Childhood Pernicious Anemia

Gastrointestinal secretory, histological, and electron microscopic aspects
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      The secretion of acid, pepsin, and intrinsic factor was studied in 9 children having true juvenile pernicious anemia (JPA), 6 children having Imerslund's syndrome (IS) and 3 children having pernicious anemia associated with gastric atrophy (PA). Biopsies of gastric mucosa were studied using the techniques of light and electron microscopy.
      Instrinsic factor secretion was low in JPA and PA patients, but normal to moderately reduced in IS patients.
      By our own examinations, acid secretion was normal during periods of adequate vitamin B12 therapy both in JPA and IS patients. By history, during periods of vitamin B12 deficiency in these same patients, histamine fast achlorhydria (not augmented) was frequent. Gastric biopsies appeared normal both in JPA and IS patients, but revealed gastric atrophy in all 3 patients having achlorhydria despite their adequate vitamin B12 replacement. No fine structural abnormalities were detected with the electron microscope. The therapeutic status correlated poorly with the histological data. Duodenojejunal biopsies appeared normal although vitamin B12 malabsorption had been demonstrated in IS.
      These data offer no certain explanation of the pathogenesis of gastric atrophy in pernicious anemia of adults.


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