Tu1503 ENDOSCOPIC AND HISTOLOGICAL CHARACTERISTICS OF NEW GASTRIC FINDINGS THAT APPEARED WITH STRONG ACID SECRETION SUPPRESSOR (P-CAB).

Abstract

Since the number of H.pylori-infected persons decreases rapidly, it is expected that acid-related diseases will continue to increase in Japan. The need for gastric acid secretion suppressors is expected to increase in the future. There are several known gastric findings associated with the use of conventional proton pump inhibitors (PPIs). However, there are no reports of gastric findings associated with the use of potassium competitive acid blocker (P-CAB) a more potent gastric acid secretion suppressor. This time we found a new gastric finding associated with the use of P-CAB. This gastric finding is white granular findings with slight elevation similar the White Glove Appearance (WGA) which is known as gastric cancer cases. Since we named this finding White Granule with Small Elevation (WGSE), we introduce WGSE of this finding with endoscopic and histological analysis. <Case 1> A 57-year-old woman was given esomeprazole (EPZ) 20 mg / day and steroid for eosinophilic gastroenteritis. When esomeprazole was changed to Vonoprazan (VPZ) 20 mg / day because erosive gastritis was apparent by endoscopy, WGSE was observed in the gastric fundic gland area. WGSE worsened with continuing VPZ and the dose was reduced to 10 mg / day. Then WGSE gradually decreased and finally disappeared when medicine was changed to famotidine 40 mg / day. <Case 2> A 75-year-old woman was started on VPZ 20 mg for severe reflux esophagitis and maintenance therapy was performed at 10 mg / day. WGSE was observed in the gastric fundic gland area. The change to EPZ 20mg / day is being considered if symptoms are stable in the future. The WGSE histological findings were so similar the WGA observed in gastric cancer cases. Its characteristic finding showed a cystic dilated duct with accumulated gastric secretions. It could be detected WGSE under only continuous P-CAB use, not observed when using PPI. In addition, WGSE decreased with tapering of P–CAB. WGSE were completely disappeared with the change to H2 receptor antagonist. Therefore, we consider that WGSE is to be a specific change with continued use of P-CAB. Previous reports have said that WGA is sometimes observed in autoimmune gastritis with hypergastrinemia, so we have been believed that hypergastrinemia due to strong gastric acid suppression is the most important cause of WGSE. The highest serum gastrin levels of our cases were 1,750 pg/ml and 4,500 pg/ml, those were markedly high level. Although hypergastrinemia occurs with continued PPI use too, no WGSE has been reported. In other words, it is thought to be a gastric finding peculiar to continued use of P-CAB with severe hypergastrinemia. When using P-CAB in the future, it is necessary to pay attention to the appearance of WGSE. Our study found WGSE, the first stomach finding that was especially apparent when using P-CAB.View Large Image Figure ViewerDownload Hi-res image Download (PPT)