Documented PAType Stomach with End Stage Atrophic Body Predominant Gastritis with IM

In many PA stomachs there is extensive IM. In some others there is less prominent IM but still extensive atrophy of the oxyntic glands, with their replacement by mucous glands (pseudopyloric metaplasia). The approach is the same for all. When this diagnosis is first made it is useful to carefully examine the stomach for polyps and carcinoids. Biopsy mapping for IM and/or dysplasia is not warranted. In a low GC country (Brown and Devesa, 2002) like the United States (only as it refers to Caucasians) there is a question as to whether any follow-up examinations should be done if the first is negative. At follow-up the most significant lesions to be found, if any, are tiny carcinoids (< 5 mm) that do not warrant removal (Lahner et al, 2001). If tiny pinpoint carcinoids are found at the first examination, I repeat the examination in 3 years, and if no change with just tiny carcinoids, then I recheck in 3 years again. Beyond that, the surveillance intervals are tempered by the age of the patient, the absence of new findings, such as larger carcinoids a 5 mm, or other lesions, such as adenomas. If there are no carcinoids at the outset, I still recheck once in 5 years. Carcinoids associated with atrophic gastritis are much more indolent and less aggressive than in the other two settings for gastric carcinoids, namely sporadic, and part of an MEN picture.

If adenomas are found, they represent an investigative alarm and the management, as discussed subsequently, is much more proactive.

Constipation Prescription

Constipation Prescription

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