Gastric Mucosal Calcinosis in a Patient with Abdominal Pain

Abstract

Purpose: Background: Calcification of the gastric mucosa (gastric mucosal calcinosis) is a rare condition and is usually found incidentally on upper endoscopy. It is most frequently associated with conditions which cause hyperphosphatemia and hypercalcemia. In patients with chronic renal disease, it may be representative of impending systemic calcinosis. We herein report a case of gastric mucosal calcinosis in an otherwise healthy patient with abdominal pain. To our knowledge, such a presentation has not been described. Case Description: A 33 year-old female with no significant past medical history was referred for outpatient evaluation of worsening post-prandial epigastric pain of several months duration. She had intermittent headaches for which she used intermittent Excedrin®. Her only other medication was an oral contraceptive pill daily; no calcium-containing products. Physical Examination was notable for minimal epigastric tenderness but otherwise was unremarkable. Recent hepatic panel and serum chemistries (including calcium and phosphate) were normal. Upper endoscopy was significant for diffuse linear whitish plaques in the gastric antrum which did not wash off. Biopsy of these areas revealed gastric mucosal calcification and marked reactive changes. No Helicobacter pylori, inflammation, or metaplasia were seen. Stains for Congo red and PAS were additionally negative. Discussion: Gastric mucosal calcinosis is an extremely uncommon condition with a reported incidence of less than 0.1%. It has been described in association with chronic renal disease, hyperparathyroidism, gastric cancer, solid organ transplant recipients, and aluminum-containing antacids and sucralfate. Gastric mucosal calcinosis has been classified as metastatic, dystrophic, or idiopathic. In metastatic calcification, elevated serum calcium and phosphate lead to calcium salt deposition in normal gastric mucosa. Other organs including the lungs, kidneys and heart can also be affected. Multiple myeloma, tumor lysis syndrome, hyperparathyroidism, end-stage renal disease, and hypervitaminosis D are associated with this pattern. In dystrophic calcification, serum electrolytes are normal and calcium salt deposition occurs in damaged or inflamed gastric tissue. Peptic ulcer disease and malignancy are examples of associated conditions. The precise significance of gastric mucosal calcinosis in association with other diseases is unclear. Our patient was placed on omeprazole 20 mg daily and reported improved symptoms at follow-up.