Nutritional Deficiencies in Atrophic Gastritis

Primary Micronutrient Deficiencies

• Iron deficiency occurs in up to 50% of patients with corpus-predominant atrophic gastritis and presents much earlier in the disease course than vitamin B-12 deficiency 1, 2, 3, 4
• The mechanism of iron deficiency is reduced gastric acid secretion, which impairs iron absorption from dietary sources 1
• Vitamin B-12 deficiency develops due to both reduced gastric acid secretion and loss of intrinsic factor production from parietal cell destruction 1, 2, 3

Clinical Approach to Screening

• All patients with atrophic gastritis, regardless of etiology, should be evaluated for iron and vitamin B-12 deficiency, especially if corpus-predominant disease is present 1, 2, 3, 4, 5, 6
• Patients presenting with unexplained iron or vitamin B-12 deficiency should be evaluated for atrophic gastritis as the underlying cause 1, 5, 6

Important Clinical Pitfalls

• Iron deficiency manifests earlier than vitamin B-12 deficiency because the body has substantial hepatic stores of vitamin B-12 that can last years, whereas iron stores deplete more rapidly 1, 2, 3