After undergoing various tests including two endoscopic gut acid tests as well as oesophageal manometer in the last ten months for continuous pain just below rib cage, bloating indigestion etc
Yesterday received a phone call from the hospital to say that all the tests where now in including biopsies taken in December 2021 and July 2022 in conclusion my stomach acid is very low at 3% and the December biopsies show I have
Gastric Intestinal Metaplasia for which there is no treatment other than a endoscopy every three years to look for Cancer my request is is anyone out there in the same boat and are they aware of any treatment and help available
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Active57
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Thank you for your posting I am waiting to be seen by a gastrologist and you have given me some idea as to what tests to request. Like you say I also suffer the discomfort the pain just under the rib cage but I also have a rather noticable swelling on the left hand side !
The bloating is something I suffer with myself which can be so damned uncomfortable at times. I am prescribed Lansoprazole which has done nothing other than to added to my B12 deficeincy.
I recently purchased some B12 with added instrinsic factor but cant say I have noticed any difference in absorbtion or symptoms. Albeit expensive I take Symprove which seem's to help a little -but its not cheap.
It seems we are in a catch two situation and have to carry on walking around as if pregnant------which is not good at my age.
What you describe, the bloating and the bulge, I had those symptoms and was diagnosed with an epigastric hernia. Look up the symptoms and see if any others sound familiar.
I had surgery to repair it the year before I was diagnosed with PA. Don't know if PA was already a less noticeable issue at that time or whether the surgery could have been the cause.
I have had a rather substantial hiatus hernia for many years but this swelling under my left breast is something different. I most certainly will look up a epigastric hernia. I also have non-errosive gastritis but I now need someone to join all the dots and give me some answer's.
I cant say I like the sound of surgery but in the back of my mind I have felt that is what is needed. I just googled it and I think you could be right.
Thank You for you’re reply I wish you well for your next appointment with you’re Gastroenterologist and hope that you get some relief from you’re symptoms
Have they suggested you supplement anything to increase stomach acid? Betaine HCl, apple cider vinegar, lime juice?
I would have to look up the research (no time toda), or others can correct me, but the metaplasia itself could be due to low stomach acid and associated high Gastrin. I am not sure if Gastric parietal cell antibody attacks themselves induce metaplasia.
Medscape has a good scientific summary of AMAG. Usually you have to create an account to read the content, but it is free.
I couldn't immediately find the medscape section, it's mixed in with chronic gastritis, will get back to you later. But this one is also good msdmanuals.com/professional...
In most of these papers, they say treatment is B12 but they never talk about increasing stomach acid. It is just my deduction. But an obvious conclusion, so I don't know why they don't treat it!
Hi Jade thanks again for you’re Responce in regard to advise from the consultant I wasn’t given any advise regarding supplementing my stomach acid I was however advised to take Amitriptyline ! and cognitive skills to help me deal with the pain !!
You're so welcome! I will try to post more resources soon. Also, I'm really sorry you're dealing with this, I can imagine it is scary.
I don't have much knowledge of Amitriptyline but I think others here do. It might be for nerve pain, which should be resolved with injections (are you getting them frequently enough?). Stomach pain can simply be from too little stomach acid. I got inflammation / gastritis when I stopped taking lime juice for a few months, and going back on it helped.
I may be misunderatanding you but no I haven't heard that someone with low stomach acid should avoid acidic foods. However it is a common suggestion for those with reflux and gastritis. It is a confusing topic, I know, mainly because doctors don't recognize that low stomach acid can also cause reflux.
In my case (and for many others here) both were due to low stomach acid. Although tomato sauce still gives me reflux, but not due to its acidity.
But some people have ulcers or gatritis due to other causes and they might do best to avoid acidic foods until the stomach lining heals.
yes you are right .. I just saw my gastro this morning and he said that we have low stomach acid and there’s no cure. It’s autoimmune and it progresses how fast don’t know. In terms of diet our bodies will figure out what doesn’t cause us pain. He had no dietary advice except eventually we start eating more blend food 😢😢😢😢😢. He said to be monitored every 3 years and theres a 10 percent of developing cancer. He was against PPI. He also said there’s a mild chance of B12 toxicity as I told him I subcutaneously inject every week so maybe to slow it down. I have noticed with me acid food don’t sit well and alcohol 🍷 . Good luck to everyone here
he also said there’s very small amounts of acids beneficial to the tummy if you had lime, lemons etc and is good but the amount is tiny tiny 😊. To have orange juice with meat and no carbs to increase iron absorption. Forgot to mention
I’m reading a book the gastritis healing book by LG capellan. I’m changing my diet a bit and seems to work . Ph over 5, no acidity food , no alcohol etc
Thank you Rosa clearly there is some confusion around if you should or should Not look to increase your stomach acid eg cider vinegar or lime juice etc
Im hoping that someone out there has the answer and will share it with us
Hello Active, Intestinal Metaplasia is to be expected with those who have PA or what is best referred to as AMAG or Autoimmune Metaplastic Atrophic Gastritis you can also find it referred to as AIG or Autoimmune Gastritis.
With AMAG as the oxyntic mucosa is being destroyed by your immune system your body is replacing those cells with cells that don't belong there. These are called Gastric Intestinal Metaplasia or GIM.
There are two types of GIM the first is GIM (Complete) which are cells that are similar to those in the small intestine and then there are the GIM (Incomplete) which look similar to those cells that belong in the large intestine. The GIM incomplete are the more aggressive and more likely to progress to cancer so it's important that the pathologist classifies your biopsy samples as complete or incomplete.
