Tricky biopsy results

[Matebele]

Greetings to all dear fellows. I received the dreaded biopsy results and my physician just touched on the lack of gastric dysplasia or malignancy but did not fully explain the medical report.Its reads as follows 'The biospsies show fragments of generally thinned gastric antral mucosa with a moderate chronic inflammatory infiltrate in the lamina propia.There is lamina propia fibrosis with lack of tubules

Some areas show foveolar hyperplasia and there is focal intestinal metaplasia'

No organisms are seen.

It's scary but could anyone help in explaining this .Thanx

[Rexz]

Matebele, Your results are nothing to be afraid of but rather to be aware of.

Here are my response to your questions and other thoughts to share with you my own knowledge gained over these past three years of which I have GI endoscopies every six months due to being high risk for cancer since I already had one instance of same.

The Lamina Propria is a loose connective tissue within the mucosa or the inner most lining of the stomach. Anything within the mucosa including the Lamina Propria may also be described as intra-mucosal, meaning confined within the mucosa or not penetrating deeper beyond the mucosa.

General thinning of mucosa is part of the Gastritis inflammation process…so is to be expected with those with PA or what is now more appropriately referred to as Autoimmune Metaplastic Atrophic Gastritis (AMAG) also known as Autoimmune Gastritis (AIG).

Intestinal Metaplasia is considered pre-cancerous lesion. Not to worry too much as it is common in people with PA.

No Dysplasia is a good sign but remember any biopsy results are only from that one tissue sample.

Not to alarm but rather inform. the increased risk of gastric cancer for people with PA is generally 3 to 7 times. There are two types of what I call imposter cells those with PA should be aware of they are Intestinal Metaplasia and Neuroendocrine Cell Hyperplasia. The Correa Scale, as accepted by the medical community, progression to cancer shows Intestinal Metaplasia => Dysplasia => Adenocarcinoma (cancer), (I have had all three of these) thankfully my cancer was removed. For high gastrin levels, common in those with PA and having low/no stomach acid, there is also the Neuroendocrine Cell Hyperplasia (NEH) => Neuroendocrine Cell Tumor (NET usually benign) => Neuroendocrine Cell or G-Cell Carcinoma in the stomach.

There are also two subtypes 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 you tell your GP to instruct the pathologist to classify your biopsy samples as complete or incomplete subtypes.

What they should really be looking for in the absence of a visible polyp or lesion for anyone with PA is the “extent” of Gastric Intestinal Metaplasia (GIM). Whether it is “Extensive” (in many areas of the stomach), and whether the biopsy samples with GIM present show as “Complete” or “Incomplete”.

It is important for them to perform this gastric mapping of biopsies as the extent and type of GIM will help in determining to some degree your individual risk or probability of cancer progression. This also helps determine the frequency of your surveillance Gastroscopies.

The European MAPSII guidelines recommends performing an endoscopy every three to five years to surveil patients with AMAG. If you have Extensive GIM and/or a family history of gastric cancer, in other words you are at higher risk, then these endoscopic surveillance intervals may be 1 year. Upper endoscopy, also known as esophagogastroduodenoscopy (EGD) in the U.S., or Gastroscopy in Europe is a procedure used to examine the lining of the esophagus, stomach, and upper part of the small intestine (duodenum).

Just as, or more, important to what the individual biopsy results were is where were they taken. For those with a PA diagnosis they should have first visually inspected the stomach, removed any polyps and taken biopsy of any suspicious lesions. Then they should have performed what is called a gastric mapping biopsies in accordance with the "Sydney Protocol" which is a set of 8 random biopsies from the gastric body, corpus/incisura and antrum. Oh, and since you have PA they should 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. It is important to make sure your GI doctor understands this as 90% Plus of gastritis is cause by H-Pylori and this Atrophic Gastritis begins in the Antrum at the bottom of the stomach. Therefore, many doctors seeing Gastritis naturally focus on the Antrum.

They should 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.

Make sure your doctor instructs pathologist to test samples for H-Pylori. a bacterium that can cause inflammation and gastritis like AMAG although not autoimmune and thus curable.

That's a lot to take in so if you have any questions feel free to DM me.

hope this helps some. Best wishes, Rexz

[Matebele in reply to Rexz]

Thanks very much Rexz.My Endos copy report reads 'Oesiphagus -Normal oropharynx.Normal oesophageal mucosa.No masses,no ulcers,no Mallory Weiss tears.No varices,no Barrets.No hiatus herniaStomach-wall has significantly few rugae and has visible vessels otherwise non ulcerated overlying mucosa.Normal distensibility.No masses.Random gastric biopsies taken

Duodenum-Normal D1 and D2 no ulcers seen

Comment -Gastric finding suggest Atrophic gastritis ,no malignant features seen.

Pylori anti bodies - negative

Unfortunately some of our doctors seem to loathe being asked questions and tend to be dismissive.

[Wwwdot in reply to Rexz]

what an incredible reply! Thank you I will try to save this discussion as I suspect I will be heading into this territory. Thank you for taking the time to share and explain so clearly. 😁