Screening
There are no guidelines recommending that patients with anemia due to cobalamin or iron deficiency specifically be screened for achlorhydria.
Measurement of anti-parietal cell antibodies and gastrin-17, and the pepsinogen I to pepsinogen II ratio seem to be the most accurate tests for first-line screening of autoimmune gastropathy. Screening for antiparietal cell antibodies alone would miss those patients who are negative for this antibody, whereas gastrin-17 levels are raised in nearly all patients with autoimmune gastropathy who have developed overt atrophy.
If the etiology of the deficiency is unexplained, esophagogastroduodenoscopy with biopsy of the oxyntic mucosa (fundus and corpus) could be considered to rule in or rule out atrophic gastritis as the etiology.
Gastric atrophy and intestinal metaplasia
The American Gastroenterological Association (AGA) recommends testing for Helicobacter pylori, followed by eradication, in patients with intestinal metaplasia (IM).[67] AGA recommends against the routine use of endoscopic surveillance in patients with IM.[67]
Patients at high risk for gastric cancer
AGA and the American Society for Gastrointestinal Endoscopy recommend surveillance endoscopy for those with IM who are at high risk for gastric cancer due to their ethnic background, extensive IM, dysplastic IM, or family history of gastric cancer.[67][121]
Use of this content is subject to our disclaimer