Proton Pump Inhibitor Induction of Gastric Cobblestone-like Lesions in the Stomach

Abstract

Objective The long-term use of proton pump inhibitors (PPIs) may induce adverse events in many organs, including the stomach. The chronic use of PPIs has been associated with the growth of fundic gland polyps (FGPs) and of gastric black spots. This study assessed the incidence of gastric lesions with cobblestone-like appearance in PPI users. Methods The clinical characteristics and endoscopic findings of patients who underwent upper gastrointestinal endoscopy after using PPIs for at least six months were analyzed. The biopsy specimens from patients with gastric cobblestone-like lesions (GCLLs) were examined histopathologically. Patients This study analyzed 171 patients who underwent upper gastrointestinal endoscopy after more than 6 months of PPI use in Mitsugi Public General Hospital from January 1, 2015, to March 31, 2016. Results Of the 171 patients, 60 (35.1%) had GCLLs and 111 (64.9%) did not. There were no significant between-group differences in age, sex, duration of PPI use, and receipt of Helicobacter pylori eradication therapy. Atrophic gastritis of the corpus was significantly less frequent in the GCLL than in the non-GCLL group (55.0% vs. 47.8%, p=0.0097). Among the GCLL group, histological examinations of 24 patients revealed cystic dilation of the fundic gland in 19 (79.2%), parietal cell hyperplasia in 18 (75.0%), and cytoplasmic vacuolation in 7 (29.2%). Conclusion GCLLs occurred frequently in long-term PPI users, especially in patients without atrophic gastritis. The pathological findings of GCLLs included parietal cell hyperplasia and fundic gland cysts. The clinical importance of these new lesions remains uncertain, but they should be observed carefully.

Factors Associated with Gastric Black Spot, White Flat Elevated Mucosa, and Cobblestone-Like Mucosa: A Cross-Sectional Study

“…Parietal cell protrusions in the shallow mucosa could cause blockage of the isthmus, increasing resistance to outflow from the gland, leading to fundic gland cysts formation in the deeper zone of the mucosa [26]. The CLM has been pathologically characterized as parietal cell protrusions and fundic gland cysts [14, 15]. BSs have been known to be composed of brownish substances and eosinophilic materials in fundic gland cysts, which are thought to result from the accumulation of secretion from lining cells of fundic gland cysts (Fig.…”

“…We defined CLM as numerous uneven, flat, elevated mucosa like “cobblestones” in gastric corpus (Fig. 3a, b) [12, 14, 15]. We searched for the presence of these 3 findings for all objectives.…”

“…However, PPI use has been suggested as a cause of various endoscopic gastric mucosal changes, including the formation of fundic gland polyp (FGP) [8-10]. Recent case series have pointed out a possible relevance between PPI use and gastric black spot (BS), and some observational studies have shown that gastric white flat elevated mucosa (WFEM) and cobblestone-like mucosa (CLM) were also related to PPI use [11-15]. The possibility of the correlation between BSs and fundic gland type gastric adenocarcinoma was pointed out by a case series report [16].…”

“…Histological examination of the gastric mucosa of patients with CLM found parietal cell protrusion, cystic dilation of fundic gland, and cytoplasmic vacuolation [14, 15]. In cases with BSs, brownish pigmentations in fundic gland cysts were found in addition to these pathological findings [11].…”

Distribution of lanthanum carbonate in the gastric mucosa confirmed by electron microscopy with a magnified endoscopy: a case report and literature review

“…He underwent screening esophagogastroduodenoscopy (EGD), which revealed whitish cobblestone-like mucosa [18,19] in the gastric corpus ( Fig. 1a) and depressed red lesions surrounded by annular whitish mucosa in the antrum (Fig.…”