Pernicious Anemia in Gastric Atrophy.
Pernicious anemia is a common accompaniment of gastricatrophy and achlorhydria. Normal gastric secretions contain a glycoprotein called
,secreted by the same parietal cells that secrete hydrochloric acid. Intrinsic factor must be present for adequate absorption of vitamin B
from the ileum. That is, intrinsic factor combines with vitamin B
inthe stomach and protects it from being digested and destroyed as it passes into the small intestine.Then, when the intrinsic factor-vitamin B
complex reaches the terminal ileum, the intrinsic factor binds with receptors on the ileal epithelial surface. This in turn makes it possible for the vitamin B
tobe absorbed.In the absence of intrinsic factor, only about 1/50 of the vitamin B
is absorbed. And, without intrinsicfactor, an adequate amount of vitamin B
is not made available from the foods to cause young, newlyforming red blood cells to mature in the bone marrow. The result is
A peptic ulcer is an excoriated area of stomach or intestinal mucosa caused principally by thedigestive action of gastric juice or upper small intestinal secretions.Figure 66-1shows the points inthe gastrointestinal tract at which peptic ulcers most frequently occur, demonstrating that the mostfrequent site is within a few centimeters of the pylorus. In addition, peptic ulcers frequently occur along the lesser curvature of the antral end of the stomach or, more rarely, in the lower end of theesophagus where stomach juices frequently reflux. A type of peptic ulcer called a
alsooften occurs wherever a surgical opening such as a gastrojejunostomy has been made between thestomach and the jejunum of the small intestine.
Basic Cause of Peptic Ulceration.
The usual cause of peptic ulceration is an
betweenthe rate of secretion of gastric juice and the degree of protection afforded by (1) the gastroduodenalmucosal barrier and (2) the neutralization of the gastric acid by duodenal juices. It will be recalled thatall areas normally exposed to gastric juice are well supplied with mucous glands, beginning withcompound mucous glands in the lower esophagus plus the mucous cell coating of the stomachmucosa, the mucous neck cells of the gastric glands, the deep pyloric glands that secrete mainly