Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 21, 2015; 21(15): 4599-4606
Published online Apr 21, 2015. doi: 10.3748/wjg.v21.i15.4599
Influence of proton pump inhibitors on gastritis diagnosis and pathologic gastric changes
Soumana C Nasser, Mahmoud Slim, Jeanette G Nassif, Selim M Nasser
Soumana C Nasser, Jeanette G Nassif, School of Pharmacy, Lebanese American University, P.O. Box 36, Byblos, Lebanon
Mahmoud Slim, Institute of Neuroscience, University of Granada, 18012 Granada, Spain
Selim M Nasser, Department of Pathology, School of Medicine, Lebanese American University, Blat 36, Lebanon
Author contributions: Nasser SC and Nasser SM were involved in the conception and design of the study; Slim M participated in the data collection of the study; Nasser SM conducted the immunohistochemical analysis and evaluation; Nasser SC, Slim M, Nassif JG and Nasser SM participated in data analysis, interpretation and evaluation, drafting and final approval of the article.
Ethics approval: The study was reviewed and approved by the Lebanese American University Institutional Review Board.
Informed consent: Informed consent was not required for this study and was waived by the Lebanese American University Institutional Review Board.
Conflict-of-interest: The authors have received research funding from the Lebanese American University for purchasing the immunochemical staining products; authors report no conflict of interest.
Data sharing: Technical appendix, statistical code, and dataset are available from the corresponding author at selim.nasser@lau.edu.lb.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Selim M Nasser, MD, Associate Professor, Chief, Department of Pathology, School of Medicine, Lebanese American University, Blat 36, Lebanon. selim.nasser@lau.edu.lb
Telephone: +961-3-259806 Fax: +961-9-547256
Received: November 3, 2014
Peer-review started: November 3, 2014
First decision: November 14, 2014
Revised: December 3, 2014
Accepted: January 8, 2015
Article in press: January 8, 2015
Published online: April 21, 2015
Processing time: 168 Days and 13.3 Hours
Abstract

AIM: To investigate the influence of proton pump inhibitors (PPIs) exposure on the diagnosis of Helicobacter pylori (H. pylori) gastritis and intestinal metaplasia.

METHODS: Chronic PPI use is associated with masking of H. pylori infection. Patients with H. pylori infection are predisposed to gastric and duodenal ulcers, and long-term infection with this organism has been associated with gastric mucosal atrophy and serious long-term complications, such as gastric lymphoma and adenocarcinoma. Three hundred patients diagnosed with gastritis between January 2008 and April 2010 were included in our study. The computerized medical database of these patients was reviewed retrospectively in order to assess whether the type of gastritis diagnosed (H. pylori vs non-H. pylori gastritis) is influenced by PPI exposure. H. pylori density was graded as low, if corresponding to mild density following the Updated Sydney System, or high, if corresponding to moderate or severe densities in the Updated Sydney System.

RESULTS: Patients were equally distributed between males and females with a median age at the time of diagnosis of 50 years old (range: 20-87). The histological types of gastritis were classified as H. pylori gastritis (n = 156, 52%) and non-H. pylori gastritis (n = 144, 48%). All patients with non-H. pylori gastritis had inactive chronic gastritis. Patients with no previous PPI exposure were more likely to be diagnosed with H. pylori gastritis than those with previous PPI exposure (71% vs 34.2%, P < 0.001). Intestinal metaplasia was more likely to be detected in the latter patients (1.4% vs 6.5%, P = 0.023). Multivariate analysis has also demonstrated that in the presence of previous PPI exposure (OR = 0.217, 95%CI: 0.123-0.385), GERD (OR = 0.317, 95%CI: 0.132-0.763, P = 0.01), alcohol intake (OR = 0.396, 95%CI: 0.195-0.804, P = 0.01), the detection of H. pylori was less likely. Chronic use of PPIs may mask H. pylori infections promoting the diagnosis of non-H. pylori gastritis and leads to a significant drop in H. pylori densities and to an increased risk of intestinal metaplasia.

CONCLUSION: The use of PPIs masks H. pylori infection, promotes the diagnosis of non-H. pylori inactive chronic gastritis diagnosis, and increases the incidence of intestinal metaplasia.

Keywords: Gastritis; Diagnosis; Helicobacter pylori; Proton pump inhibitors; Social factors

Core tip: This study investigates the influence of proton pump inhibitors (PPIs) exposure on the diagnosis of Helicobacter pylori (H. pylori) gastritis in patients undergoing endoscopic gastric biopsies. The study findings revealed that in patients undergoing gastric biopsies, the use of PPIs promotes the diagnosis of non-H. pylori gastritis, is associated with lower H. pylori densities and to increased risk of intestinal metaplasia as compared with subjects with no PPI exposure. These findings should urge health-care professionals to consider the possibility of underdiagnosed H. pylori gastritis in patients exposed to PPI.