Investigation of the Clinical Significance and Pathological Features of Lanthanum Deposition in the Gastric Mucosa

Abstract

Background: There are often specific endoscopic findings caused by deposition of lanthanum (La) in the gastric mucosa of patients taking lanthanum carbonate (LaC), a novel phosphate binder for patients on hemodialysis. We conducted a retrospective study to investigate the clinical significance of Ladeposition in the gastric mucosa, and the association between endoscopic features and histologic findings in the same population.Methods:We compared background factors in patients taking LaC with and without Ladeposition in their gastroscopic biopsy specimen. We also investigated the relationship between gastric endoscopic biopsy specimens with Ladeposition and the concurrent endoscopic images.Results:There was a significant difference in the total dose of LaC between the La-positive and La-negative groups(990 g [180–3150 g] vs. 480 g [225–1328 g]; p=0.013). In 27 biopsy specimens with specific whitish mucosa, 10 showed mild histiocytic infiltration and 17 showed strong infiltration. In contrast, among 24 specimens with non-whitishmucosa, five showed no histiocytic infiltration, 10 showed mild infiltration, and nine showed strong infiltration. There was a significant relationship between endoscopic features and the degree of histiocytic infiltration (p=0.026).Conclusions: We demonstrated that Ladeposition in the gastric mucosa depended on the total dose of LaC and was not affected by background factors. The specific endoscopic features of Ladeposition are associated with the infiltration of histiocytes, which represents the body’s normal response to foreign bodies.The protocol was registered in the University Hospital Medical Information Network Clinical Trial Registry (UMIN000038929).

Gastric lanthanosis (lanthanum deposition) in an immunosuppressed patient that discontinued lanthanum carbonate seven years ago

“…Lanthanum is likely to be resistible to intracellular digestion, so histiocytic activation with following tissue damage is conceivable. The endoscopic features show a significant relationship with the degree of histiocytic infiltration 34 . Hattori et al found that the histiocytic infiltration is specific for lanthanum deposition 8 …”