Question: My doctor says I have pernicious anemia. What causes it and what kind of treatment should be prescribed? She is giving me medication, but she hasn't told me exactly what the meds are for, as she also said that I am a celiac.

Dr. Hibberd's Answer:

Pernicious anemia is uncommon, and is discovered by the presence of an anemia. It is related to an inability to absorb vitamin B-12. Vitamin B-12 absorption normally requires the presence of a protein called intrinsic factor secreted by the stomach in order to be efficiently absorbed by our small intestine. The absence of intrinsic factor is confirmed by testing, and pernicious anemia is confirmed.

Pernicious anemia may be treated by intrinsic factor replacement or by monthly vitamin B-12 injections.

Celiac disease (CD) causes damage to the small intestine where iron, vitamin B-12, and folic acid are absorbed, and may result in deficiencies of these nutrients. Celiac disease, malabsorption and the associated bowel changes, can be reversed by following a gluten-free diet.

Once CD is treated by excluding gluten from the diet, the affected areas of the small intestine will often heal and allow absorption of these nutrients. Healing on a gluten-free diet may take 12 to 18 months.

The B-12 deficiency seen in celiac disease is usually related to malabsorption of B-12 from small bowel disease. Pernicious anemia (i.e. intrinsic factor deficiency) in celiac disease patients is actually a very rare combination.

As an aside, anyone with an anemia that continues in the absence of underlying medical conditions or who doesn't improve with iron treatment should be tested for CD.