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Answer 3
  1. Antibiotic therapy directed against Helicobacter pylori. The most common gastric lymphoma is large B-cell lymphoma, which was formerly treated with gastrectomy until it became clear that aggressive combination chemotherapy with radiation therapy was the treatment of choice for stage I disease. However, this patient has a gastric MALToma, for which there is a high association with H. pylori. Although it may be counterintuitive to treat a malignancy with antibiotic therapy, that approach has been associated with remission rates higher than 70%, with many complete remissions becoming cures. Because this approach poses minimal toxicity, it is the initial treatment of choice.4 If a patient has disease outside the stomach, or if a patient fails to respond to therapy directed against H. pylori, the most appropriate therapy would be the combination chemotherapy used for low-grade lymphoma.

     Zucca E, Roggero E, Pileri S. B-cell lymphoma of MALT type: a review with special emphasis on diagnostic and management problems of low-grade gastric tumours. Br J Haematol 1998;100:3-14.

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