Proton Pump Inhibitor-Related Gastric Mucosal Changes

Area of Science:

• Gastroenterology
• Pharmacology

Background:

• Proton pump inhibitors (PPIs) are widely prescribed for acid-related disorders and NSAID-induced gastroduodenal injuries.
• PPIs are highly effective and generally safe, but long-term use is associated with specific histopathological changes in the gastric mucosa.

Purpose of the Study:

• To highlight the endoscopic manifestations of long-term proton pump inhibitor (PPI) use.
• To emphasize the importance of recognizing PPI-induced endoscopic findings in clinical practice.
• To note the emergence of potassium-competitive acid blockers (P-CABs) and the need for further research.

Main Methods:

• Review of literature on PPI-induced histopathological and endoscopic changes.
• Description of characteristic endoscopic findings associated with long-term PPI therapy.
• Introduction of P-CABs as a newer class of acid suppressants.

Main Results:

• Long-term PPI use can lead to parietal cell protrusion, cystic dilation of gastric fundic glands, and foveolar epithelial hyperplasia.
• Endoscopic findings may include fundic gland polyps, hyperplastic polyps, white elevated lesions, cobblestone mucosa, and black spots.
• Potassium-competitive acid blockers (P-CABs) represent a new class of acid suppressants with potentially stronger inhibition.

Conclusions:

• Clinicians should be aware of PPI-induced endoscopic features in patients on chronic PPI therapy.
• Endoscopic findings can aid in identifying patients with long-term PPI use.
• Further prospective studies are needed to evaluate gastric mucosal changes associated with both PPIs and P-CABs and their clinical significance.