A high percentage of children developed low-grade enterochromaffin cell-like hyperplasia.
The hypergastrinemia associated with long-term proton-pump inhibitor (PPI) therapy is suspected of causing enterochromaffin cell-like (ECL) hyperplasia or even carcinoid tumors in the developing stomachs of children.
To address this issue, investigators in Canada retrospectively reviewed sequential gastric biopsies from 65 children who received PPI therapy for >9 months (median, 2.29 years). The median age of patients at the time of first biopsy was 8.2 years (range, <1–17 years). Biopsy tissue was stained to identify ECL cells and was read by a pathologist who was blinded to the timing of the biopsies.
ECL hyperplasia was found in 40 of 65 patients (9 patients had ECL hyperplasia prior to PPI therapy) and in 82 of 458 biopsies (67 biopsies had grade 1 hyperplasia, and 15 had grade 2 hyperplasia). The median duration of PPI use was nonsignificantly longer in patients with ECL hyperplasia than in those without (3.17 years and 2.20 years). No patients developed chronic atrophic gastritis or carcinoid tumors. The authors concluded that a high percentage of children who receive chronic PPI therapy develop ECL hyperplasia, but that it is low grade and has no known clinical implications.
Comment: This small study suggests that the hypergastrinemia produced by PPI therapy has similar effects in children similar to those in adults. The absence of high-grade hyperplasia, neoplasia, or carcinoid tumors is reassuring, but larger long-term studies are required to verify these results.
—David J. Bjorkman, MD, MSPH (HSA), SM (Epid.)
Hassall E et al. Gastric histology in children treated with proton pump inhibitors long term, with emphasis on enterochromaffin cell-like hyperplasia. Aliment Pharmacol Ther 2011 Apr; 33:829.
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