最后审阅: 19 九月 2021
最后更新: 10 六月 2021

小结

定义

病史和体格检查

其他诊断因素

  • 年龄 60 岁以上
  • 女性
  • 自身免疫性疾病
  • 虚弱
  • 昏睡
  • 运动耐量下降
  • 皮肤和结膜苍白
  • 感觉异常和行走困难
  • 营养缺乏(钴胺素、铁、钙、维生素 D)
  • 肠道感染
  • 记忆丧失、易怒、抑郁和痴呆
  • 共济失调、曳行步态、位置感觉下降、振动感觉下降
  • 舌苍白、光滑且有光泽
  • 凹甲

危险因素

  • 自身免疫性疾病
  • 年龄 60 岁以上
  • 幽门螺杆菌感染
  • 既往胃部手术
  • 高胃泌素血症
  • 胃类癌

诊断性检查

首要检查

  • 血红蛋白
  • 胃底和/或胃体的活检
  • 胃内 pH 值

需考虑的检查

  • 血清胃泌素
  • 胃酸分泌检测(胃酸分析)
  • 壁细胞抗体
  • 内因子抗体
  • 幽门螺杆菌感染的诊断性检测

新兴检查

  • 血清胃蛋白酶原 I 和 II(PGI 和 PGII)

治疗流程

急症处理

撰稿人

作者

Mitchell L. Schubert, MD
Mitchell L. Schubert

Professor of Medicine and Physiology

Virginia Commonwealth University Health System

Chief of Gastroenterology

McGuire VAMC

Richmond

VA

利益声明

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

利益声明

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

利益声明

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

鸣谢

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.

利益声明

JDB declares that he has no competing interests.

同行评议者

Joseph Pisegna, MD

Professor of Medicine

David Geffen School of Medicine at UCLA

Los Angeles

CA

利益声明

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

利益声明

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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