Gastric mucosal cracked and cobblestone-like changes resulting from proton pump inhibitor use

Objectives Use of proton pump inhibitors (PPIs) is histologically associated with oxyntic gland dilatations. Two interesting mucosal changes are often detected endoscopically in patients who use PPIs: gastric cracked mucosa (GCM) and gastric cobblestone-like mucosa (GCSM). The aim of this study was to clarify the relationship between PPI use and these mucosal changes. Methods This was a single-center observational study. All successive subjects who underwent a routine esophagogastroduodenoscopy (EGD) between August and November 2014 in Hokkaido University Hospital were enrolled. Endoscopists performed the assessment blinded to the use of PPIs and checked for GCSM and GCM using original diagnostic criteria for GCM and GCSM. Subjects were divided into two groups: those who used PPIs (the PPI group) and those who did not (the control group). Endoscopic findings and backgrounds were compared between the two groups. Results A total of 538 patients were analyzed (control group: 374 patients, men/women: 204/170, median age: 65.2 years; PPI group: 164 patients, men/women: 89/75, median age: 67.1 years). GCM was detected in 54 (10.0%) subjects, and GCSM was detected in 18 (3.3%) subjects. There was a significant difference in the prevalence rate of GCM between the control group (14/374, 3.7%) and the PPI group (40/164, 24.4%) (p < 0.01). GCSM was significantly more prevalent in the PPI group (15/164, 9.1%) than in the control group (3/374, 0.8%) (p < 0.01). Conclusions Novel GCM and GCSM endoscopic findings in the corpus area seem to be strongly associated with PPI use. This article is protected by copyright. All rights reserved.