A 46-year-old female presented at our department
with the onset of episodic dyspeptic symptoms,
mainly postprandial fullness and bloating,
as well as paresthesia. A blood test revealed
the presence of mild macrocytic anaemia (haemoglobin
11.3 g/dl; mean corpuscular volume 119
fl), a reduced level of vitamin B12 (60 pmol/l;
normal 200–750 pmol/l), hypergastrinaemia
(1363 pg/ml; normal for female <100 pg/ml), a
low level of pepsinogen I (<2.6 pg/ml; normal
30–100 pg/ml), and positivity for antibodies
against parietal cells (>1:100). The upper endoscopy
showed in oesophagus a single linear erosion
(grade A according to Los Angeles Classification),
with an absence of macroscopic gastric abnormalities.
At histology, mucosal severe atrophy with
moderate intestinal metaplasia was found in fundus
and gastric corpus with spared antrum, in the
absence of Helicobacter pylori infection. A diagnosis
of autoimmune gastritis with pernicious anaemia
was therefore made, and the patient started
vitamin B12 intramuscular injections. Due to the
absence of specific symptoms such as heartburn
and/or regurgitation and to the presence of autoimmune
gastritis, the erosive oesophagitis was not
treated. After 4 weeks of treatment with vitamin
B12, the haemoglobin, mean corpuscular volume
and vitamin B12 values were restored, paresthesia
improved, while dyspepsia remained stable, with
sporadic symptoms about once a week
