Gastric lanthanosis (lanthanum deposition) in dialysis patients treated with lanthanum carbonate

Abstract

Lanthanum carbonate (LaC) is used to prevent hyperphosphatemia in dialysis patients. It is commonly believed that there is little LaC absorption from the intestines. However, La deposition in the gastric mucosa, which we coined "gastric lanthanosis", was recently reported. We describe here the clinicopathological features of and a possible mechanism for gastric lanthanosis. This study included 23 patients with definite gastric lanthanosis. We extracted characteristic clinicopathological features of gastric lanthanosis by computed tomography (CT) imaging and endoscopic, histologic, electron-microscopic, and element analysis examinations. The Helicobacter pylori infection rate in the lanthanosis group was much lower than that among the general population. The clinicopathological features characteristic of gastric lanthanosis were mucosal high-density linear appearance by CT, reflective bright-white spots (BWS) by gastroscopy, eosinophilic histiocytes occasionally phagocytizing foreign materials by histology, and numerous electron-dense particles in the histiocytes. The particles had burr-like skeletons resembling La crystals. Gastric lanthanosis is an under-reported, but not a rare lesion. It is characterized by endoscopic BWS and histologic eosinophilic histiocytes in dialysis patients treated with LaC. The proposed mechanism for gastric lanthanosis is that LaC is dissolved by gastric juice, crystallized within the mucosa and is phagocytized by histiocytes.

Relationship between gastric lanthanum deposition and Helicobacter pylori‐associated chronic gastritis: is it rare or common?

“…Gastric mucosal alterations such as intestinal metaplasia, regenerative change, and foveolar hyperplasia were more frequently observed in mucosa with large quantities of lanthanum deposits. These results imply a correlation between underlying gastric mucosal alterations due to H. pylori ‐associated chronic gastritis and susceptibility to lanthanum deposition, which is not concordant with the observation by Shitomi et al …”

“…Gastric mucosal alterations such as intestinal metaplasia, regenerative change, and foveolar hyperplasia were more frequently observed in mucosa with large quantities of lanthanum deposits. These results imply a correlation between underlying gastric mucosal alterations due to H. pylori-associated chronic gastritis and susceptibility to lanthanum deposition, which is not concordant with the observation by Shitomi et al 1 Several factors can affect the results of testing for H. pylori infection status. For example, the use of acidsuppressing drugs such as proton pump inhibitors, might suppress growth of H. pylori, leading to false-negative results on testing for H. pylori.…”

“…We read a recent report by Shitomi et al 1 investigating the clinicopathological characteristics of 23 patients with gastric lanthanum deposition with great interest. The authors investigated the Helicobacter pylori infection status in biopsied specimens using Giemsa stain and reported that H. pylori was not identified in any of these cases.…”

“…We read a recent report by Shitomi et al . investigating the clinicopathological characteristics of 23 patients with gastric lanthanum deposition with great interest.…”

Медикаментозная Коррекция Нарушений Фосфатно-Кальциевого Обмена У Пациентов С Хронической Болезнью Почек И Минерально-Костной Болезнью

“…Недавно были проведены детальные исследования механиз-мов развития желудочного лантаноза у пациентов, принимавших препараты лантана карбоната для снижения уровня гиперфосфатемии [12].…”