Tariq Parvez.
Gastric carcinoma: Post H. Pylori Gastritis.
J Coll Physicians Surg Pak Jan ;10(4):146-8.

Mrs. N suffered from pain in epigastrium, indigestion, belching and bloating after diarrhea of one-week duration, almost nine months back. On initial and repeated endoscopies, Helicobacter pylori associated gastritis changes were noted. She was treated but there was no relief, on further investigations she was ultimately diagnosed as a case of adenocarcinoma of stomach with metastasis in the liver. Palliative gastric content drainage procedure (surgical) was performed and chemotherapy planned to improve her overall survival. H. pylori infections have recently been inducted for causing a high incidence of gastric cancer. Suspicion of malignancy in any case suffering from H. pylori infections particularly not being relieved by targeted treatment must be kept in mind to avoid such bad happenings.

Case Report: Mrs. N suffered from acute diarrhea for one week in January 1999 and got relieved after taking medication. In February,1999 she developed pain in epigastrium, indigestion, belching and bloating just after taking meals. On February 18, 1999 endoscopy was done which revealed ulcers and narrowing of the pyloric lumen. Biopsies were taken for laboratory investigations which showed Helicobacter pylori associated with mild active chronic gastritis of pyloric antrum. She was placed on antimicrobial drugs and got temporary relief by these medications. She developed this trouble again and underwent second endoscopy on March 17, 1999. The laboratory investigations on the clinical material collected through re-endoscopy and biopsy showed a similar report again. She was placed on medicines and again only temporary relief by medication was achieved. She developed recurrent attack of epigastric pain for which third time endoscopy and biopsies were repeated on April 29, 1999.Report of biopsy from the laboratory indicated it as chronic gastritis. Medicines were continued but no relief was seen rather the symptoms aggravated in the patient. Therefore, barium meal was done on September 28, 1999 which showed distended stomach with poor emptying and no filling defect. However, there was an obstruction near the pyloric end hence gastroscopy was advised by the radiologists. Endoscopy was once again repeated on October 11,1999 for the fourth time which showed an irregular friable growth in the antrum near pylorus, pyloric opening was deformed, endoscope was passed with difficulty and biopsies taken were sent for laboratory investigations. This time laboratory report was highly suggestive of adenocarcinoma of stomach that was of signet ring type. Ultrasound was done on October 18,1999,Blood tests for PT and APTT showed raised levels. However, the values of liver function test were within normal limits.

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