Adenocarcinoma arising in multiple hyperplastic polyps in a patient with Helicobacter pylori infection and hypergastrinemia during long-term proton pump inhibitor therapy.
We report a case of developing multiple adenocarcinoma foci in multiple hyperplastic polyps in a patient with Helicobacter pylori infection and hypergastrinemia during long-term proton pump inhibitor (PPI) therapy. A 57-year-old man, who was undergoing hemodialysis for chronic renal failure, underwent an upper gastrointestinal endoscopy to elucidate the cause of anemia. Atrophic gastritis with H. pylori infection and multiple adenocarcinoma foci in multiple hyperplastic polyps were found in the endoscopic and histological examinations. Enterochromaffin-like micronests and parietal cell protrusion in the background of the polyps suggested the existence of hypergastrinemia. The serum gastrin level was markedly high-10,206 pg/ml (normal range 37-172 pg/ml). The cause of this marked hypergastrinemia was not autoimmune gastritis and gastrinoma. After discontinuing PPI therapy and successful eradication of H. pylori, the serum gastrin level decreased to normal range. These findings indicate that hypergastrinemia may be caused by long-term PPI therapy in patients with H. pylori infection. This case suggests that hypergastrinemia may mediate gastric carcinogenesis in patients with H. pylori infection.
Department of Gastroenterology, Toyosato Hospital, 12 Hachime, Toyosato-cho, Inukami-gun, Shiga, 529-1168, Japan. ananjikijiki@bell.ocn.ne.jp.
Hajime
http://orcid.org/0000-0001-7157-5352
H
Anjiki
Department of Pathology, Division of Molecular Diagnostic Pathology, Shiga University of Medical Science, Otsu, Japan.
Ken-Ichi
KI
Mukaisho
Department of Gastroenterology, Toyosato Hospital, 12 Hachime, Toyosato-cho, Inukami-gun, Shiga, 529-1168, Japan.
Yu
Y
Kadomoto
Department of Gastroenterology, Toyosato Hospital, 12 Hachime, Toyosato-cho, Inukami-gun, Shiga, 529-1168, Japan.
Hisakazu
H
Doi
Department of Gastroenterology, Toyosato Hospital, 12 Hachime, Toyosato-cho, Inukami-gun, Shiga, 529-1168, Japan.
Kunio
K
Yoshikawa
Department of Pathology, Division of Molecular Diagnostic Pathology, Shiga University of Medical Science, Otsu, Japan.
Takahisa
T
Nakayama
Department of Pathology, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam.
Diem Thi-Ngoc
DT
Vo
Department of Pathology, Division of Molecular Diagnostic Pathology, Shiga University of Medical Science, Otsu, Japan.
Takanori
T
Hattori
Department of Pathology, Division of Molecular Diagnostic Pathology, Shiga University of Medical Science, Otsu, Japan.
Hiroyuki
H
Sugihara
D000230:Adenocarcinoma / Q000209:etiology*; D003043:Cocarcinogenesis; D004334:Drug Administration Schedule; D005755:Gastrins / Q000097:blood; D005757:Gastritis, Atrophic / Q000150:complications; D005773:Gastroscopy; D016481:Helicobacter Infections / Q000150:complications*; D016480:Helicobacter pylori; D006801:Humans; D006965:Hyperplasia; D008297:Male; D008875:Middle Aged; D011127:Polyps / Q000175:diagnosis / Q000209:etiology; D054328:Proton Pump Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D013274:Stomach Neoplasms / Q000175:diagnosis / Q000209:etiology*
D005755:Gastrins; D054328:Proton Pump Inhibitors
Gastric adenocarcinoma; H. pylori infection; Hypergastrinemia; Proton pump inhibitor therapy