Autoimmune gastritis and pernicious anaemia

In 1849 in the London Medical Gazette Dr Thomas Addison drew attention to a remarkable form of anaemia of idiopathic origin which in his view had not received the interest it deserved, although its existence had occasionally been pointed out by others. He described the clinical picture in three men with insidious anaemia who at postmortem examination all displayed “a diseased condition of the suprarenal capsules” [1]. Pathogenic relevance of the anaemia was suspected, but this was questioned by Dr Austin Flint, who himself had had experience of patients with insidious anaemia and who considered the possibility of a degenerative disease of the gastric tubular glands. At a clinical lecture at the Long Island College hospital in 1860, he referred to an article by Dr Handheld Jones, who some years earlier had published his findings on light microscopic examinations of a hundred stomachs. In 12 cases considerable degeneration of the gastric tubuli was noted. Dr Flint stated: “It is not difficult to see how fatal anaemia must follow an amount of degenerative disease reducing the amount of gastric juice so far that the assimilation of food is rendered wholly inadequate to the wants of the body. I shall be ready to claim the merit of this idea when the difficult and laborious researches of someone have shown it to be correct” [2]. Seventeen years later Fenwick observed atrophic glands and failure of the scrapings of the gastric mucosa to digest egg white in autopsy studies [3], and during the following decades, after analysis of the amount of ‘free acid’ in gastric juice from patients with insidious anaemia, several investigators reported achylia to be a constant finding [4].