Please help!! Biopsies show fast progression. Confused!

[rpatrick]

I am a 35 yo female 5'5" who had gastric sleeve and Nissen fundoplication surgery 18 months ago. My pre-op EGD showed large sliding hiatal hernia and mild non-reactive gastritis. At of now I have lost 25 lbs more than my dr recommended goal weight (from 211 to 115) and am now underweight. I can't stop losing weight. For the past several months I have suffered from chronic diarrhea, abdominal pain, nausea, severe dizziness, orthostatic hypotension, headaches and memory loss, to name a few. 7 months post-op I had an EGD/biopsies that came back normal duodenum, mild reactive gastropathy in stomach, and mild/moderate esophagitis.. I had an EGD mid-September (15 months post-op) and there was a 1.5 cm polyp/nodule found in my distal duodenum. Biopsy results of the duodenal nodule showed antral mucosa with reactive gastropathy negative for metaplasia, erythema in the stomach body and antrum. An EGD was then scheduled to remove the nodule via piecemeal polypectomy. This procedure took place in October (16 months post-op). At this time a second nodule had already appeared. Biopsy results of these nodules are as follows:
Sections of the duodenal bulb reveal fragments of gastric antrum mucosa. The surface is convoluted and lined by a population of reactive foveolar epithelial cells. Surrounding lamina propria is edematous and contains mixed inflammatory infiltrate of lymphocytes, plasma cells and rare eosinophils. The mucosa is focally eroded. There is patchy intestinal metaplasia. Acian blue/PAS stain is positive in the areas of intestinal metaplasia. Negative for h. Pylori. Additionally, fragments of duodenal mucosa, which show an irregular villous architecture are admixed in this section. There is loss of typical intestinal mucous cells with metaplastic change. Alcian blue/PAs stain highlights patchy gastric foveolar metaplasia of the intestinal epithelium.
Impression:
Duodenal nodule #1:
Fragments of gastric antral mucosa with reactive gastropathy, mucosal erosions, patchy intestinal metaplasia and patchy gastric foveolar metaplasia
Chronic peptic duodenitis
Duodenal bulb #2:
Gastric foveolar metaplasia of the intestinal epithelium
Chronic peptic duodenitis

Also have esophageal wall thickening.

Can someone please explain what all of this means and whether I should be concerned that these biopsies have shown rapid changes taking place in my GI system? Am I at a high risk for cancer? If so, is it likely to keep progressing at such a rapid rate?

I would be eternally grateful for a reply and information/answers to my questions. Thank you in advance for your help!!
Robin

[NeedSomeHelp456]

Hello, Do you know if a patient with "reactive gastropathy" in the antrum on biopsy is capable of fully reversing the reactive gastropathy?  If so, how long should a patient wait before giving up hope of a full recovery?  Thank you.

[Paderla Anitha, DNB]

Hi, there are different cell transitions. Metaplasia  is an initial change from normal cells to a different cell type. Then there is  dysplasia, which shows an increasing degree of disordered growth or maturation of the tissue. Then this progresses to neoplasia, which is cancer. But the changes are reversible in the metaplastic stage, so if the insult is removed at this stage, the cell type can be reversed. The results in your report reflect metaplastic changes. Regards.