Histopathology of the stomach in pernicious anaemia and jejunum in steatorrhoea.

Abstract

The post-mortem finding of gastric atrophy in pernicious anaemia, first recorded in 1870 by Fenwick, has been confirmed in a number of further autopsies reviewed by Faber (1935), Magnus and Ungley (1938) and Schindler (1947). The main changes in the stomach (Magnus, 1958) are diffuse atrophy of the mucosa of fundus and body but not of pyloric antrum and atrophy of the muscle coats of the body of stomach. In some cases there is total loss of body chief and parietal mucosal glandular cells without inflammatory change: gastric atrophy. In others, there are occasional scattered surviving specialised cells and quite well marked interstitial infiltration with lymphocytes and plasma cells: atrophic gastritis. The introduction of a flexible gastric biopsy tube by Wood, Doig, Motteram and Hughes in 1949 has led to histological studies of the gastric mucosa in a total of hundreds of living cases of pernicious anaemia and has allowed comparison with other clinical conditions (Doig and Wood, 1950, Badenoch and Richards, 1953, Palmer, 1954; Siuarla, 1954; Joske, Finckh and Wood, 1955; Markson and Davidson, 1956; Shiner and Doniach, 1957; Wynn Williams, Coghill and Edwards, 1958). The mucosa is strikingly thinned as a result of loss of gastric glands (Figs. 1a and 1b). The surviving glands form discrete rounded collections separated by fine connective tissue which is infiltrated to varying degrees with lymphocytes, macrophages, plasma cells and eosinophils (Fig. 1b).