gballarino
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70 year old male patient with a several years history of chronic type B (antral-predominant) gastritis secondary to Helicobacter pylori infection. He has never developed ulcers, and only complains of mild dyspepsia, and mild dyspnea with palpitations on exertion. He looks pale and sustains a I/VI systolic ejection murmur. Labs show Hb 10.5 MCV 104, rest normal. Urea breath test is positive. Neurologic exam ok.
:?: Does he need further diagnostic work up and evaluation? Would you screen for malignancies? How?
:?: How would you treat this patient? Should we initiate triple therapy against H. pylori or not?
:?: Follow up? at what intervals and by which method?
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Guillermo Ballarino
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| helpful
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1. Yes he needs further follow up that is endoscope and biopsy to rule out malignancy as Type B Chronic gastritis is associated with gastric adenocarcinoma
2. He should be give standard triple therapy for H. pylori.
3. Follow up if no pathology on biopsy other than Type B Chronic gastritis than follow up by urea breath test.
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| gballarino
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You perform a gastroduodenoscopy and found no ulcers. The mucosa looks thin, permiting clear visulization of the underlying blood vessels.
:?: Do you take biopsies anyway? where do you take them from? What pathology are you looking for other than adenocarcinoma?
:?: Do you still initiate triple therapy for H.pyl?
:?: Other treatment indicated?
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Guillermo Ballarino
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| Medicine Guy
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Yes i think initiate triple therapy for H.pylori.
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| gballarino
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Well.... nobody said anything about treating his b12 deficiency anemia. Wouldn´t that be number one priority at this moment? I would use intramuscular B12 injections. :?: Do you think he should be submited to a schilling test or the history speaks for itself?
Also... about H.Pylori treatment, i am confused. It seems obvious that this patient needs treatment... however, i´ve been going through the recomendations for treatment of H.pylori, and they clearly say that the only true indication for treatment is when the patient sustains PUD or acute gastritis. Otherwise, there is no evidence to support treatment. :?: Since this patient does not have ulcers, I´m wondering what would be medically correct and what would be correct in an USMLE question.
Also... :?: I´m wondering how and when to screen for MALT lymphoma, which is associated with atrophic gastritits.
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Guillermo Ballarino
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| Medicine Guy
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I think B12 def also needs to be addressed. gballarino got a point. May be a schilling test and
full work up for anemia, B12 def in particular.
Full anemia panel will be useful in this setup.
Malt Lymphoma ..errr??? ... upper gi endoscopy and
may be a bone scan.
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