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• W2977767512 abstract "A 55 year old female from Jamaica with no significant past medical history presented with two weeks of epigastric pain and black tarry stools. Patient had been taking meloxicam for one week for hip pain. On the day of admission, she had two episodes of coffee ground emesis. She was hemodynamically stable. Physical examination was notable for epigastric tenderness on palpation and melena on digital rectal exam. On admission, her hemoglobin and hematocrit were 8.6 g/dL and 26.5%, respectively. Esophagogastroduodenoscopy (EGD) showed two gastric ulcers with no stigmata of bleeding in the gastric antrum. The largest ulcer was 20 mm (Figure 1). Biopsy of the ulcer revealed no evidence of malignancy but showed moderate chronic active gastritis and Helicobacter pylori (H.pylori).The patient completed triple therapy for H. pylori and continued on a proton pump inhibitor (PPI). A repeat EGD performed 8 weeks after the initial diagnosis showed a small patch of nodular erythematous mucosa in the gastric antrum at the site of previously seen large gastric ulcer (Figure 2 ). Biopsy of this site showed moderate to poorly differentiated adenocarcinoma arising in a background of chronic gastritis with intestinal metaplasia. A discrete lesion could not be identified with EUS. CT imaging showed no evidence of metastatic disease. She underwent a distal subtotal gastrectomy, D1 lymphadenectomy, limited D2 lymphadenectomy with Billroth II reconstruction. Pathology showed 13 mm poorly differentiated adenocarcinoma invading the sub mucosa.Figure 1Figure 2H. pylori infection can lead to several gastrointestinal conditions including gastritis peptic ulcer disease, gastric mucosa-associated lymphoid tissue lymphoma and gastric cancer. One pathway to gastric cancer involves mucosal changes progressing from chronic superficial gastritis to atrophic gastritis. The mucosa then changes to intestinal metaplasia and progresses to dysplasia and adenocarcinoma. It is common to prescribe acid suppressing medications to treat epigastric discomfort. Although these medications can help relieve symptoms, ulcerated lesions that are typically found at EGD may not be detected in these patients due to healing of the ulcer.PPIs were also shown to have healing effect on malignant ulcers.This is important because the prognosis of patients with gastric cancer depends almost entirely on the stage at which the disease is diagnosed. In our case, the treatment with PPI demonstrated healing of the ulcers when in fact; there was a developing gastric adenocarcinoma underneath.The purpose of this case report is to highlight the need to conduct follow-up EGDs with biopsies and re-evaluate the use of PPIs prior to initial endoscopy in order to maximize the diagnostic yield of gastric cancer, especially in patients older than 45 years of age with dyspepsia or with other risk factors." @default.
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• W2977767512 date "2015-10-01" @default.
• W2977767512 modified "2023-09-27" @default.
• W2977767512 title "Gastric Adenocarcinoma Underlying a Healed Ulcer" @default.
• W2977767512 doi "https://doi.org/10.14309/00000434-201510001-01164" @default.
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