Development of type I gastric carcinoid in patients with chronic atrophic gastritis

Abstract

SUMMARY BackgroundLong-term observational studies assessing the incidence of type I gastric carcinoid (typeIGC) in patients with chronic atrophic gastritis are few.

Factors associated with elevated serum chromogranin A levels in patients with autoimmune gastritis

“…Although CgA is used for neuroendocrine tumors, CgA elevation is seen in individuals with carcinoid tumors, in chronic atrophic gastritis (19), and due to patients using proton-pump inhibitors (PPIs) for a long period of time (5), which causes ECL cell hyperplasia. Vannella et al (20) followed-up 367 chronic atrophic gastritis patients regularly with gastroscopy. They reported that an increase in gastrin and CgA levels were both associated with the presence of type I gastric carcinoid in the univariate analysis.…”

Nowotwory neuroendokrynne żołądka i dwunastnicy z uwzględnieniem gastrinoma (zasady postępowania rekomendowane przez Polską Sieć Guzów Neuroendokrynnych)

“…In patients with suspected gastrinoma, PPI can be substituted in this period with oral H2-receptor antagonists, but it is recommended SZKOLENIE PODYPLOMOWE that they are also discontinued at least 48 hours before the examination [8]. Because sudden discontinuation of PPI in a ZES patient may result in complications due to a sudden increase in hydrochloric acid secretion, some experts currently recommend conducting diagnostics without the withdrawal of PPI, or with a dose reduction.…”

“…In practice, the diagnostics starts with determination of serum gastrin concentration under fasting conditions (FSG), which is increased to 98% for ZES patients. The evidence of hypergastrinaemia is not sufficient to diagnose ZES because there are other reasons for increased gastrin concentration than gastrinoma [5,8]: -with hypo/achlorhydria -atrophic gastritis, using PPI, -with hyperchlorhydria: H. pylori infection, pyloric stenosis, renal failure, antral G-cell syndromes, short bowel syndrome. In 40-60% of patients with ZES, the FSG value is lower than 10 times the normal gastrin concentration under fasting conditions, and it is comparable to gastrin concentrations in the course of H. pylori infection.…”

“…Therefore, the effective eradication of H. pylori is necessary before a gastrinoma diagnosis can be established [8].…”

“…They occur in less than 1% of patients, more often in women, and are diagnosed mostly between the ages of 40 and 60 years. The increased availability of endoscopic examinations is expected to lower the age of patients diagnosed with g-NETs of type 1 [8,9].…”