One more dysplasia

Gastric epithelial dysplasia is the earliest visible stage of neoplasia. Most histopathologists can recognize or at least suspect it, and a set of established clinical responses follow its detection. In contrast, proliferations and dysplastic changes of gastric endocrine cells are difficult to identify and generally neglected. Such changes are known to predispose to the development of carcinoid tumours and usually arise in patients with corpus-predominant atrophic gastritis and elevated gastrin levels. A report in this issue suggests that patients with dysplasia of the enterochromaffin-like cells have a much greater risk of developing carcinoid tumours than previously suspected. These carcinoids (known as type I) tend to have an indolent course, are almost never functional and have a favourable prognosis; nevertheless, they need to be detected and excised endoscopically. Because of the small numbers of patients in this series and the relatively short follow-up time of the study, it would be premature to issue guidelines on the long-term management of patients with atrophic gastritis and hypergastrinaemia. However, it is incumbent on clinical researchers with access to well-defined cohorts, such as the one studied here, to continue the follow-up studies that will lead to a more precise definition of risk and to the development of usable evidence-based clinical strategies.