Hôpital Robert Debré, service d’hépato-gastroentérologie et de cancérologie digestive, 51092 Reims Cedex, France
Hôpital Robert Debré, service d’anatomie pathologique, 51092 Reims Cedex, France
Pernicious anemia is the culmination of type-1 autoimmune gastritis toward gastric fundic atrophy. At its advanced phase, it results in achlorhydria and a decreased production of intrinsic factor, yielding B12 vitamin deficiency. Diagnostic criteria of pernicious anemia remain controversial. It would seem preferable to extent its definition to the whole autoimmune process, whatever the stage of gastritis, and to evoke this diagnosis in case of chronic atrophic gastritis when not related to Helicobacter pylori (several pathological differences exist between these two types of gastritis) in association with autoimmune signs, clinical or biological. Around 20-27% of patients have iron deficiency, which is sometimes the first sign of the disease. B12 deficiency is a late manifestation. Pernicious anemia rarely complicates with gastric adenocarcinoma, whereas it predisposes more often to the development of fundic well-differentiated neuroendocrine tumors, derived from enterochromaffin-like cells (EC-Lomas). These tumors are mostly benign and require surgical excision only in exceptional circumstances. Gastric polyps from other causes are frequent (up to 40 %), such as hyperplatic polyps. This educative case report aims to comprehensively review most current topics on pernicious anemia.