ATROPHIC GASTRITIS IN THE AGED

The incidence of gastritis and the correlation of this finding with the presence of circulating parietal cell antibodies and gastric secretory function was studied in 24 asymptomatic subjects aged over 6o years. A gastric biopsy examination, a maximal histamine-stimulation test, a test for parietal cell antibody and a Schilling test were performed on each subject. The biopsy specimens were examined by histological and histochemical methods. The gastric juice was assayed for acid and intrinsic factor content, and the serum iron and vitamin B₁₂ levels were measured. All but one subject showed some degree of chronic atrophic gastritis. Close correlation was found between gastric secretory function, the histological changes in the gastric mucosa and the reduction in specialized cells demonstrated on histochemical examination. Two subjects presented a “pre-pernicious anæmia” picture with gross reduction in intrinsic factor secretion, a degree of malabsorption of vitamin B₁₂ but no evidence of vitamin B₁₂ deficiency; a very similar case not included in the series is described to illustrate the diagnostic problem which may occur with hæmatological evidence of vitamin B₁₂ deficiency as a result of atrophic gastritis. Serum iron levels were reduced in some cases with severe atrophic gastritis. Antibodies to parietal cells occurred with increasing frequency as the changes in the gastric mucosa became more marked. Atrophic gastritis is a common finding in the “normal” aged male even in the absence of gastrointestinal symptoms, and a clinical picture simulating early pernicious anæmia may occur as a result of “normal ageing” of the gastric mucosa.