Heartburn in Pernicious Anemia — A Consequence of Bile Reflux

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Abstract
HEARTBURN is thought to result most commonly from reflux of gastric acid from stomach to esophagus,1 although pancreatic-biliary juice has been implicated as a cause in post-gastrectomy patients. Reflux of gastric juice may lead to esophagitis; however, the acid-peptic concept fails to explain heartburn and esophagitis in patients with achlorhydria.2 We recently encountered a patient with pernicious anemia who had heartburn. Studies to elucidate the mechanism for heartburn in the absence of gastric acid form the basis of this report.Case ReportIn 1970, a 52-year-old woman had a megaloblastic anemia that responded to parenteral vitamin B12. Pernicious . . .