What is the diagnosis and treatment for pan gastric basal cell hyperplasia?

From the Guidelines

Pan gastric basal cell hyperplasia should be managed by addressing the underlying cause, which may include acid suppression therapy and Helicobacter pylori eradication, with regular follow-up endoscopies to monitor the condition and prevent potential progression to gastric cancer. This condition is characterized by excessive growth of basal cells throughout the entire stomach lining, often diagnosed through endoscopic biopsies and histological examination. Treatment typically involves acid suppression therapy with proton pump inhibitors (PPIs) such as omeprazole 20-40 mg daily or pantoprazole 40 mg daily for 8-12 weeks, as well as Helicobacter pylori eradication therapy consisting of a PPI plus two antibiotics (clarithromycin 500 mg and amoxicillin 1000 mg, all twice daily for 14 days) if H. pylori infection is present 1.

Key Considerations

• Regular follow-up endoscopies with biopsies are crucial to monitor the condition, typically at 6-12 month intervals initially, as this condition may be associated with an increased risk of developing gastric cancer in some cases.
• Patients should avoid gastric irritants such as NSAIDs, alcohol, and smoking.
• The condition results from chronic irritation of the gastric mucosa, leading to increased cell turnover and proliferation of the basal cell layer as a protective response.
• In some cases, this hyperplasia may be a precursor to more serious conditions, which is why ongoing monitoring is essential.

Management Approach

• All dysplasia should be confirmed by an experienced GI pathologist, and clinicians should refer patients with visible or nonvisible dysplasia to an endoscopist or center with expertise in the diagnosis and management of gastric neoplasia 1.
• Individuals with indefinite or low-grade dysplasia who are infected with H. pylori should be treated and have eradication confirmed, followed by repeat endoscopy and biopsies by an experienced endoscopist, as visual and histologic discernment may improve once inflammation subsides 1.
• Endoscopic resection is both diagnostic and therapeutic, and should be considered for patients with endoscopically visible dysplasia, with the goal of en bloc, R0 resection to enable accurate pathologic staging with the possibility of curative intent 1.

From the Research

Pan Gastric Basal Cell Hyperplasia

• Basal cell hyperplasia is a condition where there is an increase in the number of basal cells in the epithelium of the esophagus or stomach.
• The severity of basal cell hyperplasia can vary, with some studies defining it as normal (< or = 25% of esophageal epithelial height), mild (26%-50%), moderate (51%-75%), or severe (> 75%) 2.
• Basal cell hyperplasia has been observed in patients with gastroesophageal reflux disease (GORD) and eosinophilic esophagitis, with the severity of hyperplasia being more pronounced in patients with eosinophilic esophagitis 2.
• In patients with GORD, basal cell hyperplasia has been shown to decrease in severity with treatment with proton pump inhibitors (PPIs) 3.
• The relationship between basal cell hyperplasia and gastric intestinal metaplasia (GIM) is not well established, although GIM is a precursor lesion to gastric cancer and has been associated with Helicobacter pylori infection 4.
• Primary gastrin cell hyperplasia is a distinct condition characterized by an increase in the number of G-cells in the gastric antrum, leading to basal hypergastrinemia and peptic ulcer disease 5.

Risk Factors and Associations

• Risk factors for basal cell hyperplasia include gastroesophageal reflux disease, eosinophilic esophagitis, and Helicobacter pylori infection 3, 2, 4.
• Basal cell hyperplasia has been associated with an increased risk of gastric cancer, although the exact relationship is not well established 4.
• Primary gastrin cell hyperplasia has been associated with peptic ulcer disease and basal hypergastrinemia 5.

Diagnosis and Treatment

• Diagnosis of basal cell hyperplasia typically involves endoscopy with biopsy and histological examination of the esophageal or gastric mucosa 3, 2.
• Treatment of basal cell hyperplasia depends on the underlying cause, with PPIs being effective in reducing the severity of hyperplasia in patients with GORD 3.
• Surveillance patterns for basal cell hyperplasia are not well established, although regular endoscopy with biopsy may be recommended for patients with a history of GIM or gastric cancer 4.