From the Guidelines
Inactive gastritis can potentially lead to malabsorption, particularly of nutrients like vitamin B12, iron, and calcium, due to reduced production of intrinsic factor or stomach acid, although this is more commonly associated with significant damage to the gastric mucosa or complications like pernicious anemia. Inactive gastritis, especially in its chronic form, may interfere with normal digestive processes, potentially causing malabsorption [no direct evidence from 1, but general medical knowledge applies]. The study on postgastrectomy follow-up 1 highlights the importance of monitoring and supplementation of iron, vitamin B12, and vitamin D as well as calcium due to malabsorption risks following gastrectomy, which can be related to the removal of parts of the stomach and not directly to inactive gastritis. However, the principles of malabsorption due to altered stomach function can be applied to understanding the potential effects of inactive gastritis on nutrient absorption.
Key points to consider:
- Inactive gastritis may lead to reduced production of stomach acid and intrinsic factor, essential for nutrient absorption.
- Malabsorption is more likely in cases of atrophic gastritis with significant gastric mucosa damage.
- Symptoms of malabsorption include unexplained weight loss, fatigue, and nutrient deficiencies.
- Treatment focuses on addressing the underlying cause of gastritis and may include nutrient supplementation, as seen in postgastrectomy care 1, where monitoring and supplementation of specific nutrients are crucial to prevent long-term complications like anemia and osteoporosis.
Given the potential for malabsorption and its impact on morbidity, mortality, and quality of life, it is crucial to manage inactive gastritis proactively, especially in patients showing signs of malabsorption or those with a history of gastritis that could lead to such complications.
From the Research
Inactive Gastritis and Malabsorption
- Inactive gastritis, also known as atrophic gastritis, can lead to malabsorption of certain nutrients, including vitamin B-12 2, 3, 4, 5.
- The use of proton pump inhibitors (PPIs) and H2 receptor antagonists can also contribute to vitamin B-12 deficiency by suppressing gastric acid production, which is necessary for the absorption of vitamin B-12 from food 2, 3, 4, 5.
Mechanisms of Malabsorption
- Atrophic gastritis can lead to a decrease in the production of gastric acid and intrinsic factor, a protein necessary for the absorption of vitamin B-12 2.
- PPIs and H2 receptor antagonists can further reduce gastric acid production, making it more difficult for the body to absorb vitamin B-12 from food 3, 4, 5.
- The use of PPIs has been shown to be associated with a higher risk of vitamin B-12 deficiency compared to H2 receptor antagonists 4.
Clinical Implications
- Vitamin B-12 deficiency can lead to a range of clinical symptoms, including megaloblastic anemia, peripheral neuropathy, and cognitive dysfunction 5.
- Monitoring of vitamin B-12 status is recommended for patients taking PPIs, H2 receptor antagonists, or metformin, especially if they have a history of atrophic gastritis or other risk factors for vitamin B-12 deficiency 5.
- Vitamin B-12 supplements may be necessary for patients with altered blood biomarkers or clinical signs consistent with low or deficient vitamin B-12 status 5.