A link between asthenia, pallor, and jaundiceBMJ 2016; 353 doi: https://doi.org/10.1136/bmj.i2937 (Published 07 June 2016) Cite this as: BMJ 2016;353:i2937
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The authors have reported a classic case of autoimmune gastritis and pernicious anaemia. As a gastroenterologist, I can confirm that such 'textbook' cases still commonly present and the case provides and interesting and relevant ecucational tool. The authors rightly emphasize both the important role of primary care in diagnosing and managing these patients and the uncertainty over continued endoscopic screening. Perhaps the authors have overstated the case of endoscopic screening, although as cited some guidelines do advocate this but in many areas this would not be usual practice. However given the rate of detection of neoplasia (predominantly type 1 gastric carcinoids) of over 1% per year in autoimmune atrophic gastritis, there is a reasonable argument for screening.
The authors have provided a sensible list of differential diagnosis, but do seem to have omitted food-cobalamin malabsorption. This is probably relatively common, gastritis, without atrophy, metaplasia or autoimmune parietal cell destruction, usually associated with H pylori infection is associated with diminished absorption of food-bound cobalamin. The diagnostic pathway outlined by the authors will probably pick this up, but it is important to remember that B12 malabsoprtion can occur with histological gastritis but without the atrophic changes typically associated with autoimmune gastritis.,
Competing interests: No competing interests