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MEGALOBLASTIC AND TRANSITIONAL MEGALOBLASTIC ANÆMIA FOLLOWING PARTIAL GASTRECTOMY
Author(s) -
DELLER D. J.
Publication year - 1962
Publication title -
australasian annals of medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.596
H-Index - 70
eISSN - 1445-5994
pISSN - 0571-9283
DOI - 10.1111/imj.1962.11.4.235
Subject(s) - achlorhydria , gastrectomy , medicine , gastroenterology , atrophic gastritis , pernicious anaemia , vitamin b12 , hypoproteinemia , stomach , megaloblastic anemia , glossitis , pernicious anemia , surgery , malabsorption , gastritis , anemia , pathology , tongue , cancer
SUMMARY Studies of nine patients with megaloblastic anæmia and 18 patients with transitional megaloblastic erythropoiesis following partial gastrectomy are reported. The 27 patients had had either gastric ulcer or duodenal ulcer and had been operated on by the Pólya or Billroth I technique. Free acid had been present in the gastric secretion before surgery in those patients on whom the test had been performed, and the histological picture of the stomach removed at operation had not resembled the gastric atrophy of Addisonian pernicious anæmia. A long latent period (average 10 years) elapsed between gastric surgery and the diagnosis of anæmia. Atrophic glossitis was detected in seven patients, and subacute combined degeneration of the spinal cord was present in two patients. Loss of weight, weakness, anorexia, fullness after eating, the “dumping” syndrome, bilious vomiting and diarrhœa were frequent symptoms after operation. The majority of the patients were shown to have subnormal levels of vitamin B 12 in the serum, reduced levels of iron in the serum, impaired absorption of labelled vitamin B 12 which was corrected by intrinsic factor, steatorrhœa, achlorhydria, reduced uropepsinogen excretion, atrophic gastritis and jejunitis. Considered as a group, patients with megaloblastic anæmia had lower serum levels of vitamin B 12 , greater degrees of anæmia and less severe iron deficiency than patients with transitional megaloblastic erythropoiesis. It is considered that the present study provides evidence that megaloblastic anæmia is not a chance association with gastrectomy, and that the relationship is causal. Megaloblastic anæmia and transitional megaloblastic erythropoiesis after partial gastrectomy are usually due to a deficiency of vitamin B 12 . Resection of part of the stomach which secretes intrinsic factor, together with progressive atrophy of the remaining stomach, leads to the reduced secretion of gastric intrinsic factor and so to defective absorption of vitamin B 12 contained in food. Clinical vitamin B 12 deficiency develops many years later.