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Gastroenterology (Expert Forum)
B12 Deficiency
Answered by
Kevin Pho, MD - Internal Medicine
KevinMD.com
This forum is for questions regarding Gastroenterology issues such as Acid Reflux (GERD), Barretts Esophagus, Colitis, Colon/Bowel Disorders, Crohn's Disease, Diverticulitis/Diverticulosis, Digestive Disorders, IBS, Stomach Pain.
B12 Deficiency
by geocyn, Jan 16, 2007 12:00AM
My wife was diagnosed with a B12 deficiency close to 6 years ago when she was 29 years old. Her main symptom was a tingling sensation in one hand. After a few appointments with the general doc, her blood showed low B12 levels and was referred to a gastro. The gastro performed a colonoscopy (normal) and upper endoscopy. He said that she had a very low intrinsic factor due to gastritis. She has been on B12 injections ever since and has been doing fine and recovered the feeling in her hand quickly after she started the injections.
Recently, she visited our general doc and he said to follow up with the gastro since it has been over 5 years. Orignally, the gastro said that my wife should have the endoscopy done every 10 years until 50 yrs old and then every 5 years after that. Our general doc said he would like to see this procedure done every 5 years starting now.
I called the gastro to get more details on the original diag and he wasn't available, but the nurse said my wife was diagnosed with mild gastritis 6 years ago. It sounded like the gastro suspected atrophic gastritis, but the biopsy came back mild gastritis.
Some questions I have are:
1) Is there such a thing as "mild" atrophic gastritis and if so, can it lead to B12 deficiency and low intrinsic factor?
2) Is this rare at such a young age - 29?
3) The gastro did say she was at increased risk of ulcers and gastric cancer - does this mean she is at a higher risk of cancer at a younger age since she has gastritis at such a young age?
4) Is the risk extremely high compared to the normal population? I've read it can be up to 3 times as high as the normal population.
5) Do the majority of people with atrophic gastritis tend to have complications such as ulcers/cancer?
6) Do you agree with performing the endoscopy every 5 years starting now?
7) Is there a certain diet she should stick to that might help avoid complications?
8) Anything else we should ask her gastro? - her appointment is for next month.
Thank you so much for providing this service!
Recently, she visited our general doc and he said to follow up with the gastro since it has been over 5 years. Orignally, the gastro said that my wife should have the endoscopy done every 10 years until 50 yrs old and then every 5 years after that. Our general doc said he would like to see this procedure done every 5 years starting now.
I called the gastro to get more details on the original diag and he wasn't available, but the nurse said my wife was diagnosed with mild gastritis 6 years ago. It sounded like the gastro suspected atrophic gastritis, but the biopsy came back mild gastritis.
Some questions I have are:
1) Is there such a thing as "mild" atrophic gastritis and if so, can it lead to B12 deficiency and low intrinsic factor?
2) Is this rare at such a young age - 29?
3) The gastro did say she was at increased risk of ulcers and gastric cancer - does this mean she is at a higher risk of cancer at a younger age since she has gastritis at such a young age?
4) Is the risk extremely high compared to the normal population? I've read it can be up to 3 times as high as the normal population.
5) Do the majority of people with atrophic gastritis tend to have complications such as ulcers/cancer?
6) Do you agree with performing the endoscopy every 5 years starting now?
7) Is there a certain diet she should stick to that might help avoid complications?
8) Anything else we should ask her gastro? - her appointment is for next month.
Thank you so much for providing this service!
Doctor's Answer
by Kevin Pho, MD, Jan 17, 2007 12:00AM
, Jan 17, 2007 12:00AM
To answer your questions:
1) Mild atrophic gastritis can indeed lead to B-12 deficiency and a low intrinsic factor.
2) This can have an autoimmune etiology can can present in younger patients. It is markedly more common in women.
3) There is an increased risk of cancer - hence the recommendation for regular endoscopic evaluation.
4) Studies suggest a 3 to 18 times increased risk compared to the population without gastritis.
5) The incidence of cancer still will be uncommon, but the risk will be greater than that of the normal population.
6) That is not an unreasonable course of action - although there is no clear data that regular endoscopy can save lives.
7) I am not aware of specific dietary treatments for this condition.
8) In addition to regular endoscopy, screening for carcinoid tumors can be considered - this can be discussed with your personal physician.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
kevinmd_
1) Mild atrophic gastritis can indeed lead to B-12 deficiency and a low intrinsic factor.
2) This can have an autoimmune etiology can can present in younger patients. It is markedly more common in women.
3) There is an increased risk of cancer - hence the recommendation for regular endoscopic evaluation.
4) Studies suggest a 3 to 18 times increased risk compared to the population without gastritis.
5) The incidence of cancer still will be uncommon, but the risk will be greater than that of the normal population.
6) That is not an unreasonable course of action - although there is no clear data that regular endoscopy can save lives.
7) I am not aware of specific dietary treatments for this condition.
8) In addition to regular endoscopy, screening for carcinoid tumors can be considered - this can be discussed with your personal physician.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
kevinmd_
