Basic Research
Copyright ©2005 Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 7, 2005; 11(45): 7078-7083
Published online Dec 7, 2005. doi: 10.3748/wjg.v11.i45.7078
Vitamin B12 deficiency and gastric histopathology in older patients
KR Dholakia, TS Dharmarajan, D Yadav, S Oiseth, EP Norkus, CS Pitchumoni
KR Dholakia, Department of Medicine, Our Lady of Mercy Medical Center, Bronx, NY; University Hospital of New York Medical College, Valhalla, NY, United States
TS Dharmarajan, Department of Medicine, Division of Geriatrics, Our Lady of Mercy Medical Center, Bronx, NY; University Hospital of New York Medical College, Valhalla, NY, United States
D Yadav, Department of Medicine, Division of Gastroenterology, Our Lady of Mercy Medical Center, Bronx, NY; University Hospital of New York Medical College, Valhalla, NY, United States
S Oiseth, Department of Pathology, Our Lady of Mercy Medical Center, Bronx, NY; University Hospital of New York Medical College, Valhalla, NY, United States
EP Norkus, Department of Medical Research, Our Lady of Mercy Medical Center, Bronx, NY; University Hospital of New York Medical College, Valhalla, NY, United States
CS Pitchumoni, Department of Medicine, Division of Gastroenterology, Hepatology and Clinical Nutrition, St. Peter’s Medical Center, University of Medicine and Dentistry of New Jersey, New Brunswick, NJ, United States
Author contributions: All authors contributed equally to the work.
Supported by the Fellowship Training Programs in Gastroenterology and Geriatric Medicine at Our Lady of Mercy Medical Center
Correspondence to: Dharmarajan TS, MD, 31 Pheasant Run, Scarsdale, New York 10583, United States. dharmarajants@yahoo.com
Telephone: +1-718-920-9041 Fax: +1-914-723-4297
Received: March 18, 2005
Revised: April 2, 2005
Accepted: April 9, 2005
Published online: December 7, 2005
Abstract

AIM: To compare upper gastric endoscopic and histopathologic findings in older adults in the presence and absence of B12 deficiency.

METHODS: A prospective analysis of upper gastric endoscopic and gastric histopathologic findings from 30 newly identified B12-deficient patients (11 males, 19 females) and 16 controls with normal B12 status (6 males, 10 females) was performed. For all subjects, the indication for upper endoscopy and gastric biopsy were unrelated to B12 status. A single pathologist, blinded to B12 status, processed and interpreted the biopsy samples. Endoscopic and histopathologic findings were correlated with age, gender, hematocrit (Hct), MCV and B12 status.

RESULTS: The B12-deficient group had significantly lower mean serum B12 levels compared to the controls (P<0.00005) while their mean Hct, MCV and serum albumin levels were similar. Iron deficiency (ferritin-based) was present in 21% of B12-deficient patients and intrinsic factor antibodies were present in 29% (5/17) of B12-deficient patients. The endoscopic findings revealed significantly different rates of gastritis and atrophy between the B12-deficient and control groups (P = 0.017). B12-deficient patients had significantly less superficial gastritis (62% vs 94%) and significantly more atrophic gastritis (28% vs 0%) as compared to the controls (P = 0.039). Intestinal metaplasia was similar in both groups. Helicobacter pylori infection rates were similar in the B12-deficient patients and controls (40% vs 31%).

CONCLUSION: Significantly different endoscopic findings and types of gastritis could often be observed in the presence and absence of B12 deficiency. Atrophy, based on endoscopy, and atrophic gastritis, based on histopathology, suggest the presence of B12 deficiency. Gastric histopathology is not influenced by the age, gender, Hct or MCV of the patients.

Keywords: Vitamin B12 deficiency; Gastric histopathology; Older adults