{"type":"rich","version":"1.0","provider_name":"Transistor","provider_url":"https://transistor.fm","author_name":"Board Pearls","title":"Chapter 7, Ep 1 of 2: Atrophic Correa ZES","html":"<iframe width=\"100%\" height=\"180\" frameborder=\"no\" scrolling=\"no\" seamless src=\"https://share.transistor.fm/e/20580f37\"></iframe>","width":"100%","height":180,"duration":889,"description":"Covers the chronic gastritides and precursor lesions of the stomach for boards, unified by what each disease does to gastrin. Teaches autoimmune atrophic gastritis, the H. pylori Correa cascade toward intestinal-type cancer, Menetrier disease, and Zollinger-Ellison syndrome. Emphasizes the two high-yield differentials: high gastrin sorted by gastric pH, and giant gastric folds sorted by acid output and biopsy.\n \nTopics covered\n\nAutoimmune atrophic gastritis\nB12 and iron deficiency\nType 1 gastric neuroendocrine tumors\nH. pylori Correa cascade\nIntestinal metaplasia staging and surveillance\nMenetrier disease\nZollinger-Ellison syndrome\nMEN1 and gastrinoma triangle\n \n \nKey decisions\n\nAutoimmune atrophic gastritis destroys body/fundus parietal cells with antral sparing, causing achlorhydria, failed B12 and iron absorption, and reflex hypergastrinemia driving ECL hyperplasia into type 1 NETs.\nNever give folate for unexplained macrocytic anemia without checking B12; folate corrects the anemia while dorsal column and corticospinal neurologic disease keeps progressing.\nHigh gastrin sorts on gastric pH: pH under 2 with gastrin over 1000 is gastrinoma; gastrin over 1000 with pH above 2 is atrophic gastritis. Intermediate gastrin (100 to 1000) needs secretin, positive being a paradoxical rise over 120 within 10 to 15 minutes.\nGiant gastric folds sort on acid and protein: Menetrier is low acid with protein loss (foveolar hyperplasia via EGFR, treat with anti-EGFR antibody); ZES is high acid without protein loss; lymphoma and linitis-plastica adenocarcinoma need deep biopsy.\nEradicate H. pylori at every cascade stage, but eradication lowers risk without erasing it once metaplasia appears; high-stage atrophy/metaplasia gets surveillance endoscopy about every 3 years, escalated by ancestry, first-degree relative, incomplete-type metaplasia, and both-region involvement.\nIn MEN1 gastrinoma (multiple, duodenal, rarely cured surgically), treat hyperparathyroidism first with...","thumbnail_url":"https://img.transistorcdn.com/-FuAdDBcPDLhEoUmroZKtOBRvuBn_FHPpYlh41hOnU4/rs:fill:0:0:1/w:400/h:400/q:60/mb:500000/aHR0cHM6Ly9pbWct/dXBsb2FkLXByb2R1/Y3Rpb24udHJhbnNp/c3Rvci5mbS9iNzlh/ZTU4Y2MzNWExMjQ5/MjA5OWMwMmI3ZTk5/NGFiZS5wbmc.webp","thumbnail_width":300,"thumbnail_height":300}