Gastroscopic Screening for Gastric Carcinoids and Carcinoma in Pernicious Anemia

Abstract

Among 196 patients examined in 1972-1985 because of pernicious anemia (PA), 105 patients under the age of 76 years were invited for gastroscopic screening, and 71 patients (68%) participated. Gastroscopy revealed carcinoid tumor(s) in 5 patients (7%) but no case of carcinoma. In addition, one patient with gastric carcinoid, 5 patients with adenocarcinomas and one with a concomitant carcinoid and carcinoma had already been diagnosed earlier in the overall PA group on the basis of clinical symptoms. Thus, within a follow-up of 0-20 years (mean 7 years) the total frequency of gastric carcinoid tumors was 4% and that of carcinoma 3%. Patients with carcinoid tumors had a long duration of PA and young age of onset; these cases were not necessarily those with the highest serum gastrin levels. Even though most gastric carcinoids are small subclinical tumors of uncertain clinical significance, their unexpectedly high frequency, combined within the risk of carcinoma in PA, might indicate the need for gastroscopic follow-up, at least in cases of juvenile onset PA.

Gastric cancer in patients with type I gastric carcinoids

“…An older study reported an annual incidence of 2 %, observing 8 new cases of T1-GCs in 416 patient-years [7]. In the above cited study, pernicious anemia was present in almost 50 % of patients with T1-GCs [9], while previous studies exclusively included patients with this condition [7,8,[10][11][12].…”

“…Gastrin acts as a growth type factor for enterochromaffin-like cells, which in ABG are chronically induced to proliferate through a multistep process passing from hyperplasia to dysplasia and then to carcinoids [3][4][5]. Long-term observational studies assessing the incidence of T1-GCs in ABG patients are scarce [6][7][8]. In a recent cohort study, ABG patients were followed up for 1,463 person-years, reporting an annual incidence rate of 0.4 % for type I gastric carcinoids [9].…”

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

“…Autoimmune gastritis is also a risk factor for gastric neuroendocrine tumors (carcinoids) and gastric cancer development (2). Gastric cancer incidence ranges from 1 to 3% for gastric carcinoma and from 2 to 12.5% for carcinoid tumors in patients with AIG with or without pernicious anemia (3)(4)(5)(6). Gastric carcinoid tumors that occur in patients with AIG are labeled as type I gastric carcinoids.…”

Pernicious anaemia.

“…7 What of the patients with normoblastic marrows with either a normal blood film or a raised mean cell volume who have a low serum cobalamin concentration and malabsorb cobalamin? They probably have gastric atrophy.…”