Proton Pump Inhibitor-Related Gastric Mucosal Changes

Abstract

Proton pump inhibitors (PPIs) are used worldwide to treat of acid-related disorders such as peptic ulcer and gastroesophageal reflux disease and to prevent gastroduodenal injuries due to nonsteroidal anti-inflammatory drugs. PPIs are the most potent inhibitors of gastric acid secretion currently available, and they are one of the most commonly prescribed classes of drugs because of their high efficacy and low toxicity. However, long-term PPI use causes histopathological changes such as parietal cell protrusion into the gland lumen, cystic dilation of gastric fundic glands, and foveolar epithelial hyperplasia. These changes can manifest on endoscopic examination as fundic gland polyps, hyperplastic polyps, multiple white and flat elevated lesions, cobblestonelike mucosa, or black spots. Clinicians must be aware of PPIinduced endoscopic features in patients with chronic longterm PPI use. Conversely, identifying patients with long-term PPI use based on their endoscopic findings is important. Recently, potassium-competitive acid blockers (P-CABs), a new class of acid suppressants that inhibit gastric acid secretion more strongly than PPIs, have recently been introduced clinically. Further long-term prospective studies on these gastric mucosal lesions in patients with either PPI or P-CAB use are required to investigate their association with histopathological changes and to establish the clinical significance of these findings.

Proton Pump Inhibitor-Associated Large Hyperplastic Polyp in Non-<b><i>Helicobacter pylori</i></b>-Infected Stomach

“…Suppression of gastric acid secretion by long-term PPI administration has been reported to increase serum gastrin levels [ 12 ], causing histopathological changes, such as parietal cell protrusions and dilated oxyntic glands [ 13 ]. In addition, it is speculated that hypergastrinemia causes HPs due to hyperplasia of the gastric foveolar epithelium [ 14 ]. In the present case, after 14 years of PPI therapy, there was not only evidence of hypergastrinemia (gastrin, 1,060 pg/mL) but a histological examination also revealed parietal cell protrusions and dilated oxyntic glands, which appeared to support the hypothesis that this case constituted one of PPI-associated HPs.…”

Efficacy and Safety of Rebamipide versus Its New Formulation, AD-203, in Patients with Erosive Gastritis: A Randomized, Double-Blind, Active Control, Noninferiority, Multicenter, Phase 3 Study

“…3 In addition, PPIs have several adverse effects in the stomach, such as oxyntic cell and enterochromaffin-like cell hyperplasia and the occurrence of hyperplastic and fundic gland polyps due to hypergastrinemia. [4][5][6] Furthermore, some studies have suggested that long-term PPI use might affect the progression of atrophic gastritis and the development of gastric cancer. 7,8 To overcome these limitations, gastric mucoprotective agents are frequently used alone or in combination with acid-suppressing agents.…”

Gastric NET Subtypes: Do We Need An Additional One?

“…Only 7 weeks after having withdrawn PPIs, an impressive picture of previously numerous fundic glands had changed significantly. Although there has been some debate on the impact of PPI on fundal gland polyp development [9], recent meta-analyses have concluded an association between long-term (> 12 months) use of PPI and fundic gland polyps [10,11]; our case adds a convincing example to this association.…”