A 55-year-old man presents with persistent dyspepsia. Endoscopy reveals an ulcerated lesion in the gastric antrum. Biopsy shows low-grade B-cell lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma). H. pylori testing is positive. What is the most appropriate initial management?
- A Total gastrectomy with lymph node dissection
- B H. pylori eradication therapy with follow-up endoscopy ✓
- C Multiagent chemotherapy (CHOP regimen)
- D Radiation therapy to the gastric region
Correct answer: B. H. pylori eradication therapy with follow-up endoscopy
Explanation
Gastric MALT lymphoma is strongly associated with H. pylori infection. In early-stage disease, H. pylori eradication is first-line therapy, producing complete regression in approximately 75 to 80 percent of cases because the lymphoma is initially antigen-driven. Surgery, chemotherapy, and radiation are reserved for refractory disease, high-grade transformation, or advanced-stage lymphoma. Repeat endoscopy is essential to confirm histological remission after eradication.
Reference: Harrison's Principles of Internal Medicine, 20th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.