Chronic Atrophic Gastritis with Negative Intrinsic Factor and Parietal Cell Antibody Presenting as a Severe Hemolytic Anemia

Clinical efficacy of Weisu granule combined with Weifuchun tablet in the treatment of chronic atrophic gastritis and its effect on serum G-17, PG I and PG II levels

OBJECTIVE

The aim of this prospective study was to explore the clinical efficacy of Weisu granules combined with Weifuchun tablets in the treatment of chronic atrophic gastritis and its effect on serum gastrin-17 (G-17), pepsinogen I (PG I), and II (PG II) levels.

METHODS

Totally, 120 patients with chronic atrophic gastritis admitted to our hospital from February 2019 to February 2020 were enrolled and randomized into a control group (n=60) treated with Weifuchun tablets, and a experimental group given Weisu granules. Serum G-17, PG I, and PG II levels, inflammatory factor levels, TCM syndrome scores, gastric mucosa pathological scores, and clinical efficacy were compared between the two groups. Gastric tissue changes were observed using gastroscopy and HE staining.

RESULTS

After treatment, the levels of serum G-17, PG I, and PG II of the experimental group were significantly better than those of the control group (P<0.001). The levels of inflammatory factors, traditional Chinese medicine (TCM) syndrome scores, and gastric mucosal pathology scores of the experimental group were significantly lower than those of the control group (P<0.001). The overall response rate of the experimental group was significantly higher than that of the control group (P<0.05). The experimental group showed a lower HP positive result and a higher HP negative conversion ratio than the control group (all P<0.05). HE staining results revealed that after treatment, the number of glands was basically restored to the level of normal gastric mucosa, and the improvement of inflammatory cell infiltration in the experimental group was significantly better than that in the control group.

CONCLUSION

Weisu granule combined with Weifuchun tablets can ameliorate serum G-17, PG I, and PG II levels in patients with chronic atrophic gastritis, relieve inflammatory responses and clinical symptoms, and improve the treatment effect, which is worth promoting in clinical practice.

CLINICAL TRIAL REGISTRATION

Chinese Registry of Clinical Trials.

TRIAL REGISTRATION NUMBER

ChiCTR200002548416. Trial URL: http://www.chictr.org.cn/showproj.aspx?proj=26516901.

Chronic Atrophic Gastritis Presenting as Hemolytic Anemia due to Severe Vitamin B12 Deficiency

Vitamin B12 is an essential nutrient which plays an important role in neurological function, hematopoiesis, and DNA synthesis. Low levels usually stem from either poor intake or a malabsorptive process. Presently, the most common cause of vitamin B12 deficiency is food-bound cobalamin malabsorption, which occurs when there is impaired release of vitamin B12 from ingested food due to an outstanding factor preventing the release of the nutrient from its transport protein. Such causes include achlorhydria, gastritis, gastrectomy, or the use of PPIs or antacids. A rarer cause is autoimmune chronic atrophic gastritis, resulting in pernicious anemia. In this disease process, there is destruction of parietal cells and thus a reduction in intrinsic factor, which is essential to the absorption of vitamin B12. Deficiency will result in a variety of abnormalities including but not limited to pancytopenia, paresthesias, and neuropsychiatric symptoms. A rare manifestation of vitamin B12 deficiency is hemolytic anemia, which occurs due to intramedullary and extramedullary dysfunction. This case describes a 46-year-old male with no past medical history who presented with chest pain, fatigue, and progressive weakness, found to have hemolytic anemia, ultimately attributed to vitamin B12 deficiency. Antiparietal cell antibodies and intrinsic factor antibodies (IFA) were both negative. Still, the patient underwent an endoscopy with biopsies of the stomach; pathology was consistent with chronic metaplastic atrophic gastritis. The patient improved with intramuscular vitamin B12 supplementation. This case highlights both a rare cause and presentation of vitamin B12 deficiency. Patients with autoimmune chronic atrophic gastritis should have antiparietal cell or intrinsic factor antibodies. Still, seronegative patients have been reported, like this patient. Additionally, hemolytic anemia secondary to vitamin B12 deficiency is uncommon. The presentation will usually mirror that of a thrombotic microangiopathy (TMA), including hemolytic anemia with schistocytes on peripheral blood smear and thrombocytopenia, as it did in this patient. This clinical entity is described as pseudothrombotic microangiopathy and is crucial to identify in order to prevent the initiation of invasive treatment strategies such as plasmapheresis.