Gastric carcinoid tumors originate from enterochromaffin-like (ECL) cells. ECL cells are confined in the gastric fundus and corpus cells (L. Vannella et al., 2011). ECL cells have the task of secreting histamine, which leads the secretion of parietal cells (L. Vannella et al., 2011). Histamines are produced by the immune system, and in response causes inflammation. Parietal cells are the epithelial cells that secrete hydrochloric acid (HCL) and intrinsic factor. These cells are located in the gastric glands found in the lining of the fundus and in the body of the stomach.
Gastric carcinoids are classified into three different subgroups: Type I, Type II, and Type III (L. Vannella et al., 2011). Type I gastric carcinoids cause atrophic body gastritis (ABG), type II cause multiple endocrine neoplasia (Men-I), and type III has no specific back group disease (L. …show more content…
Vannella et al., 2011). Type I gastric carcinoids are 75% of all gastric carcinoids and occur in 1-2% of ABG patients (Delle Fave G. et al., 2012). Type I Gastric Carcinoids, are generally present in 77% of cases as multifocal polypoid mucosal protrusions (<10 mm) in the corpus and/or fundus of the stomach (G. Cadiot et al., 2010). 27% are limited to the mucosa, 64% only invading to the mucosa and/or submucosa and only 9% invading the muscularis propria (G. Cadiot et al., 2010). Type I gastric carcinoids are usually not invasive. The person usually has multiple carcinoids if type I is present, and they usually are well differentiated. Type I gastric carcinoids are asymptomatic. They are usually discovered during a routine upper gastrointestinal endoscopy for other indications such as anemia, nonspecific abdominal pain, or gastroesphageal reflux disease (GERD) (G. Cadiot et al., 2010). Physicians usually suggest numerous biopsies because there is an increased risk of gastric adenocarcinoma in type I patients (G. Cadiot et al., 2010). Abdominal ultrasound is recommended to search for liver metastases (cancerous tumors that have spread from somewhere else in the body) (G. Cadiot et al., 2010). Chronic atrophic gastritis (CAG) causes loss of appropriate glands in the body, which leads to achlorohydria and hypergastrinemia (L. Vanella et al., 2011). Research has been done to see if proton pump inhibitors cause gastric carcinoids. Gastric carcinoids account for 7% of gastrointestinal carcinoids (Hodgson et al., 2005). Proton pump inhibitors (PPIs) are used with hypergastrinema, gastric enterochromaffin-like (ECL) cell hyperplasia, and the development of gastric carcinoids (Hodgson et al., 2005). PPIs limit the amount of stomach acid produced by the glands in the lining of the stomach (Hodgson et al., 2005). So, researchers believe PPIs could be causing more harm than good. Methods University of Sapienza has a medical doctor by the name of Gianfranco Delle Fave, who has been studying carcinoid tumors (L. Vannella et al., 2011). Dr. Fave and several others did a study to determine if patients with chronic atrophic gastritis (CAG developed type I gastric carcinoids. The study diagnosed 367 patients with CAG between 1992 and 2008 (245 women, median age 54 years, range 18-79 years) (L. Vannella et al., 2011). CAG patients underwent gastroscopy with biopsies and those with proven histological diagnosis of CAG were informed about the increased risk of gastric neoplasia associated with CAG and about the need for regular follow-up by gastroscopy (L. Vannella et al., 2011). During the study 102 patients dropped-out because four patients died from causes not related to CAG and 98 patients refused to participate in farther follow-up (L. Vannella et at., 2011). After, all of …show more content…
Type I Gastric Carcinoids, 9 out of 367 (2.4%) patients [six women, median age 59 (range 40-72) years] were diagnosed with type I gastric carcinoids at the initial diagnosis of CAG (L. Vannella et al., 2011). The chart shows that all patients besides one had polys of the body with a diameter between 0.3 and 3 cm at gastroscopy (L. Vannella et al., 2011). In six out of nine (66.7%) patients with type I gastric carcinoids, the body gastric mucosa presented a severe atrophy, in the remaining cases the atrophy was moderate (L. Vannella et al., 2011). 40% of the patients had a recurrence rate.
