title: Gastric as well as duodenal biopsies may be useful in the investigation of iron deficiency anaemia.
abstract: 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 determine 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 be routinely performed in these patients.
  
  
  METHODS
  Forty-one consecutive patients with iron deficiency anaemia and no specific gastrointestinal symptoms or evidence of a bleeding lesion on faecal occult blood testing or upper gastrointestinal or colonic endoscopy.
  
  
  METHODS
  As well as routine duodenal biopsies, samples were taken from gastric corpus and antrum for evidence of gastric atrophy. Achlorhydria was considered 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 concentrations ranged from 4.1 to 10.9 g/dl. Eight (20%) of the 41 patients had corpus-predominant or generalized atrophy and high plasma gastrin levels, of whom six had serum intrinsic factor and/or gastric parietal cell antibodies: two also had Giardia lamblia organisms in duodenal biopsies. Four other patients (10%) had villous atrophy of the duodenum.
  
  
  CONCLUSIONS
  As well as confirming the importance of seeking coeliac disease in patients with iron deficiency anaemia, our results suggest that achlorhydric gastric atrophy is also a common association. Gastric biopsies should be taken in patients with no other explanation for anaemia. The finding of Giardia organisms in two achlorhydric patients, with a possible contributory role, suggests that duodenal biopsies should be obtained even if serum coeliac-related antibodies are absent.
authors.affiliation: Dept. of Gastroenterology, Antrim Hospital, Northern Ireland.
authors.forename: W
authors.initials: W
authors.lastname: Dickey
authors.forename: B D
authors.initials: BD
authors.lastname: Kenny
authors.forename: S A
authors.initials: SA
authors.lastname: McMillan
authors.forename: K G
authors.initials: KG
authors.lastname: Porter
authors.forename: J B
authors.initials: JB
authors.lastname: McConnell
mesh_terms: D000293:Adolescent; D000368:Aged; D000369:Aged, 80 and over; D018798:Anemia, Iron-Deficiency / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D001706:Biopsy; D004386:Duodenum / Q000473:pathology*; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005492:Folic Acid / Q000097:blood; D005500:Follow-Up Studies; D005755:Gastrins / Q000097:blood; D005757:Gastritis, Atrophic / Q000150:complications* / Q000453:epidemiology / Q000473:pathology; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D013270:Stomach / Q000473:pathology*; D014805:Vitamin B 12 / Q000097:blood
chemical_list: D005755:Gastrins; D006454:Hemoglobins; D005492:Folic Acid; D014805:Vitamin B 12