Togo Kazumi, Ueo Tetsuya, Yao Kenshi, Wada Kurato, Honda Hideho, Inoue Syotaro, Fukuda Masahide, Yanai Yuka, Yonemasu Hirotoshi, Murakami Kazunari
Department of Gastroenterology, Oita Red Cross Hospital, Japan.
Department of Endoscopy, Fukuoka University Chikushi Hospital, Japan.
Endosc Int Open. 2018 Jul;6(7):E830-E837. doi: 10.1055/a-0611-4825. Epub 2018 Jul 4.
The presence of white opaque substance (WOS) is an endoscopic marker of intestinal metaplasia. Considering that the nature of WOS is absorbed lipid droplets, lipase plays an important role in the lipid absorption process and is inactivated at strong acidity. WOS may only be present in a hypochlorhydria state following infection, and, thus, may not be highly sensitive marker, especially in eradicated patients. We investigated the relationship between WOS and gastric acid conditions.
A total of 501 patients were retrospectively evaluated for the presence of WOS at 2 regions of interest using magnifying narrow-band imaging. The pH level of collected gastric juice was also measured. Study end points were (1) prevalence of WOS and its relationship with gastric juice pH in 3 groups: uninfected infected, and -eradicated; (2) the relationship between prevalence of WOS and gastric juice pH before and after proton pump inhibitor (PPI) administration in 29 -eradicated cases.
Prevalence of WOS was 0 % (0 /206), 28.4 % (31/109), and 3.2 % (6/186) in the -uninfected, -infected, and -eradicated groups, respectively. Mean gastric juice pH was significantly higher in WOS-positive cases than in WOS-negative cases in the -infected and -eradicated groups ( < 0.0001). Mean gastric juice pH increased from 1.1 to 6.9 after PPI administration and WOS prevalence increased from 0 % (0/29) to 45 % (13/29) of cases.
The prevalence of WOS is closely associated with the neutralization of intragastric pH.
白色不透明物质（WOS）的存在是肠化生的内镜标志物。鉴于WOS的本质是吸收的脂滴，脂肪酶在脂质吸收过程中起重要作用且在强酸性条件下失活。WOS可能仅在感染后的胃酸缺乏状态下存在，因此可能不是高度敏感的标志物，尤其是在根除幽门螺杆菌的患者中。我们研究了WOS与胃酸状况之间的关系。
对501例患者进行回顾性评估，使用放大窄带成像在2个感兴趣区域检测WOS的存在情况。同时测量收集的胃液的pH值。研究终点为：（1）3组（未感染、感染和根除幽门螺杆菌组）中WOS的患病率及其与胃液pH值的关系；（2）29例根除幽门螺杆菌病例中，质子泵抑制剂（PPI）给药前后WOS患病率与胃液pH值的关系。
未感染组、感染组和根除幽门螺杆菌组中WOS的患病率分别为0%（0/206）、28.4%（31/109）和3.2%（6/186）。在感染组和根除幽门螺杆菌组中，WOS阳性病例的平均胃液pH值显著高于WOS阴性病例（P<0.0001）。PPI给药后，平均胃液pH值从1.1升至6.9，WOS患病率从0%（0/）升至45%（13/29）。
WOS的患病率与胃内pH值的中和密切相关。