The European MAPSII guidelines recommend performing an endoscopy every three to five years to surveil patients with autoimmune gastritis (PA). If you have Extensive GIM and/or a family history of gastric cancer in other words you are an higher risk then these endoscopic surveillance intervals my be 1 year.
There is no real treatment or cure for AMAG I have searched the universe and talked to many doctors. If anyone finds anything please share. So for now just be aware and ensure that you are surveilled properly. Also go back and make sure you understand you family history. If there is PA and/or stomach cancer. Some people are more prone or predisposition to get stomach cancer so family history is a serious clue to give to your GP. The good thing is that early detection of gastric cancer is completely curable through Endoscopic resection and is painless. The bad thing is that the cure is for that instance of cancer only. If you are high risk then it becomes a game of "whack-a-mole" as I call it. You just have to keep looking and when its devious little head pops up you whack it. or excise it. so is the life of me 😂
Things to ask your GP that they consider:
1. Make sure to ask that they do gastric mapping biopsies in accordance with the "Sydney Protocol" which is a set of 8 random biopsies from the gastric body, corpus/incisursa and antrum. Oh and also make sure they really look at the Fundus the very top of your stomach. This is where most of your Parietal Cells reside and where they are being destroyed so the inflammation from AMAG starts here. biopsies not separated and labeled by location
2.Have them stay away from biopsy of the pyloric-duodenal junction unless they see some visible lesion. The reason is this junction between stomach and small intestine naturally has cells that belong to both stomach and small intestine and thus can be confused with intestinal metaplasia.
3. Make sure they instruct pathologist to test samples for H-Pylori. a bacteria that can cause inflammation and gastritis similar to AMAG.
4. Make sure they place each tissue biopsy in separate containers labeled with the location it was taken from.
5. Make sure they instruct pathologist to classify samples with GIM present as "complete" or incomplete"
6. Ask them to measure your stomach acid levels. I did this and it was done as part of my regular endoscopy cancer screening. They will first introduce a small amount of "something" I forget what at the moment, but could certainly be gastrin, into your stomach to excite your parietal cell proton pumps to produce acid, much like if you've eaten something. Then they will just suck some gastric juice out and measure the PH. If the PH is around 2 or 3 then that is very acidic if it's 6 or 7 then that means no acid or achlorhydria. anywhere in between is low acid or Hypochlorhydria. It is important to know this in order to know how aggressively you need to treat your gastric acid condition. My PH measurement was 6 so I've mostly zero stomach acid. For that I am prescribed but is OTC to take Betaine HCI and Digestive Enzymes before I eat each meal. That has helped my digestion tremendously.
I've become somewhat of an expert on this as because I have an endoscopic cancer screening every six months and go through this procedure with my doctor each time because they forget. I get every six months because I am considered extremely high risk as I have a family history of PA with stomach cancer and I myself have extensive GIM in other words it shows up on every biopsy sample each screening and both complete and incomplete. I've also had an instance of a lesion removed from my Fundus that was Hyperplasia and Adenocarcinoma. So that is OK so long as they catch it early and they can do what's called an endoscopic mucosal resection (EMR) where they excise it.
Here is a good description of GIM from The Cleveland Clinic in US
Now regarding the pain you have just beneath the ribs. IF this pain is just under the lower rib on your right side then it is most likely your gallbladder. Another thing your doctors/GP will not know is that AMAG and low/no stomach acid severely affects how your gallbladder functions. In fact your whole digestive process. The first being the opening of the pyloric sphincter that allows your food or now chyme to enter the small intestine. Acid plays a huge role in the opening of that sphincter. If you've no acid then the sphincter may not be opening properly and your food just sits there thus the feeling of fullness and bloating and often regurgitating or vomiting. The other thing is your gallbladder may become full of "sludge" or stones. This can also be cause by no stomach acid as your stomach acid plays a huge role here to. Normally when your food enters the small intestine the acid excites cells on the walls of the intestine to produce a hormone call CCK. This is a messenger hormone to cause the gallbladder to contract and thus squirt Bile into the small intestine to help with digestion. Without stomach acid the gallbladder not contracting my theory is that the bile stored within the gallbladder turns to sludge much like old gasoline or petrol as you call it in the UK in your car turns to gel if it sits to long. This can cause pain if you are passing any of those stones through the common bile duct. Like I said IF that pain is on your right side just under the lower rib then pay attention and have it looked at especially if the feeling radiates across the upper part of your abdomen or your back which can mean you've a stone blocking your bile duct.
I have seen a very well regarded gastro consultant three times, maybe four, and he has not explained any one thing as well as you have explained tons of things here. I wish gastro consultants could be sent off to speak to you.
I have had near constant pain just below my breast bone and lower right rib area since December last year consultant has said I’m to take Amitriptyline for 6 weeks minimum and let my GP know how it goes
hi I was diagnosed with autoimmune atrophic gastritis, as you I have low stomach acid.
I have endoscopy every year so far but that is due to my gastroenterologist listening to me.
I SI hydro B12 as every 3 months was useless. Basically I look after myself I take supplements as I have malnourishment and don’t put weight on. I lost a lot of weight at the beginning. I take folic acid, liquid iron, magnesium, B vitamins and others like glutamine, calcium, vit C.
I am gluten-free and am still trying to kick sugar and dairy.
I hope this helps you as the NHS hasn’t been much help.
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Biopsy Results
Just diagnosed with autoimmune atrophic gastritis with intestinal metaplasia
endoscopy
I feel like crying ...
