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November 26, 1997

Gastric Hypochlorhydria and Achlorhydria in Older Adults-Reply

JAMA. 1997;278(20):1659-1660. doi:10.1001/jama.1997.03550200035023

The studies by Dr Russell and colleagues have added to our appreciation that achlorhydria, resulting from either omeprazole administration or atrophic gastritis, can cause malabsorption of protein-bound vitamin B12.1 Though we did not determine absorption or levels of vitamin B12, we do not share his view that our data show one third of elderly Americans to be at risk of malabsorption of food-bound vitamin B12. Six (2%) of our 248 subjects were receiving vitamin B12 injections, 4 of whom had low basal acidity by the resin test (urine quinine <90 pg in 2 hours) and severe atrophic gastritis (serum pepsinogen [PG] I <20 pg/L). In the other 2 subjects, both parameters were normal. Twenty-two (9%) of 243 elderly subjects had PG I/PG II ratios less than 2.9, indicating atrophic gastritis. None was anemic. Those who had severe atrophic gastritis (PG I ≤20 pg/L) (n=11) also