An Elevated Type of Gastric Ulcer Scar in Patients Treated with Cimetidine

Abstract

An elevated type of gastric ulcer scar (EUS) (A) was noted in 8 out of 227 ulcer patients treated with cimetidine. These were compared with 15 patients with EUS (B), not treated with cimetidine and the etiology of the lesion was discussed. The incidence of EUS (3.5%) and the average age of the patients were higher (61 years) in the A group than in the B group. The scar was seen all over the stomach in the A group. The period from detection of gastric ulcer to confirmation of EUS averaged 4 weeks, and there was no difference between the two groups. No difference was seen in the histological findings of elevated lesions either. In the A group, it appears that EUS was induced by rapid tissue regeneration due to the strong anti-ulcer effect of cimetidine in ulcer lesions, since it was noted in the regions where it had previously been considered unlikely to occur.

Large Hyperplastic Polyp Developing After Endoscopic Mucosal Resection of Gastric Adenoma in a Patient Receiving Immunosuppressive Therapy

“…In the case of gastric ulcers, this requires the reconstitution of epithelial structures and of the underlying connective tissue. A variety of growth factors and cytokines, especially epidermal growth factor, transforming growth factor‐alpha, basic fibroblast growth factor, and vascular endothelial growth factor, have been implicated in this process, as these are able to regulate important cellular functions, such as proliferation, migration, differentiation, secretion, and extracellular matrix degradation, all of which are essential for the tissue healing process 4 . Although gastric ulcers usually leave flat scars with or without converging folds, some leave elevated scars that are grossly indistinguishable from EGC type IIa, and which are histologically composed of hyperplastic pyloric glands with cyst‐like dilatation (i.e.…”

“…There are some reports that the use of an H2 receptor antagonist is related to the development of hyperplastic polyp in the process of ulcer healing, which might be through inducing rapid tissue regeneration 4 . Long‐term use of proton pump inhibitors may also be associated with the development of hyperplastic polyps 11 .…”

Endoscopic Ultrasonographic Evaluation of Gastric Ulcer Healing on Treatment with Proton Pump Inhibitors versus H2-Receptor Antagonists

“…Some clinical studies have shown that a PPI is more effective for treating gastric ulcers than H2-RA (3)(4)(5)(6). Elevated protrusions of the ulcer base have been observed more frequently in patients treated with a PPI than in those treated with Hz-RA (7)(8)(9), suggesting that H2-RAs and PPIs are associated with different healing processes.…”