Patients Gender Age (years) Gastrin (pg/mL) CgA (ng/mL) Body atrophy* Pernicious anaemia Endoscopic findings Detection of typeIGC Recurrence
1. * Scored accordingly to the Sydney System. 1 F 45 305 60 2 No Body polyp of 0.5 cm At diagnosis
Gastric carcinoids are classified into three different subgroups: Type I, Type II, and Type III (L. Vannella et al., 2011). Type I gastric carcinoids cause atrophic body gastritis (ABG), type II cause multiple endocrine neoplasia (Men-I), and type III has no specific back group disease (L. …show more content…
Vannella et al., 2011). Type I gastric carcinoids are 75% of all gastric carcinoids and occur in 1-2% of ABG patients (Delle Fave G. et al., 2012). Type I Gastric Carcinoids, are generally present in 77% of cases as multifocal polypoid mucosal protrusions (<10 mm) in the corpus and/or fundus of the stomach (G. Cadiot et al., 2010). 27% are limited to the mucosa, 64% only invading to the mucosa and/or submucosa and only 9% invading the muscularis propria (G. Cadiot et al., 2010). Type I gastric carcinoids are usually not invasive. The person usually has multiple carcinoids if type I is present, and they usually are well differentiated. Type I gastric carcinoids are asymptomatic. They are usually discovered during a routine upper gastrointestinal endoscopy for other indications such as anemia, nonspecific abdominal pain, or gastroesphageal reflux disease (GERD) (G. Cadiot et al., 2010). Physicians usually suggest numerous biopsies because there is an increased risk of gastric adenocarcinoma in type I patients (G. Cadiot et al., 2010). Abdominal ultrasound is recommended to search for liver metastases (cancerous tumors that have spread from somewhere else in the body) (G. Cadiot et al., 2010). Chronic atrophic gastritis (CAG) causes loss of appropriate glands in the body, which leads to achlorohydria and hypergastrinemia (L. Vanella et al., 2011). Research has been done to see if proton pump inhibitors cause gastric carcinoids. Gastric carcinoids account for 7% of gastrointestinal carcinoids (Hodgson et al., 2005). Proton pump inhibitors (PPIs) are used with hypergastrinema, gastric enterochromaffin-like (ECL) cell hyperplasia, and the development of gastric carcinoids (Hodgson et al., 2005). PPIs limit the amount of stomach acid produced by the glands in the lining of the stomach (Hodgson et al., 2005). So, researchers believe PPIs could be causing more harm than good. Methods University of Sapienza has a medical doctor by the name of Gianfranco Delle Fave, who has been studying carcinoid tumors (L. Vannella et al., 2011). Dr. Fave and several others did a study to determine if patients with chronic atrophic gastritis (CAG developed type I gastric carcinoids. The study diagnosed 367 patients with CAG between 1992 and 2008 (245 women, median age 54 years, range 18-79 years) (L. Vannella et al., 2011). CAG patients underwent gastroscopy with biopsies and those with proven histological diagnosis of CAG were informed about the increased risk of gastric neoplasia associated with CAG and about the need for regular follow-up by gastroscopy (L. Vannella et al., 2011). During the study 102 patients dropped-out because four patients died from causes not related to CAG and 98 patients refused to participate in farther follow-up (L. Vannella et at., 2011). After, all of …show more content…
Type I Gastric Carcinoids, 9 out of 367 (2.4%) patients [six women, median age 59 (range 40-72) years] were diagnosed with type I gastric carcinoids at the initial diagnosis of CAG (L. Vannella et al., 2011). The chart shows that all patients besides one had polys of the body with a diameter between 0.3 and 3 cm at gastroscopy (L. Vannella et al., 2011). In six out of nine (66.7%) patients with type I gastric carcinoids, the body gastric mucosa presented a severe atrophy, in the remaining cases the atrophy was moderate (L. Vannella et al., 2011). 40% of the patients had a recurrence rate.
Patients Gender Age (years) Gastrin (pg/mL) CgA (ng/mL) Body atrophy* Pernicious anaemia Endoscopic findings Detection of typeIGC Recurrence
1. * Scored accordingly to the Sydney System. 1 F 45 305 60 2 No Body polyp of 0.5 cm At diagnosis