Upper gastrointestinal endoscopy in pernicious anemia: Diagnosis and complications

Aims Pernicious anemia is an autoimmune atrophic gastritis of the fundus, predominantly responsible for a malabsorption of vitamin B12, which has the potential to progress to tumor complications.

The aim of our study is to highlight the endoscopic and histological aspects of this condition

Methods This is a retrospective study carried out between January 2006 and July 2024, reporting all patients with vitamin B12 deficiency or affected by pernicious anemia. All patients underwent esophagogastroduodenoscopy with systematic antral and fundic biopsies and biopsies of eventual lesions.

Results Out of 24,982 endoscopies, 452 cases of pernicious anemia were identified, resulting in a prevalence of 1.8%. The average age of patients was 47 years (33-77 years). The sex ratio was 1.07 with a slight male predominance (52%).

Esophagogastroduodenoscopy found rarefaction of fundic folds in 56% of patients and fundic polyps in 44.6%. It revealed no anomalies in 19% while it identified an ulcerative-budding process at the antro-fundic junction in one case and a Plummer-Vincent ring in other. Histological examination showed chronic atrophic funditis in 45% of cases, chronic atrophic funditis with intestinal and pyloric metaplasia in 48% and ECL cell hyperplasia in 37%, neuroendocrine tumors in 13% and hyperplastic polyps in 8%. Additionally, MALT lymphoma was found in 2 cases and gastric adenocarcinoma in one case. Helicobacter pylori infection was present in 64% of hyperplastic polyps.

Conclusions Pernicious anemia is a precancerous condition. In our study, 13% of patients developed neuroendocrine tumors and only one case progressed to gastric adenocarcinoma. This highlights the importance of regular endoscopic and histological monitoring for early detection and management of potential complications.

 

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Conflicts of Interest

Authors do not have any conflict of interest to disclose.

Publication History

Article published online:
27 March 2025