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Ocular Pathology
Author(s) -
MYRON YANOFF
Publication year - 1964
Publication title -
medical journal of australia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 131
eISSN - 1326-5377
pISSN - 0025-729X
DOI - 10.5694/j.1326-5377.1964.tb109560.x
Subject(s) - citation , computer science , information retrieval , library science
controlled the diarrhoea (Gellman, 1956; Halstedt et alii, 1956). The exact mechanism by which the organisms interfere with vitamin B12 absorption is not clear. Most of the available evidence suggests that the malabsorption is due to a disturbance of the physico-chemical composition of the chyme, causing interference with digestion and absorption in the neighbourhood of the infected diverticula (Cooke et alii, 1963). It has also been suggested (Dawson and Isselbacher, 1960) that the bacteria may induce the conversion of conjugated bile salts to toxic unconjugated salts, which interfere with fat absorption. Superadded bowel infection may play a part, as well as simple bacterial competition (Halstedt et alii, 1956). The amount of stored vitamin B'2 and the patient's dietary habits may also play a part in the actual precipitation of the anremia. In a recent review of the literature, Cooke et alii found that abdominal pain, usually intermittent, occurred in 23 out of 30 well-documented cases. It is suggested that sudden onset of pain following ingestion of food (as occurred in our case) may be due to sudden distension or impaction within a diverticulum. The persistent burning pain noted by some patients could be due to chronic low-grade infection of diverticula, and this correlates well with the observation that the pain is often relieved by antibiotic therapy. Our patient had also an augmented histamine-fast achlorhydria, and, on biopsy, gastric atrophy was found. In a previously reported series of five cases (Badenoch et alii, 1955), three patients had histamine-fast achlorhydria, and two of them, on biopsy, were found to have gastric atrophy. The other two patients had free acid in the gastric juice, and a biopsy in one of these also showed gastric atrophy; gastric biopsy was not performed in the other two cases. It is interesting to note that in one of these cases, in modification of the triad, gastric atrophy and histamine-fast achlorhydria were present as well, but anesmia was absent. Gastric atrophy is thus a common finding in these patients, but the exact significance of this association is still poorly understood.