Casual identification of severe gastric atrophy with macrocytosis complicated by acute coronary syndrome.

Chronic atrophic gastritis (CAG) and gastric cancer are leading causes of morbidity and mortality worldwide. Serum pepsinogens have been used as biomarkers of gastric mucosa status, including gastric inflammation, so that they might be useful for detection of gastric atrophy or gastric neoplasm at an early stage. Serum pepsinogen 1 and pepsinogen 2 concentrations are known to increase in the presence of Helicobacter pylori-related non-atrophic chronic gastritis, and the eradication of this pathogen is associated with a significant decrease in their values. We describe here the case of an asymptomatic 60 years old man, with a casual serological diagnosis of severe gastric atrophy, macrocytosis and severe complications, culminating in an acute coronary syndrome. This case report raises some important considerations, such as the fact that CAG could not be correctly and early diagnosed and that it may be misleadingly regarded as a rare condition, whereas its prevalence is conversely largely underestimated. This may lead to severe complications that may include gastric malabsorption and vitamin B 12 deficiency, along with gastrointestinal, neurologic, psychiatric, cardiovascular, cerebral and peripheral vascular disorders.