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Adenocarcinoma arising in multiple hyperplastic polyps in a patient with Helicobacter pylori infection and hypergastrinemia during long-term proton pump inhibitor therapy

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Abstract

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.

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Authors and Affiliations

  1. Department of Gastroenterology, Toyosato Hospital, 12 Hachime, Toyosato-cho, Inukami-gun, Shiga, 529-1168, Japan

    Hajime Anjiki, Yu Kadomoto, Hisakazu Doi & Kunio Yoshikawa

  2. Department of Pathology, Division of Molecular Diagnostic Pathology, Shiga University of Medical Science, Otsu, Japan

    Ken-ichi Mukaisho, Takahisa Nakayama, Takanori Hattori & Hiroyuki Sugihara

  3. Department of Pathology, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam

    Diem Thi-Ngoc Vo

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  1. Hajime Anjiki
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  2. Ken-ichi Mukaisho
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  6. Takahisa Nakayama
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  9. Hiroyuki Sugihara
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Correspondence to Hajime Anjiki.

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Conflict of interest:

Hajime Anjiki, Ken-ichi Mukaisyo, Yu Kadomoto, Hisakazu Doi, Yoshikawa Kunio, Takahisa Nakayama, Diem Thi-Ngoc Vo, Hattori Takanori and Sugihara Hiroyuki declare that they have no conflict of interest.

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All procedures followed have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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Informed consent was obtained from all patients for being included in the study.

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Anjiki, H., Mukaisho, Ki., Kadomoto, Y. et al. Adenocarcinoma arising in multiple hyperplastic polyps in a patient with Helicobacter pylori infection and hypergastrinemia during long-term proton pump inhibitor therapy. Clin J Gastroenterol 10, 128–136 (2017). https://doi.org/10.1007/s12328-017-0714-7

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  • DOI: https://doi.org/10.1007/s12328-017-0714-7

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