If you don't consider this, you will miss it!

This is the stomach of a middle aged lady undergoing gastroscopy because of anaemia. 
WHAT IS THE DIAGNOSIS?

a) HP associated gastritis

This is beyond gastritis! The fundal mucosa is pale and atrophic rather than red and inflammed!

b) Atrophic gastritis

The fundal mucosa does appear atrophic apart from a few scattered red patches which is all that remains of the normal gastric lining. But how about the antrum?

c) Autoimmune gastritis

Correct!

D) Coeliac disease

That duodenal mucosa is unremarkable. The 'polyp' in the 3 o'clock position is obviously the duodenal papilla.

Explanation

Those red spots in the gastric fundus is what remains of the more normal gastric mucosa whilst most of the surrounding mucosa is atrophic. In contrast, the antrum is unremarkable, as is the duodenum.  This is an example of a 'body predominant' gastritis and your endoscopic diagnosis should be an autoimmune gastritis!   The antral G-cells, found deep within the antral pyloric glands are pumping out huge amounts of gastric which is leading to ECL cell hyperplasia and multiple small NET's.   In fact, most patients with type I gastric carcinoids have an autoimmune gastritis!  The anaemia was due to vitamin B12 deficiency.  ​