Biopsy Report

[nanci]

I posted a few weeks ago about my diagnosis and the info I received from the doctor's office. His nurse read the report to me saying it was Chronic Gastritis with Intestinal Metaplasia. When I asked for an explanation of IM, she said it was like a tissue forming for the stomach to heal itself. My search on the internet told me a different story so I called back and she told me the doctor did not read IM as precanceous. That I did not have GERD at all and IM is sometimes precanceous in Barretts but in my case, it was clearly tissue healing. She suggested that I speak to the doctor personally so I made an app't to meet with him on 9-12.

Last week, I had the hospital fax me the pathology report. It reads as follows....

DIAGNOSIS: Gastric Biopsies
- Chronic Gastritis with Intestinal Metaplasia
- Fragments of Duodenal Mucosa

COMMENT: Alcian yellow stain was performed confirming absence of surface bacilli.

GROSS DESCRIPTION Received in formation are five fragments of light tan mucoid tissue aggregating 6mm. Totalled

That was it! My thoughts are how can the doctor interpret that IM means healing. I am totally baffled. He suggested no follow-up was necessary; to just take the PPI's. If IM technically means pre-canceous as my research says, then how can he not pay attention to this and have me in for at the very least, yearly scopes.  

Are there medical professisonal on this board who can elaborate on this.  I don't want to meet with him and lose it - he is reputed to be one of the best gastro doctors in the area.

[RTFLY]

I hope this helps. Don't get too hot with your doc. Chronic Gastritis effects glandular and superficial areas areas of gastric mucosa and progresses to glandular destruction which may be followed by a reduction in gland number(atrophy) and/or gland metaplasia. Metaplastic cells are normal for their particular type, but not location. When certain cells are destroyed, in your case the glandular cells, they are replaced by other cells not made for that area. But they are also not bad for that area. Metaplasia is a protective response to adverse conditions. I read your previous submission and it's good to hear that your H. Pylori was negative. This form of gastritis is more commonly known to lead to gastric carcinoma(cancer). Intestinal Metaplasia is representitive of abnormal cell formation but only abnormal for that area. Take some time and speak with your physician about your particular case. If you still don't trust his findings, my suggestion would be to seek out a new physician. Good luck and take care...
                                               J.C.

[nanci]

Thanks for your input.  I suspect this may be my case as the nurse explained - that the tissue is growing in an attempt to heal but I will get a full explanation from the doctor when I meet with him.

A few questions for you if you don't mind.  If I am negative for h-pylori and I have a chronic case, what is your opinion on what is causing this.  I've had this conditon off and on for 7 yrs with this time being the absolute worse.  In April, I took a fall which brought me to the ER.  At the time, they told me my arm was bruised and they would call if findings showed otherwise.  They never called, somebody forgot to!  So it fell between the cracks.  So, I'm thinking it's a bruised arm. For the entire month of April and some of May, I took 3 Advil, three times a day for the pain.  Ended up being a broken arm when I finally went to an ortherpedic guy.  

The gastro doctor didn't think taking Advil caused my symtoms to return with such vengence or at the very least, it had little to do with it and he said even if it was the case, I would have felt better in a few weeks.

If this is a chronic condition, will I have to live like this forever experencing symptoms off an on?  

And, do you think PPI's are the route to take.  I take two Prevacid a day and have been for a few weeks now.  I tried Nexium and Protonix but neither brought continued relief.  Prevacid is better but I sill wake up with burning.  I have eliminated all the trigger foods, caffine, wine, etc.  I have been taking PPI's since July.

Thanks, your comments are appreciated.

[RTFLY]

Nanci-the other cause I am aware of for chronic gastritis is an auto-immune response/sickness. Your immune system is out of whack and fights certain areas or things that it shouldn't be fighting. H. Pylori is the other cause as you are aware and generally those patients are asymptomatic, meaning they don't show the symptoms you are experiencing as often as you do. They are also more prone to gastric carcinoma as I stated before, according to literature. I agree with your physcician when he stated that the Advil(NSAID=non-steroidal anti-inflammatory drug)may not have caused the flare up and if it did, once the Advil was stopped, that your symptoms would disappear. However, literature also states that NSAID's CAN exacerbate gastritis symptoms. Being a chronic condition and having little experience with this disease, I can not say how long you will have to deal with this. Other auto-immune, chronic inflammatory conditions I am familiar with come and go. Symptoms may come for a while and then calm down for a while, but you still have the disease. Again, ask your doc when you see him and get his opinion. As for your doc's approach using PPI's, that is his course of medical regimine and I can not comment on that. It is a recommended course of therapy for your illness, so I would stick with that. I hope you have a good visit with your doc and try and maintain composure :o) A good physician/patient relationship is great to have and you can really gain confidence when this occurs. Good luck and take care...
                                             J.C.

[pebs]

biopsy report  the multiple biopsies from  the stomach (gastric body ) have confirmed the presence of " chronic gastritis" with "intestinal metaplasia" but there is no evidence of dysplasia or malignancy. These results are similar to those on previous occasions and in keeping with a diagnosis of pernicious anaemia. To anyone out there who suspects pernicious anaemia  chickensoups data was  so accurate it was textbook, as indeed all her comments  are  accurate and straight to the point   her common sense approach to  all sorts of topics is  a pleasure to read,  I am  always interested in what she has to say, question to you chickensoup- have you a medical background or just very well informed?   Nanci this is for you at what age were you diagnosed with pernicious anaemia?

pebs

[JackieG]

Hi pebs:

No medical background here (although I have learned about some maladies the hard way). I do suspect that we have a few healthcare professionals in the Group though. Judging from their advice, I think RTFLY and Wilson may both work in the healthcare field.

Regards,
Chicken Soup