title: Gastric neuroendocrine carcinoma after long-term use of proton pump inhibitor.
abstract: We present a case of a gastric neuroendocrine carcinoma in a patient with a history of long-term proton pump inhibitor (PPI) use. A 49-year-old man using PPI for the last 15 years due to gastroesophageal reflux disease developed progressive dysphagia, dyspepsia and weight loss. Upper gastrointestinal endoscopy, endoscopic ultrasonography and abdominal CT diagnosed a malignant tumor localized to a hiatal hernia. Fasting serum chromogranin A and gastrin concentrations were elevated (32 nmol/l and 159 pmol/l, respectively). Helicobacter pylori PCR analysis of antral biopsies was negative. Biopsies from endoscopically normal oxyntic mucosa showed enterochromaffin-like (ECL) cell hyperplasia. Tumor biopsies revealed a poorly differentiated neuroendocrine carcinoma. Sevier-Munger staining, immunohistochemistry and electron microscopy indicated ECL cell as origin of the tumor cells. Concerns have previously been raised about the safety of long-term PPI use due to a possible increased risk of cancer. This case illustrates a patient with a poorly differentiated neuroendocrine carcinoma with ECL cell characteristics probably induced by hypergastrinemia secondary to long-term PPI use.
authors.affiliation: Departments of Gastroenterology and Hepatology, St. Olavs Hospital, Trondheim, Norway. constantin.jianu@ntnu.no
authors.forename: Constantin S
authors.initials: CS
authors.lastname: Jianu
authors.forename: Ove J
authors.initials: OJ
authors.lastname: Lange
authors.forename: Trond
authors.initials: T
authors.lastname: Viset
authors.forename: Gunnar
authors.initials: G
authors.lastname: Qvigstad
authors.forename: Tom C
authors.initials: TC
authors.lastname: Martinsen
authors.forename: Reidun
authors.initials: R
authors.lastname: Fougner
authors.forename: Per M
authors.initials: PM
authors.lastname: Kleveland
authors.forename: Reidar
authors.initials: R
authors.lastname: Fossmark
authors.forename: Øyvind
authors.initials: Ø
authors.lastname: Hauso
authors.forename: Helge L
authors.initials: HL
authors.lastname: Waldum
mesh_terms: D053799:2-Pyridinylmethylsulfinylbenzimidazoles / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use; D018278:Carcinoma, Neuroendocrine / Q000175:diagnosis / Q000473:pathology*; D053379:Chromogranin A / Q000097:blood / Q000187:drug effects; D005755:Gastrins / Q000097:blood / Q000187:drug effects; D005764:Gastroesophageal Reflux / Q000188:drug therapy; D006801:Humans; D064747:Lansoprazole; D008297:Male; D008875:Middle Aged; D054328:Proton Pump Inhibitors / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use; D013274:Stomach Neoplasms / Q000175:diagnosis / Q000473:pathology*; D013997:Time Factors
chemical_list: D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D053379:Chromogranin A; D005755:Gastrins; D054328:Proton Pump Inhibitors; D064747:Lansoprazole