodano, a previous contributor to this monograph. JDB declares that he has no competing interests.

Peer reviewers VIEW ALL

Professor of Medicine

David Geffen School of Medicine at UCLA

Los Angeles

CA

Disclosures

JP declares that he has no competing interests.

Associate Professor of Gastroenterology and Internal Medicine

Medical University of Graz

Attending Gastroenterologist

University Hospitals Graz

Austria

Disclosures

HFH has been reimbursed by Astra Zeneca, Nycomed, and Janssen, the manufacturers of proton-pump inhibitors, for attending several conferences and speaking, and has been paid by Astra Zeneca for running educational programs.

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