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. Topics covered Autoimmune atrophic gastritis B12 and iron deficiency Type 1 gastric neuroendocrine tumors H. pylori Correa cascade Intestinal metaplasia staging and surveillance Menetrier disease Zollinger-Ellison syndrome MEN1 and gastrinoma triangle Key decisions Autoimmune 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. Never give folate for unexplained macrocytic anemia without checking B12; folate corrects the anemia while dorsal column and corticospinal neurologic disease keeps progressing. High 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. Giant 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. Eradicate 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. In MEN1 gastrinoma (multiple, duodenal, rarely cured surgically), treat hyperparathyroidism first with parathyroidectomy because lowering calcium reduces gastrin and acid; localize with DOTATATE PET, control acid to under about 10 mEq/hr. For the full chapter with MCQs, tables, and primary-guideline references, visit www.boardpearls.com. Questions or feedback: [email protected]. (00:00) - Introduction: gastrin ties it together (00:30) - Autoimmune atrophic gastritis: one anatomic lesion (02:56) - Endoscopy, biopsy, and serology (04:46) - The H. pylori cancer cascade (05:49) - Staging atrophy and metaplasia for surveillance (07:07) - Menetrier disease and giant folds (09:18) - Zollinger-Ellison syndrome

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