Pernicious Anaemia, Intragastric Bacterial Overgrowth, and Possible Consequences

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Abstract
Intragastric bacterial colonization is well known in pernicious anemia (PA), but its consequences have rarely been investigated. The clinical history blood samples and endoscopic biopsies from the stomach and duodenum of 80 patients with PA were studied. In a random subgroup of 22 patients gastric juice was collected for aerobic culture and for estimation of nitrate, nitrate-reducing bacteria, nitrite and N-nitrosamines; duodenal juice was studied in parallel in 8 of these subjects. Gastric and duodenal juice had high bacterial counts; fecal organisms were found in 14 patients. The mean count of nitrate-reducing bacteria was signficantly higher than in a control group of patients with peptic ulcer disease (P < 0.001), as was the nitrite concentration (P < 0.001). Thirty-three of the 80 patients had gastric dysplasias; 1 early gastric carcinoma was also found. Duodenitis was present in 39 of 80 cases, in 6 associated with partial villous atrophy. A history of malabsorption and/or chronic intermittent diarrhea was obtained significantly more often from patients with duodenitis. Four patients developed acute gastroenteritis shortly before or during the time of the study, two having a Salmonella infection. Bacterial overgrowth in PA may be facilitated by altered immunological conditions, since low serum levels of IgA and IgG were found in this patient group.