GASTRIC AS WELL AS DUODENAL BIOPSIES MAY BE USEFUL IN THE INVESTIGATION OF IRON-DEFICIENCY ANEMIA

Background: Iron absorption is known to be impaired in the setting of gastric achlorhydria, yet gastric atrophy is not usually considered an aetiological factor for iron deficiency anaemia. We aimed to determin e the prevalence of achlorhydric gastric atrophy in patients with iron deficiency and no identifiable source of gastrointestinal blood loss, and to assess whether gastric, as well as duodenal, biopsies should b e routinely performed in these patients. Patients: Forty-one consecuti ve patients with iron deficiency anaemia and no specific gastrointesti nal symptoms or evidence of a bleeding lesion on faecal occult blood t esting or upper gastrointestinal or colonic endoscopy. Methods: As wel l as routine duodenal biopsies, samples were taken from gastric corpus and antrum for evidence of gastric atrophy. Achlorhydria was consider ed to be present if plasma gastrin measured on a sample obtained with the patient fasting was over 200 ng/l. Serum was tested for intrinsic factor and gastric parietal cell antibodies. Results: Haemoglobin conc entrations ranged from 4.1 to 10.9 g/dl. Eight (20%) of the 41 patient s had corpus-predominant or generalized atrophy and high plasma gastri n levels, of whom six had serum intrinsic factor and/or gastric pariet al cell antibodies: two also had Giardia lamblia organisms in duodenal biopsies. Four other patients (10%) had villous atrophy of the duoden um. Conclusions: As well as confirming the importance of seeking coeli ac disease in patients with iron deficiency anaemia, our results sugge st that achlorhydric gastric atrophy is also a common association. Gas tric biopsies should be taken in patients with no other explanation fo r anaemia. The finding of Giardia organisms in two achlorhydric patien ts, with a possible contributory role, suggests that duodenal biopsies should be obtained even if serum coeliac-related antibodies are absen t.