The risk of gastric carcinoma and carcinoid tumours in patients with pernicious anaemia. A prospective follow-up study.

BACKGROUND This endoscopic follow-up study was undertaken to evaluate the risk of gastric cancer (GC) and carcinoids in patients with pernicious anaemia (PA) and to analyse whether early detection of GC could be provided by regular endoscopic follow-up. METHODS Screening gastroscopy was performed in 71 patients with pernicious anaemia, and thereafter they were followed up with gastroscopies at 3-year intervals for a mean time of 5.8 years. Standardized incidence ratios (SIR) were calculated, the expected number being based on incidence rates in the whole Finnish population. RESULTS Two GCs were found during the follow-up period; one of these patients was asymptomatic and the other had abdominal symptoms. The SIR was 5.0 (95% confidence interval, 0.6-18). Eight carcinoids were detected, and all but one were removed endoscopically, and no metastases were found. The patients who had carcinoid tumours were younger at the diagnosis of PA than those who did not develop carcinoids (mean, 40 versus 55 years). Additionally, the patients with carcinoids had longer duration of PA (mean, 11 versus 5 years). CONCLUSIONS During the follow-up period the risk of GC was increased. The risk of gastric carcinoids seems to be very high in patients with pernicious anaemia when compared with a normal population, but they are mostly relatively benign tumours. Regular routine gastroscopic follow-up is not indicated in patients with pernicious anaemia.

[1]  J. Rehfeld,et al.  Basal chromogranin A and gastrin concentrations in circulation correlate to endocrine cell proliferation in type-A gastritis. , 1997, Scandinavian journal of gastroenterology.

[2]  J. Virtamo,et al.  Risk of gastric carcinoma in patients with mucosal dysplasia associated with atrophic gastritis: a follow up study. , 1996, Journal of clinical pathology.

[3]  A. Sandvik,et al.  Marked increase in gastric acid secretory capacity after omeprazole treatment. , 1996, Gut.

[4]  A. West,et al.  Gastric carcinoid tumors: the biology and therapy of an enigmatic and controversial lesion. , 1995, The American journal of gastroenterology.

[5]  F. Sundler,et al.  Time-dependent changes in enterochromaffin-like cell kinetics in stomach of hypergastrinemic rats. , 1993, Gastroenterology.

[6]  O. Luinetti,et al.  Three subtypes of gastric argyrophil carcinoid and the gastric neuroendocrine carcinoma: a clinicopathologic study. , 1993, Gastroenterology.

[7]  L. Villani,et al.  Enterochromaffin-like (ECL) cells and their growths: relationships to gastrin, reduced acid secretion and gastritis. , 1993, Bailliere's clinical gastroenterology.

[8]  L. Hansson,et al.  Pernicious anemia and subsequent cancer. A population‐based cohort study , 1993, Cancer.

[9]  H. Järvinen,et al.  Gastroscopic follow up of pernicious anaemia patients. , 1993, Gut.

[10]  Y. Dayal.  Hyperplastic proliferations of the ECL cells. , 1992, The Yale journal of biology and medicine.

[11]  H. Waldum,et al.  Trophic effect of gastrin on the enterochromaffin like cells of the rat stomach: establishment of a dose response relationship. , 1992, Gut.

[12]  O. Cummings,et al.  Rapid regression of enterochromaffinlike cell gastric carcinoids in pernicious anemia after antrectomy. , 1992, Gastroenterology.

[13]  G. Mcentee,et al.  Primary gastric carcinoids: A view on management , 1990, The British journal of surgery.

[14]  F. Sundler,et al.  Enhanced hyperplasia of gastric enterochromaffinlike cells in response to omeprazole-evoked hypergastrinemia in rats with portacaval shunts. An immunocytochemical and chemical study. , 1990, Gastroenterology.

[15]  R. Hoover,et al.  Cancer risk following pernicious anaemia. , 1989, British Journal of Cancer.

[16]  P. Sipponen,et al.  Gastroscopic Screening for Gastric Carcinoids and Carcinoma in Pernicious Anemia , 1988, Endoscopy.

[17]  W. Creutzfeldt,et al.  Histopathological classification of nonantral gastric endocrine growths in man. , 1988, Digestion.

[18]  H. Järvinen,et al.  Gastric carcinoid tumours and atrophic gastritis. , 1987, Acta chirurgica Scandinavica.

[19]  A. Ost,et al.  Gastric carcinoid tumors: endoscopic removal or gastric resection? Case report. , 1986, Acta chirurgica Scandinavica.

[20]  H. Renvall,et al.  Relations between circulating gastrin and endocrine cell proliferation in the atrophic gastric fundic mucosa. , 1986, Scandinavian journal of gastroenterology.

[21]  N. Havu.  Enterochromaffin-like cell carcinoids of gastric mucosa in rats after life-long inhibition of gastric secretion. , 1986, Digestion.

[22]  L. Melton,et al.  Risk of development of gastric carcinoma in patients with pernicious anemia: a population-based study in Rochester, Minnesota. , 1985, Mayo Clinic proceedings.

[23]  P. Davies,et al.  MULTIFOCAL GASTRIC CARCINOID TUMOURS, ACHLORHYDRIA, AND HYPERGASTRINAEMIA , 1985, The Lancet.

[24]  H. Renvall,et al.  Gastric endocrine cell hyperplasia and carcinoid tumors in pernicious anemia. , 1985, Gastroenterology.

[25]  V. Go,et al.  The syndrome of gastric argyrophil carcinoid tumors and nonantral gastric atrophy. , 1983, Annals of internal medicine.

[26]  P. Cotton,et al.  Gastroscopic screening in 80 patients with pernicious anaemia. , 1983, Gut.

[27]  I. Samloff,et al.  Pepsinogens I and II: Purification from gastric mucosa and radioimmunoassay in serum , 1982 .

[28]  S. Eriksson,et al.  Pernicious anemia as a risk factor in gastric cancer. The extent of the problem. , 2009, Acta medica Scandinavica.

[29]  S. French,et al.  Kulchitsky cell hyperplasia and multiple metastasizing carcinoids of the stomach , 1981 .

[30]  L. Elsborg,et al.  Pernicious anaemia as a risk factor in gastric cancer. , 2009, Acta medica Scandinavica.

[31]  Z. Cope.  England's Oldest Hospital , 1963 .

[32]  J. Mosbech,et al.  Mortality from and Risk of Gastric Carcinoma Among Patients with Pernicious Anaemia* , 1950, British medical journal.