Summary
Definition
History and exam
Other diagnostic factors
- idade >60 anos
- sexo feminino
- doenças autoimunes
- fraqueza
- letargia
- tolerância reduzida ao exercício
- palidez da pele e conjuntival
- parestesias e dificuldade de ambulação
- deficiência nutricional (cobalamina, ferro, cálcio, vitamina D)
- infecção entérica
- perda de memória, irritabilidade, depressão e demência
- ataxia, marcha arrastada, senso de posição diminuído, percepção de vibração diminuída
- língua pálida, lisa e brilhante
- coiloníquia
Risk factors
- doenças autoimunes
- idade >60 anos
- infecção por Helicobacter pylori
- cirurgia gástrica prévia
- hipergastrinemia
- carcinoide gástrico
Diagnostic investigations
1st investigations to order
- hemoglobina
- biópsia do corpo e/ou fundo do estômago
- pH intragástrico
Investigations to consider
- gastrina sérica
- teste de secreção de ácido gástrico (análise gástrica)
- anticorpos anticélulas parietais
- anticorpos antifator intrínseco (FI)
- testes diagnósticos para infecção por Helicobacter pylori
- pepsinogênio sérico I e II (PGI e PGII)
Treatment algorithm
todos os pacientes
Contributors
Authors
C. Prakash Gyawali, MD, FRCP
Professor of Medicine
Division of Gastroenterology
WashU Medicine
St. Louis
MO
Disclosures
CPG declares that he has no competing interests.
Acknowledgements
Dr C. Prakash Gyawali would like to gratefully acknowledge Dr Joseph Spataro, Dr Hamzeh Saraireh, Dr Mitchell L. Schubert, and Dr Juan Diego Baltodano, previous contributors to this topic.
Disclosures
JS declares that he has no competing interests. HS is the author of one study referenced in this topic. MLS is an author of several studies referenced in this topic. JDB declares that he has no competing interests.
Peer reviewers
George Triadafilopoulos, MD
Professor of Medicine
Department of Gastroenterology, Hepatology & Nutrition
Division of Internal Medicine
The University of Texas MD Anderson Cancer Center
Houston
TX
Disclosures
GT declares that he has no competing interests.
Peter J. Kahrilas, MD
Gilbert H. Marquardt Professor of Medicine
Professor of Medicine (Gastroenterology and Hepatology)
Feinberg School of Medicine
Northwestern University
Evanston
IL
Disclosures
PJK 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.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Gupta S, Li D, El Serag HB, et al. AGA clinical practice guidelines on management of gastric intestinal metaplasia. Gastroenterology. 2020 Feb;158(3):693-702.Full text Abstract
Malfertheiner P, Megraud F, Rokkas T, et al. Management of Helicobacter pylori infection: the Maastricht VI/Florence consensus report. Gut. 2022 Aug 8.Full text Abstract
Chey WD, Howden CW, Moss SF, et al. ACG clinical guideline: treatment of Helicobacter pylori infection. Am J Gastroenterol. 2024 Sep 1;119(9):1730-53.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Diferenciales
- Hipocloridria e hipergastrinemia induzidas por medicamento antissecretor
More DiferencialesGuías de práctica clínica
- Treatment of Helicobacter pylori infection
- Management of Helicobacter pylori infection: the Maastricht VI/Florence consensus report
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