Atrophic gastritis is common in elderly people, resulting in hypochlorhydria and reduced gastric secretion. There is no consensus whether atrophic gastritis and the decrease in gastric acid secretion are normal processes of aging or a result of Helico-bacter pylori infection. Independent of the cause, lack of gastric acid may interfere with the optimal absorption of nutrients. In the case of vitamin bi2, this may have clinical consequences. The mechanism for the reduced absorption of vitamin B12 is not clear, but protein-bound colabamin absorption is reduced in the elderly with atrophic gastritis or hypochlorhydria and this situation can be reversed with free vitamin B12 (the crystalline form) administration. Again, the prevalence of vitamin B12 deficiency is higher in H. pylori infection and eradication of this bacteria may correct vitamin B12 levels.

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