A 36-year-old woman comes to the office due to vague epigastric abdominal pain, occasional nausea, and bloating. She has no associated weight loss. Medical history is notable for moderate obesity and chronic allergic rhinitis. The patient takes no medications and does not use tobacco, alcohol, or illicit drugs. She was a vegetarian for several years but now consumes a wide variety of foods, including meat products. The patient has traveled abroad extensively in the past. Vital signs are normal. Examination shows mild epigastric tenderness to deep palpation. Laboratory results reveal mild anemia. Upper gastrointestinal endoscopy shows diffuse erythema of the antral mucosa. Biopsy reveals an inflammatory cell infiltrate involving the superficial mucosal layers. The underlying cause of this patient's current condition can also lead to which of the following?

Question

A 36-year-old woman comes to the office due to vague epigastric abdominal pain, occasional nausea, and bloating.  She has no associated weight loss.  Medical history is notable for moderate obesity and chronic allergic rhinitis.  The patient takes no medications and does not use tobacco, alcohol, or illicit drugs.  She was a vegetarian for several years but now consumes a wide variety of foods, including meat products.  The patient has traveled abroad extensively in the past.  Vital signs are normal.  Examination shows mild epigastric tenderness to deep palpation.  Laboratory results reveal mild anemia.  Upper gastrointestinal endoscopy shows diffuse erythema of the antral mucosa.  Biopsy reveals an inflammatory cell infiltrate involving the superficial mucosal layers.  The underlying cause of this patient's current condition can also lead to which of the following?

Quizplus · Accepted Answer

11ec160b_395a_b547_9249_790927fb6677_MD0001_00 This patient with antral-predominant gastritis likely has an acute Helicobacter pylori infection, which typically presents as nonatrophic gastritis. Destruction of somatostatin-producing cells in the antrum leads to unchecked gastrin secretion and results in excess production of stomach acid and an increased risk of duodenal ulcers. If left untreated, chronic H pylori infection typically spreads to involve the corpus (body) and fundus of the stomach and is characterized by patchy, multifocal gastric atrophy with intestinal metaplasia. Patchy destruction of parietal and G cells results in diminished acid secretion and hypochlorhydria. Patients with chronic gastritis are less likely to develop duodenal ulcers but due to the associated chronic inflammation, they are at increased risk of gastric ulcers and malignancy, particularly gastric lymphoma (ie, mucosa-associated lymphoid tissue [MALT] lymphoma) and gastric adenocarcinoma. (Choice B) H pylori-associated ulcers can cause gastric outlet obstruction, not gastroparesis, which is commonly due to uncontrolled diabetes or infiltrative diseases (eg, scleroderma). (Choice C) Celiac disease is an immune-mediated response to a protein in gluten and can cause microcytic anemia due to iron malabsorption. Autoimmune diseases are associated with autoimmune gastritis, not H pylori infection. (Choice D) Ileal obstruction can occur due to Crohn disease, which can also cause abdominal pain and blood-loss anemia. However, H pylori infects gastric mucosa; the ileum is typically unaffected. (Choice E) Unlike chronic H pylori-associated atrophic gastritis, which causes patchy atrophy with sparing of some parietal cells (allowing for continued intrinsic factor production and B₁₂ absorption), autoimmune gastritis is characterized by diffuse and more complete immune-mediated destruction of parietal cells and intrinsic factor. This results in impaired vitamin B₁₂ absorption and pernicious anemia. Educational objective: Acute Helicobacter pylori infection initially causes nonatrophic antral gastritis and an increased risk for duodenal ulcers. Chronic infection results in patchy, multifocal, atrophic gastritis with loss of parietal cells and G cells in the gastric body; this is associated with decreased acid secretion and an increased risk of gastric ulcers, gastric adenocarcinoma, and MALT lymphoma. __________ References: Gastric adenocarcinoma: the role of Helicobacter pylori in pathogenesis and prevention efforts. (http://www.ncbi.nlm.nih.gov/pubmed/27222587)

A 36-Year-Old Woman Comes to the Office Due to Vague