[673] 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 gradePPI use documented% correctPPI-effect gradePPI use documented% correct
0 (n = 37 )2532.40 (n = 22)1436.4
1 (n = 61)5285.21 (n = 54)2953.7
2 (n = 29)2586.22 (n = 15)960.0
3 (n = 12)1191.73 (n = 6)350.0

Conclusions: In H. pylori-negative subjects, oxyntic gland dilatations and parietal cell protrusions are strongly related to documented PPI use. No such changes are associated with H2-B therapy. In contrast, in H. pylori gastritis so-called PPI-effects were equally prevalent in PPI-users and non-users, suggesting that other factors other than these medications are involved in the induction of oxyntic cell hyperplasia (Krishnamurthy & Dayal, Hum Pathol, 1997). Therefore, pathologists should refrain from diagnosing "PPI-effects" in H. pylori-infected patients. Furthermore, since this piece of diagnostic information is of little use to the clinician, we suggest that comments regarding the supposed evidence of PPI use should be avoided in the diagnosis of all gastric biopsy specimens.
Category: Gastrointestinal

Monday, March 4, 2013 9:30 AM

Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 103, Monday Morning


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