Multiple White and Flat Elevated Lesions Observed in the Stomach: A Prospective Study of Clinical Characteristics and Risk Factors

Abstract

Objective Multiple white and flat elevated lesions (MWFLs) observed in the stomach have only been presented in abstracts at academic conferences over the last decade; therefore, relatively little is known about these lesions. Our aim was to prospectively clarify the clinical characteristics of MWFLs, to identify their risk factors and to retrospectively evaluate the clinical progression of these lesions. Methods A prospective analysis of clinical characteristics and risk factors was conducted in participants who underwent esophagogastroduodenoscopic screening at our hospital. A retrospective analysis of the medical chart of patients identified as having MWFLs was conducted to describe the clinical progression of these lesions. Results The prevalence rate of MWFLs was 10.4% (80/767), with the following risk factors identified on a logistic regression analysis: use of proton pump inhibitors [odds ratio (OR), 3.51; 95% confidence interval (CI), 1.92-6.43], female sex (OR, 1.92; 95% CI, 1.19-3.12) and a 1-year increase in age (OR, 1.05; 95% CI, 1.02-1.08). Among the 70 cases with MWFLs observed over a mean duration of 2.3 years, no progression of MWFLs was detected in 67 cases (96%). Among the 3 remaining cases, progression was mild, with none of the lesions progressing to malignancy. Conclusion The use of proton pump inhibitors (PPIs), female sex, and age are risk factors for MWFLs. We believe that endoscopists should recognize these lesions.

Changes in gastric morphology during long-term use of vonoprazan compared to proton pump inhibitors

“…(6) An association between the presence of multiple white elevated lesions and PPI use has been reported. (5,6,15) The high frequency of female gender and advanced age in patients with the morphological changes in the present study is consistent with previous Japanese studies. (5,9,15) Among healthy individuals, postprandial gastrin levels in women are two-to three-fold higher than in men.…”

“…(5,6,15) The high frequency of female gender and advanced age in patients with the morphological changes in the present study is consistent with previous Japanese studies. (5,9,15) Among healthy individuals, postprandial gastrin levels in women are two-to three-fold higher than in men. (16) During GERD therapy with PPIs, women also have higher gastrin levels compared to men.…”

Proton Pump Inhibitor-Related Gastric Mucosal Changes

“… 10 , 33 In observational studies, multiple white and flat elevated lesions were found to be significantly associated with PPI use (OR, 3.58; 95% CI, 1.94 to 6.61), H. pylori eradication therapy (OR, 2.11; 95% CI, 1.08 to 4.11), female sex (OR, 1.92; 95% CI, 1.19 to 3.12), aging (OR, 1.05; 95% CI, 1.02 to 1.08), and moderate to severe atrophic gastritis (OR, 2.63; 95% CI, 1.52 to 5.63). 12 , 33 - 35 These lesions are also related with administration of histamine receptor antagonists and H. pylori eradication, and are therefore not uniquely associated with chronic PPI use. Furthermore, these lesions can be misdiagnosed as intestinal metaplasia.…”

The endoscopic predictors of Helicobacter pylori status: a meta-analysis of diagnostic performance

“…Other findings are less well understood, such as the presence of ‘WFELs’ which are observed in the fundus of an H pylori- naïve and H pylori -eradicated stomach, although are of uncertain clinical significance. 49 The included studies make reference to WFELs but did not include data to analyse their significance. Similarly, it was not possible to provide new diagnostic accuracy calculations for the findings of gastric hyperplastic polyps or xanthomas because of paucity of data.…”

“…Gastric erosions 9.0 (4.9-15.9) 93.4 (83.6-97. significance. 49 The included studies make reference to WFELs but did not include data to analyse their significance. Similarly, it was not possible to provide new diagnostic accuracy calculations for the findings of gastric hyperplastic polyps or xanthomas because of paucity of data.…”