Factors Associated with Gastric Black Spot, White Flat Elevated Mucosa, and Cobblestone-Like Mucosa: A Cross-Sectional Study

Abstract

Background/Aims: Previous studies have reported a possible relevance between proton pump inhibitor (PPI) use and 3 new gastric mucosal changes: black spots (BSs), white flat elevated mucosa (WFEM), and cobblestone-like mucosa (CLM). The aim of this study was to investigate the association between these mucosal changes and multiple factors including PPI use. Methods: All subjects who underwent a routine esophagogastroduodenoscopy (EGD) were successively enrolled. Endoscopists carried out the EGD after being blinded about ­information on patient PPI usage and determined the presence of these mucosal changes. The ratio of each factor was ­compared in cases with and without each gastric finding. Results: Out of 1,214 patients, BSs were recognized in 75 (6.2%) cases, WFEM in 59 (4.9%), and CLM in 41 (3.4%). In logistic regression analysis, PPI use was significantly correlated with all of these findings (BSs: OR 2.94; 95% CI 1.66–5.21), (WFEM: OR 3.58; 95% CI 1.94–6.61), and (CLM: OR 4.57; 95% CI 2.34–9.96), and Helicobacter pylori eradication was related to BSs (OR 3.01; 95% CI 1.73–5.24) and WFEM (OR 2.11; 95% CI 1.08–4.11). Decision-tree analyses showed that H. pylori eradication was associated with all findings. Conclusions: All of the considered findings were correlated with PPI and H. pylori eradication.

Proton Pump Inhibitor-Related Gastric Mucosal Changes

“…38 In a cross-sectional study, multivariate analyses showed that the cobblestone-like mucosa was associated with PPI use (OR, 4.57; 95% CI, 2.34 to 9.96) and diabetes mellitus (OR, 3.41; 95% CI, 1.47 to 7.91). 12 A prospective, multicenter study also showed that the cobblestone-like mucosa was associated with PPI use (OR, 13.72; 95%, CI, 5.49 to 35.28), sex (female: OR, 0.32; 95% CI, 0.09 to 0.89), and age of the patients (≥50 years: OR, 4.46, 95% CI, 1.15 to 29.49). 10 Cobblestone-like mucosa has been histopathologically characterized by PCP and cystic dilatation of fundic glands, and these changes are especially prominent in non-atrophic gastric regions with abundant fundic glands.…”

“…2C). 12,25 These lesions are usually found in the upper gastric corpus and fundus, and close observation allows identification of tubular structures on their surface (Fig. 2D).…”

“…[5][6][7][8] PPI-induced endoscopic features such as formation of fundic gland polyps, hyperplastic polyps, multiple white and flat elevated lesions, cobblestone-like mucosa, and black spots have been reported in recent studies (Table 1). [9][10][11][12] In the clinical setting, it is important to be aware of PPI-related gastric endoscopic features exhibited by long-term users. Conversely, it is also important to identify long-term PPI users based on their endoscopic findings.…”

Review: Diagnosis of Helicobacter pylori infection

“…9 Another artificial intelligence system, namely convolutional neural network (CNN), was also constructed to ascertain H. pylori infection status. 13 White opaque substance, an endoscopic marker of intestinal metaplasia visualized by magnifying NBI, was shown to be associated with gastric acidity. Using an algorithm, an accuracy of 80% was obtained for H. pylori negative status, 84% for posteradication status, but only 48% for H. pylori positive status, within a lapse time of 261 seconds.…”

“…12 Another study confirmed the association of gastric black spots with H. pylori eradication and PPI and also found white flat elevated mucosa and cobblestone-like mucosa associated with PPI use. 13 White opaque substance, an endoscopic marker of intestinal metaplasia visualized by magnifying NBI, was shown to be associated with gastric acidity. Indeed, strong acidity inactivates the lipase which plays a role in the lipid absorption process.…”