Last reviewed: 25 Jun 2021
Last updated: 10 Jun 2021

Summary

Definition

History and exam

Other diagnostic factors

  • age >60 years
  • female sex
  • autoimmune disorders
  • weakness
  • lethargy
  • decreased exercise tolerance
  • skin and conjunctival pallor
  • paresthesias 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
  • hypergastrinemia
  • gastric carcinoid

Diagnostic investigations

1st investigations to order

  • hemoglobin
  • biopsy of corpus and/or fundus of stomach
  • intragastric pH

Investigations to consider

  • serum gastrin
  • gastric acid secretory test (gastric analysis)
  • parietal cell antibodies
  • intrinsic factor antibodies
  • diagnostic tests for Helicobacter pylori infection

Emerging tests

  • serum pepsinogen I and II (PGI and PGII)

Treatment algorithm

Contributors

Authors

Mitchell L. Schubert, MD
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 topic.

Joseph Spataro, MD
Joseph Spataro

Academic Fellow

Division of Gastroenterology, Hepatology, and Nutrition

Virginia Commonwealth University Health System

Richmond

VA

Disclosures

JS declares that he has no competing interests.

Hamzeh Saraireh, MD
Hamzeh Saraireh

Academic Fellow

Division of Gastroenterology, Hepatology, and Nutrition

Virginia Commonwealth University Health System

Richmond

VA

Disclosures

HS declares that he is the author of one study referenced in this topic.

Acknowledgements

Dr Mitchell L. Schubert, Dr Joseph Spataro, and Dr Hamzeh Saraireh would like to gratefully acknowledge Dr Juan Diego Baltodano, a previous contributor to this topic.

Disclosures

JDB declares that he has no competing interests.

Peer reviewers

Joseph Pisegna, MD

Professor of Medicine

David Geffen School of Medicine at UCLA

Los Angeles

CA

Disclosures

JP declares that he has no competing interests.

Heinz F. Hammer, MD

Associate Professor of Gastroenterology and Internal Medicine

Medical University of Graz

Attending Gastroenterologist

University Hospitals Graz

Austria

Disclosures

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

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