Emergency advise needed, please help!

[AnilV]

Dear Doctor:
Since July 2009, Ani has been suffering  severe diarrhea with nausea for weeks.  Has other symptoms such as drastic weight loss and fatigue. Consulted gastroenterologist who performed endoscopy along with biopsies.

His UGI Endoscopy report findings:
Esophagus: Has 2 erosions at lower end, G. E. Junction at 39 cm, small hiatus hernia.
Stomach: Body, fundus, pylorus and antrum has erythema with congested greater curvature folds
Duodenum: D1 is normal and D2 has normal folds Gastric and D3 BC taken
Impression: GERD LA-B, small hiatus hernia
His Histopathology report results came as follows:

HISTOPATHOLOGY REPORT
A.  Duodenal mucosa is patchily eroded and contains moderate diffuse infiltrate of plasma cells, lymphocytes and eosinophils in the lamina propria.Villi and villous crypt ratio are near normal.Part of normal    muscularis mucosae present.  No Brunner glands, granuloma, collagenosis, or atypia noted.
B.  Gastric mucosa is patchily eroded and has moderate diffuse infiltrate of plasma cells, lymphocytes and eosinophils in the oedematous lamina propria. Few glands are crowded showing mild dysplasia, regenerating activity and intestinal metaplasia. Focal distortion of glands present. Part of normal muscularis mucosae seen. No granuloma, collagenosis, increase in IEL or atypia noted. H.Pyloris seen.

A.  CHRONIC NON-SPECIFIC DUODENITIS.
B. HELICOBACTOR ASSOCIATED CHRONIC GASTRITIS WITH PATCHY INTESTINAL METAPLASIA AND MILD DYSPLASIA.
1) Where it mentions "HELICOBACTOR ASSOCIATED CHRONIC GASTRITIS WITH PATCHY INTESTINAL METAPLASIA AND MILD DYSPLASIA,"  is there something to be extremely concerned about? Is this pre-cancerous or has it already progressed to cancer?

2) What type of treatment  is recommended?
Currently having breathing difficulty and doctor said due to his stomach ailment. Currently taking Amoxicllin, Clarithromycin and Rabeprazole.
Need your esteemed opinion and advise, please

Thank you
Leena

[Kevin Pho, MD]

The biopsy results are consistent with H Pylori, a bacteria that is associated with inflammation and ulcers.  Typically, the treatment includes 2 antibiotics as well as a proton pump inhibitor, which you are currently on.

Judging from the biopsy results, there is no evidence of cancer.

Metaplasia and dysplasia suggests that there is damage to the lining of the stomach, which may be due to the chronic inflammation.  

H pylori can be associated with gastric cancer and gastric lymphoma, so the changes on the biopsy results bear monitoring.

These options can be discussed with your personal physician.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin Pho, M.D.

KevinMD.com
Twitter.com/kevinmd

[AnilV]

Hi Dr. Kevin Pho:

I sent an emergency query yesterday with regards to my friend who is based in India. He has been unwell since July. I was trying to seek some advise or opinion from a gastroenterologist or a knowledgable doctor who is here in the US since the gastroenterologist that is attending to his case in India is seeking other doctors opinion. Some doctors were of the opinion that Helicobactor associated chronic gastritis with patchy intestinal metaplasia and mild dysplasia might be precancerous whereas other doctors are of the opinion that this can be misleading and it might already be cancer. While I was surfing on the net searching for a gastroenterologist I came across your website and there was a charge of $16 from you. I decided to opt for this thinking definitely my query will be answered by you since I paid for it but disappointedly none was forthcoming! The query which was posted after mine was answered but mine has not. Since this case is precancerous or cancer related, I need some advise right away. If you are not able to help, atleast let me know, so that I can send my query to other willing doctors who can grant me advise. As you know time is a crucial factor here, Dr. Pho.....  

Thanking you,

Sincerely

Leena