A 55-year-old woman with epigastric discomfort undergoes gastroscopy showing a thickened gastric fold. Biopsy reveals a marginal zone B-cell lymphoma of MALT type, H. pylori positive by rapid urease test. Staging shows disease confined to the gastric mucosa without nodal involvement or t(11;18) translocation. What is the most appropriate first-line treatment?
- A Radical gastrectomy
- B H. pylori eradication therapy ✓
- C CHOP chemotherapy with rituximab
- D Involved field radiotherapy
Correct answer: B. H. pylori eradication therapy
Explanation
Early-stage gastric MALT lymphoma depends on antigenic stimulation by H. pylori, so first-line therapy is standard eradication (a proton pump inhibitor with two antibiotics), which achieves complete regression in up to 70 to 80 percent of cases. The absence of t(11;18) predicts responsiveness because that translocation confers resistance to eradication. Surgery, chemotherapy and radiotherapy are reserved for eradication failures or advanced disease.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.