Department of Comprehensive Medicine, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba, Sendai, Miyagi, 980-8574, Japan.
J Gastroenterol. 2010 Jun;45(6):618-24. doi: 10.1007/s00535-010-0207-7. Epub 2010 Feb 23.
To investigate the development of fundic gland polyp (FGP) and gastric hyperplastic polyp (HPP) during long-term proton pump inhibitor (PPI) therapy and risk factors of each polyp via patient status in a multicenter prospective study.
The risk of developing FGP may increase during long-term PPI therapy. However, the association with PPI-induced hypergastrinemia is unclear. Helicobacter pylori (Hp) infection (which there is a high rate of in Japan) may influence the development of HPP.
Reflux esophagitis patients on PPI maintenance therapy were enrolled. At baseline, the presence of protruding lesion (gastric polyps) and mucosal atrophy was examined endoscopically. The serum gastrin level (SGL) and Hp infection status were noted. The patients took rabeprazole 10 mg/day for 104 weeks and endoscopy was performed at weeks 24, 52, 76, and 104 to check for newly developed FGPs and HPPs. The hazard ratios (HRs) of risk factors were calculated.
191 patients were analyzed. The distribution of patients with baseline SGLs (pg/mL) of <200, >or=200 to <400, and >or=400 was 118 (61.8%), 51 (26.7%), and 22 (11.5%), respectively. 78 (40.8%) patients were Hp-positive, and gastric polyps were found in 70 (36.6%) patients. By the end of rabeprazole therapy, 26 (13.6%) and 17 (8.9%) patients had developed new FGPs and HPPs. In terms of risk factors, Hp-positive was significantly lower (HR=0.288; 95% CI, 0.108-0.764) for FGP while SGL>or=400 pg/mL was significantly higher (HR=4.923; 95% CI, 1.486-16.31) for HPP.
During long-term PPI therapy, FGP development was associated with absence of Hp infection. Meanwhile, Hp infection and high SGL may influence HPP development.
通过多中心前瞻性研究，探讨质子泵抑制剂（PPI）长期治疗过程中胃底腺息肉（FGP）和增生性胃息肉（HPP）的发展情况，以及每种息肉的相关危险因素。
长期 PPI 治疗可能会增加 FGP 的发病风险。然而，其与 PPI 诱导的高胃泌素血症的关系尚不清楚。在日本，幽门螺杆菌（Hp）感染率较高，可能会影响 HPP 的发生。
纳入接受 PPI 维持治疗的反流性食管炎患者。基线时，通过内镜检查观察是否存在突出性病变（胃息肉）和黏膜萎缩。记录血清胃泌素水平（SGL）和 Hp 感染情况。患者每天服用雷贝拉唑 10 mg，持续 104 周，在第 24、52、76 和 104 周进行内镜检查，以检查新发生的 FGPs 和 HPPs。计算危险因素的风险比（HRs）。
对 191 名患者进行了分析。基线时 SGL（pg/mL）<200、≥200 至<400 和≥400 的患者分布分别为 118 例（61.8%）、51 例（26.7%）和 22 例（11.5%）。78 例（40.8%）患者 Hp 阳性，70 例（36.6%）患者有胃息肉。雷贝拉唑治疗结束时，26 例（13.6%）和 17 例（8.9%）患者新发生了 FGP 和 HPP。就危险因素而言，Hp 阳性患者 FGP 的风险显著降低（HR=0.288；95%CI，0.108-0.764），而 SGL≥400 pg/mL 患者 HPP 的风险显著升高（HR=4.923；95%CI，1.486-16.31）。
在长期 PPI 治疗过程中，FGP 的发生与 Hp 感染缺失有关。同时，Hp 感染和高 SGL 可能会影响 HPP 的发生。
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