title: Gastric mucosal cracked and cobblestone-like changes resulting from proton pump inhibitor use.
abstract: OBJECTIVE
  Use of proton pump inhibitors (PPI) is histologically associated with oxyntic gland dilatations. Two interesting mucosal changes are often detected endoscopically in patients who use PPI: gastric cracked mucosa (GCM) and gastric cobblestone-like mucosa (GCSM). The aim of the present study was to clarify the relationship between PPI use and these mucosal changes.
  
  
  METHODS
  This was a single-center observational study. All successive subjects who underwent a routine esophagogastroduodenoscopy (EGD) between August and November 2014 in Hokkaido University Hospital were enrolled. Endoscopists carried out the assessment blinded to the use of PPI and checked for GCSM and GCM using original diagnostic criteria for GCM and GCSM. Subjects were divided into two groups: those who used PPI (PPI group) and those who did not (control group). Endoscopic findings and backgrounds were compared between the two groups.
  
  
  RESULTS
  A total of 538 patients were analyzed (control group: 374 patients, men/women: 204/170, median age: 65.2 years; PPI group: 164 patients, men/women: 89/75, median age: 67.1 years). GCM was detected in 54 (10.0%) subjects, and GCSM was detected in 18 (3.3%) subjects. There was a significant difference in the prevalence rate of GCM between the control group (14/374, 3.7%) and the PPI group (40/164, 24.4%) (P < 0.01). GCSM was significantly more prevalent in the PPI group (15/164, 9.1%) than in the control group (3/374, 0.8%) (P < 0.01).
  
  
  CONCLUSIONS
  Novel GCM and GCSM endoscopic findings in the corpus area seem to be strongly associated with PPI use.
authors.affiliation: Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Shuichi
authors.initials: S
authors.lastname: Miyamoto
authors.affiliation: National Hospital Organization Hakodate Hospital, Hakodate, Japan.
authors.forename: Mototsugu
authors.initials: M
authors.lastname: Kato
authors.affiliation: Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Momoko
authors.initials: M
authors.lastname: Tsuda
authors.affiliation: Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Kana
authors.initials: K
authors.lastname: Matsuda
authors.affiliation: Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Tetsuhito
authors.initials: T
authors.lastname: Muranaka
authors.affiliation: Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Abiko
authors.affiliation: Hakodate Municipal Hospital, Hakodate, Japan.
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Ono
authors.affiliation: Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Mizushima
authors.affiliation: Iwamizawa Municipal General Hospital, Iwamizawa, Japan.
authors.forename: Saori
authors.initials: S
authors.lastname: Omori
authors.affiliation: Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Keiko
authors.initials: K
authors.lastname: Yamamoto
authors.affiliation: National Hospital Organization Hakodate Hospital, Hakodate, Japan.
authors.forename: Katsuhiro
authors.initials: K
authors.lastname: Mabe
authors.affiliation: Division of Endoscopy, Hokkaido University Hospital, Sapporo, Japan.
authors.forename: Shoko
authors.initials: S
authors.lastname: Ono
authors.affiliation: Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Takahiko
authors.initials: T
authors.lastname: Kudo
authors.affiliation: Division of Endoscopy, Hokkaido University Hospital, Sapporo, Japan.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Shimizu
authors.affiliation: Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Naoya
authors.initials: N
authors.lastname: Sakamoto
mesh_terms: D000368:Aged; D001706:Biopsy; D004108:Dilatation, Pathologic; D016145:Endoscopy, Digestive System; D005260:Female; D005753:Gastric Mucosa / Q000187:drug effects* / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010295:Parietal Cells, Gastric / Q000187:drug effects / Q000473:pathology; D054328:Proton Pump Inhibitors / Q000009:adverse effects*; D012189:Retrospective Studies; D013272:Stomach Diseases / Q000188:drug therapy* / Q000473:pathology
chemical_list: D054328:Proton Pump Inhibitors
keywords: gastric cobblestone-like mucosa; gastric cracked mucosa; helicobacter pylori; parietal cell; proton pump inhibitor