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
所有患者
撰稿人
作者
Mitchell L. Schubert, MD
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
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
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.
鉴别诊断
- 抗分泌药物引起的低胃酸和高胃泌素血症
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