Abstract
Acid secretion inhibitors, such as proton pump inhibitors (PPIs) and potassium competitive acid blockers (PCABs), are used to treat ulcers after endoscopic submucosal dissection (ESD) for early gastric cancer. These drugs can influence serum gastrin and pepsinogen (PG) levels; however, their definite effects remain unclear. This open-label, randomized study investigated the effect of acid secretion inhibitors on the serum gastrin and pepsinogen levels. In total, 76 patients were enrolled in the study. They underwent gastric ESD and received a PPI (n = 21) or PCAB (n = 55). Changes in the serum gastrin and PG levels before and 4 weeks after administration were examined. Patient factors associated with the alteration of serum PG or gastrin levels were identified. The median serum levels of gastrin, PGI, and PGII before the administration of the acid secretion inhibitors were 110.5 pg/mL, 36.4 ng/mL, and 8.9 ng/mL, respectively; after administration, the levels increased to 300 pg/mL, 64.7 ng/mL, and 15.8 ng/mL, respectively (P < 0.01). Univariate analysis revealed that PCABs led to a more significant increase in the serum gastrin and PG levels as compared to PPIs. Furthermore, the PG levels were significantly increased in patients with previous Helicobacter pylori infections than in those with current infections. In conclusion, the serum gastrin and PG levels increased after the use of acid secretion inhibitors. This elevation was affected by the type of drug used, whereas the elevation in PGs was affected by the patient's background as well.
Highlights
Endoscopic submucosal dissection (ESD) for gastric cancer is a minimally invasive and highly curative treatment that has gained popularity globally
We have previously reported that the PGI/PGII ratio and serum gastrin level are associated with the Helicobacter pylori (H. pylori) infection status [11] and that the risk of gastric cancer can be determined by measuring the PGI level and the PGI/ II ratio [12]
We have investigated the increase in the serum gastrin and PG levels after pump inhibitors (PPIs) or potassium competitive acid blockers (PCABs) administration and the factors related to the increase
Summary
Endoscopic submucosal dissection (ESD) for gastric cancer is a minimally invasive and highly curative treatment that has gained popularity globally. Bleeding from stomach ulcers (artificial ulcers) created following excision of the lesion has been a complication linked with ESD [1]. For the treatment of ESD-induced stomach ulcers, proton pump inhibitors (PPIs) have been routinely employed [2, 3]. A new potassium competitive acid blocker (PCAB), vonoprazan, was reported to have a higher treatment potential for acid-related diseases (including artificial ulcers after ESD) than conventional agents [4]. In Japan, PPIs and PCABs have been shown to be the preferred drugs in the treatment of the increasing number of patients with gastroesophageal reflux disease [5, 6]
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