Antacids may increase the appearance of white opaque substance in Helicobacter pylori-eradicated gastric epithelial neoplasia

Abstract

Background and study aims White opaque substance (WOS) in gastric epithelial neoplasia is helpful for qualitative diagnosis of neoplasia. We hypothesized that WOS of neoplasia is strongly influenced by acid recovery after Helicobacter pylori eradication, similar to that of gastric intestinal metaplasia. The aim of this study was to investigate whether antacids increase the appearance of the WOS in H. pylori-eradicated neoplasia. Patients and methods A total of 38 gastric epithelial neoplasias (12 adenomas and 26 adenocarcinomas) detected after H. pylori eradication were retrospectively evaluated. Presence or absence of WOS was evaluated by magnifying endoscopy with narrow band imaging before and after antacid administration. The pH of collected gastric juice was also measured. Study endpoints were (1) prevalence of WOS in the neoplasia before and after antacid administration, and the histological difference (adenoma and adenocarcinoma); and (2) relationship between the prevalence of WOS and gastric juice pH. Results WOS prevalence increased from 0 % (0/38) to 44.8% (17/38) after antacid administration. WOS prevalence in adenomas was more significantly increased compared to that in adenocarcinomas (83.3 % vs 26.9 %, P = 0.0077). Prevalence of WOS in gastric neoplasias was only observed at neutral levels of gastric juice pH, and WOS was not observed at strong acidic levels. Conclusions Antacid administration may increase the appearance of WOS in gastric epithelial neoplasia (especially adenomas) detected after H. pylori eradication with acid recovery.

Endoscopic finding of hematin represents strong gastric acidity

“…We have recently reported that qualitative diagnosis of gastric epithelial neoplasia detected after H. pylori eradication was difficult because of the effects of restoration of acid secretion [ 24 , 25 ]. In that report, we speculated that gastric neoplasms, especially intestinal-type adenomas, might be more strongly influenced by the recovered acidity and are unable to reveal their original characteristics, because we have more frequently experienced difficulty in the qualitative diagnosis of gastric adenomas detected after H. pylori eradication [ 24 , 25 ]. Therefore, if the presence of hematin predicts strong gastric acidity, we recommend reassessment after neutralizing gastric acid with PPI or potassium-competitive acid blocker for accurate diagnosis of gastric adenomas detected after H. pylori eradication [ 24 , 25 ].…”

“…In that report, we speculated that gastric neoplasms, especially intestinal-type adenomas, might be more strongly influenced by the recovered acidity and are unable to reveal their original characteristics, because we have more frequently experienced difficulty in the qualitative diagnosis of gastric adenomas detected after H. pylori eradication [ 24 , 25 ]. Therefore, if the presence of hematin predicts strong gastric acidity, we recommend reassessment after neutralizing gastric acid with PPI or potassium-competitive acid blocker for accurate diagnosis of gastric adenomas detected after H. pylori eradication [ 24 , 25 ]. Furthermore, we have recently clarified the clinical significance of the WOS, which signifies “absorbed lipid droplets” in intestinal metaplasia, and its limitations with respect to intragastric acid conditions [ 2 , 3 ].…”