Frequent Dizziness and Fatigue That Won't Improve? Consider Autoimmune Gastritis with Severe Anemia
Dizziness, heart palpitations, fatigue, and lack of energy—these were the symptoms that had plagued a 50-year-old woman for over six months. Initially treated at a local clinic for what was assumed to be a common cold, her condition failed to improve. In fact, her symptoms worsened, prompting her to seek further evaluation at our hospital. After a comprehensive diagnostic process, she was diagnosed with autoimmune gastritis accompanied by severe anemia. With targeted treatment including vitamin B12 injections and oral medication, her health gradually improved.
Patient Profile
- Gender: Female
- Age: 50
- Diagnosis: Autoimmune gastritis with severe anemia
- Hospital: The Second People's Hospital of Liaocheng
- Visit Date: March 2021
- Treatment Plan: Vitamin B12 intramuscular injections + pantoprazole sodium enteric-coated capsules
- Duration: One month
- Outcome: Significant improvement in anemia and related symptoms
Initial Consultation: Symptoms Pointed to a Hidden Condition
The patient reported experiencing persistent dizziness, heart palpitations, fatigue, poor concentration, and memory loss for more than six months. These symptoms severely impacted her daily life and work. Despite being prescribed acetaminophen at a local clinic, there was no improvement—only progression of her condition. Accompanied by anxiety due to prolonged illness, she eventually visited our hospital upon recommendation from her primary physician.
Physical examination revealed pallor in her face, conjunctiva, and nail beds—classic signs of anemia. Her symptoms included dizziness, palpitations, fatigue, and memory issues, but there was no history of heavy menstruation, melena, or trauma-related bleeding. This ruled out external blood loss as the cause. To determine whether it was a hematopoietic disorder or deficiency, we conducted a series of tests including complete blood count (CBC), stool analysis, and gastroscopy.
Test results showed a red blood cell count of 1.96×10^12/L, hemoglobin level of 59g/L, and mean corpuscular volume of 113fL. Stool tests were negative for occult blood, and gastroscopy confirmed chronic atrophic gastritis (O-3 type) with histopathology supporting the diagnosis. Based on these findings, we concluded autoimmune gastritis with severe megaloblastic anemia caused by vitamin B12 deficiency.
Treatment Approach: Targeted and Safe Intervention
Given the patient's perimenopausal status and increased risk of osteoporosis, corticosteroids were not recommended despite their use in some cases of autoimmune gastritis. Instead, we opted for a safer approach using pantoprazole sodium enteric-coated capsules to protect the gastric mucosa and intramuscular vitamin B12 injections to address the deficiency.
The patient was advised to undergo regular follow-ups including CBC testing and endoscopic examinations to monitor disease progression and response to treatment.
Positive Response After One Month of Therapy
After completing one month of treatment, the patient showed significant recovery. Follow-up CBC results indicated a red blood cell count of 4.28×10^12/L, hemoglobin levels rising to 108g/L, and mean corpuscular volume dropping to 86fL. Serum vitamin B12 levels reached 1034pg/ml. Most importantly, symptoms like dizziness, palpitations, and fatigue were markedly reduced, and cognitive functions such as attention and memory returned to normal.
Post-Treatment Care: Lifestyle and Emotional Support Matter
While medical treatment played a critical role in her recovery, lifestyle adjustments were equally important. I advised the patient to:
Avoid overexertion and maintain a balanced work-rest schedule
Quit smoking and avoid alcohol consumption
Steer clear of spicy or irritating foods
Focus on a nutritious, diverse diet rich in fresh produce
Family support was also emphasized. Loved ones should understand the emotional toll chronic illness can take and offer patience and encouragement, especially when mood swings or anxiety arise during long-term treatment.
Clinical Insight: Recognizing Autoimmune Gastritis Beyond Digestive Symptoms
Autoimmune gastritis is a chronic condition characterized by immune-mediated atrophy of the gastric mucosa, particularly in the corpus region. When autoantibodies attack parietal cells and intrinsic factor, vitamin B12 absorption is impaired, leading to megaloblastic anemia. Notably, this patient did not present with typical digestive symptoms like loss of appetite, bloating, or abdominal pain. Instead, she came in primarily due to anemia-related complaints.
This case highlights the importance of considering autoimmune gastritis in patients presenting with unexplained anemia—even in the absence of gastrointestinal symptoms. Moreover, since this condition requires long-term monitoring and has no definitive cure, patient education and psychological support are essential components of successful management.