Vitamin B12 deficiency and gastric histopathology in older patients

Table 1 Histopathology: Definitions

Chronic atrophic gastritis (CAG): more extensive inflammation accompanied by glandular atrophy. CAG further subdivided into mild, moderate and severe based on atrophy involving the upper one-third, upper two-thirds and full thickness of the mucosa respectively

Chronic superficial gastritis (CSG): inflammation limited to the foveolar region unaccompanied by glandular atrophy. (Figures 1B-D)

Gastric atrophy (GA): thinning of the mucosa with an absence of inflammatory changes

Hyperplasia: an increase in the number of mucosal epithelial cells

Metaplastic changes:

Intestinal metaplasia characterized by goblet cells, brush border cells, Paneth cells and endocrine cells. (Figures 1B and 1C)

Pyloric metaplasia of the fundus characterized by mucus secreting glands

Table 2 Baseline patient characteristics

Variable	B12 deficient(n = 30)	Controls(n = 16)	P-value
Age (yr)	78 ± 11	77 ± 8	0.9090 1
Gender (M:F)	11:19	6:10	1.0000 2
Serum B12 (pg/L)	183 ± 60	872 ± 459	<0.00005 1
Hematocrit (%)	34.9 ±4.8	33.4 ± 3.7	0.3010 1
MCV (%)	86.5 ± 7.6	87.4 ± 9.9	0.7321 1
Serum albumin (g/dL)	2.9 ± 0.5	2.9 ± 0.7	0.9692 1
H pylori infection (+/-)	12 / 18	5 / 11	1.000 2
Intrinsic factor Ab (+/-)	5/ 12

¹Data presented as the means ± SD or actual numbers. Statistical comparisons used Student t-tests or χ²-square analysis.

Table 3 Endoscopy findings

B12 deficient group (n = 30) (%)		Control group (n = 16) (%)
Normal	11 (36.7)	Normal	5 (31.3)
Gastritis	8 (26.7)	Gastritis	11 (68.8)
Atrophy	8 (26.7)	Atrophy	0 (0)
Polyps	1 (3.3)	Polyps	0 (0)
Others 1	2 (6.7)	Others	0 (0)

¹ (includes 1 case of hiatal hernia and 1 case of candidiasis). Endoscopic findings between groups were compared using Fisher’s exact test, (P=0.017).

Table 4 Histopathology of the gastric fundic region

B12 deficient group (n = 27) (%)		Control group (n = 4) (%)
Normal	3 (11.1)	Normal	0 (0)
Inflammation	16 (59.3)	Inflammation	4 (100)
Atrophy	8 (29.6)	Atrophy	0 (0)

Histopathology findings between groups were compared using Fisher’s exact test, (P=0.541).

Table 5 Histopathology of the gastric antral region

B12 deficient group (n = 6) (%)		Control group (n = 12) (%)
Normal	0 (0)	Normal	2 (14.3)
Inflammation	5 (83.3)	Inflammation	6 (42.9)
Hyperplasia	1 (16.7)	Hyperplasia	0 (0)
Intestinal metaplasia	0 (0)	Intestinal metaplasia	4 (28.6)

Histopathology findings between groups were compared using Fisher’s exact test, (P=0.157).

Table 6 Gastritis types

B12 deficient group (n = 29) (%)		Control group (n = 16) (%)
Normal	3 (10.3)	Normal	1 (6.3)
Superficial gastritis	18 (62.1)	Superficial gastritis	15 (93.7)
Atrophic gastritis	8 (27.6)	Atrophic gastritis	0 (0)

Gastritis types between groups were compared using Fisher’s exact test, (P=0.039). The B12 deficient group is 29 in Table 6vs 30 in Tables 7 and 8 because one biopsy sample could not be classified into a specific category.

Table 7 Metaplasia in B12 deficiency and controls

B12 deficient group (n = 30) (%)		Control group (n = 14) (%)
No metaplasia	22 (73.3)	No metaplasia	10 (71.4)
Hyperplasia	1 (3.3)	Hyperplasia	0 (0)
Intestinal metaplasia	7 (23.3)	Intestinal metaplasia	4 (28.5)

Metaplasia between groups was compared using Fisher’s exact test, (P=1.000).

Table 8 Frequency of H pylori infection

B12 deficient group (n = 30) (%)		Control group (n = 16) (%)
H pylori positive	12 (40)	H pylori positive	5 (31.2)
H pylori negative	18 (60)	H pylori negative	11 (68.8)

Fisher’s exact test determined that H pylori infection rates were similar in B12 deficient and control patients (P = 1.000) and that the presence of intrinsic factor antibodies was low and unrelated to H.pylori infection in the B12 deficient group (1/7 in H pylori+ vs. 0/10 in H pylori– patients, P = 0.338; data not presented).