To the Editor.
—A 70-year-old white woman was referred to me by her family physician for endoscopy of her upper gastrointestinal tract because of a positive Helicobacter pylori blood test and persistent mild epigastric discomfort. At endoscopy, I discovered antral gastritis and abnormal fundal mucosa, which was positive for mucosa-associated lymphoid tissue (MALT). Antral biopsies were positive for H pylori and gastritis. Subsequently, the patient was treated with amoxicillin and omeprazole; the endoscopy repeated 8 weeks later revealed persistent MALT-positive fundal mucosa, but no H pylori. She was re-treated for H pylori with tetracycline, metronidazole, and bismuth for 3 more weeks. Four weeks later, repeat endoscopy revealed no change in the MALT-positive fundal mucosa and no H pylori. Three months later, she underwent endoscopy again with the same result and is now being assessed for possible chemotherapy, radiation therapy, or both. I believe this patient may confirm the suspicion of