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Endoscopic ultrasonography features of gastric mucosal cobblestone-like changes from a proton-pump inhibitor

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Abstract

A 68-year-old man with no symptoms presented to Hokkaido University Hospital for esophagogastroduodenoscopy screening. He had a history of Helicobacter pylori eradication. Initial esophagogastroduodenoscopy showed no gastric cobblestone-like mucosa or gastric cracked mucosa. After 1 year, he received esomeprazole (20 mg) once daily for heartburn at another hospital. Esophagogastroduodenoscopy was performed after 2 years of esomeprazole administration. Endoscopic findings showed that after H. pylori eradication, according to the Kyoto classification, gastric cobblestone-like mucosa presented in the gastric body area. Dilation of the oval crypt opening and intervening part in the gastric cobblestone-like mucosa was detected by endoscopy with narrow band imaging. Endoscopic ultrasonography revealed a thick gastric second layer and sporadic small a-echoic lesions in the low-echoic thickened second layer in the gastric cobblestone-like mucosa. The gastric cobblestone-like mucosa biopsy specimen showed parietal cell protrusions and oxyntic gland dilatations. Recently, we reported that gastric mucosal changes such as gastric cracked mucosa and gastric cobblestone-like mucosa were caused by proton-pump inhibitors; however, the gastric cobblestone-like mucosa was not examined by endoscopic ultrasonography. In this case, endoscopic ultrasonography findings suggested that oxyntic gland dilatations caused the elevated gastric mucosa, such as gastric cobblestone-like mucosa, from the use of proton-pump inhibitors.

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Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan

    Shuichi Miyamoto, Takahiko Kudo, Kana Matsuda, Satoshi Abiko, Momoko Tsuda, Takeshi Mizushima, Keiko Yamamoto & Naoya Sakamoto

  2. National Hospital Organization Hakodate Hospital, 16-gou, 18-banchi, Kawahara-chou, Hakodate, 041-8512, Japan

    Mototsugu Kato

  3. Division of Endoscopy, Hokkaido University Hospital, Sapporo, Japan

    Shoko Ono & Yuichi Shimizu

Authors
  1. Shuichi Miyamoto
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  2. Takahiko Kudo
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  3. Mototsugu Kato
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  4. Kana Matsuda
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  5. Satoshi Abiko
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  6. Momoko Tsuda
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  7. Takeshi Mizushima
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  8. Keiko Yamamoto
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  9. Shoko Ono
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  10. Yuichi Shimizu
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  11. Naoya Sakamoto
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Corresponding author

Correspondence to Mototsugu Kato.

Ethics declarations

Conflict of interest:

Mototsugu Kato has received honoraria from Eisai Co., Ltd.; Daiichi Sankyo Co., Ltd.; and AstraZeneca K.K. and has received scholarship grants from Eisai Co., Ltd.; Takeda Pharmaceutical Co., Ltd.; Daiichi Sankyo Co., Ltd.; and AstraZeneca K.K. and Astellas Pharma Inc. Y. Shoko Ono has been involved in speaking and teaching commitments for Eisai Co., Ltd.; Daiichi Sankyo Co.; and AstraZeneca K.K. Yuichi Shimizu has received research grants from Takeda Pharmaceutical Co.; Eisai Co., Ltd.; and AstraZeneca K.K. Naoya Sakamoto has received honoraria from Bristol-Myers Squibb and Janssen Pharmaceutical K.K. and research funding from Chugai Pharmaceutical Co., Ltd. and Bristol-Myers Squibb. Naoya Sakamoto received honoraria from Bristol-Myers Squibb and Janssen Pharmaceutical K.K. and research funding from Chugai Pharmaceutical Co., Ltd. and Bristol-Myers Squibb.

Human Rights:

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

Informed Consent:

Informed consent was obtained from this patient for being included in the study.

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Miyamoto, S., Kudo, T., Kato, M. et al. Endoscopic ultrasonography features of gastric mucosal cobblestone-like changes from a proton-pump inhibitor. Clin J Gastroenterol 10, 220–223 (2017). https://doi.org/10.1007/s12328-017-0724-5

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  • DOI: https://doi.org/10.1007/s12328-017-0724-5

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