The Effects of Proton Pump Inhibitors on the Oxyntic Mucosa Can Only Be Reliably Assessed in the Absence of Helicobacter Infection
Kirthi R Kumar, Ramiz Iqbal, Elizabeth Coss, Christina Park, Byron Cryer, Robert M Genta. UT Southwestern Medical School, Dallas, TX; Dallas VAMC, Dallas, TX; Dallas VA Medical Center, Dallas, TX; Miraca Life Sciences Research Institute, Irving, TX
Background: During proton pump inhibitor (PPI) therapy oxyntic glands may become unevenly dilated and acquire a ragged lining with protruding parietal cells. Although such changes are often referred to as PPI-effects, little evidence supports the accuracy of this designation. This study was designed to evaluate the strength of the association between parietal cell protrusions, dilated oxyntic glands, and use of PPIs and Histamine2-receptor blockers (H2-B).
Design: Topographically defined biopsies (2 each from corpus and antrum, and 1 from transitional zone) were obtained from patients recruited into a novel therapeutic trial for H. pylori. History of PPI and H2-B use was collected. Two blinded pathologists used a scale of 0 to 3 to grade the intensity of putative PPI effects on the oxyntic mucosa. PPI and H2-B use were then disclosed and the accuracy of pathologists' assessment was evaluated.
Results: Of 236 patients studied, 97 had H. pylori gastritis (median age 65 years; 89% men; 57% PPI users) and 139 did not (median age 66 years; 90% men; 81% PPI users). Table 1 shows the correlation between the pathologists' assessment and actual PPI use. Use of H2-B (data not shown) had no detectable effect on the oxyntic glands.
|H. pylori-negative (n = 139)||H. pylori-positive (n = 97)|
|PPI-effect grade||PPI use documented||% correct||PPI-effect grade||PPI use documented||% correct|
|0 (n = 37 )||25||32.4||0 (n = 22)||14||36.4|
|1 (n = 61)||52||85.2||1 (n = 54)||29||53.7|
|2 (n = 29)||25||86.2||2 (n = 15)||9||60.0|
|3 (n = 12)||11||91.7||3 (n = 6)||3||50.0|