Proton Pump Inhibitor Associated Multiple Gastric Hyperplastic Polyps With Uncontrollable Bleeding: A Case Report.

BACKGROUND/AIM: The long-term use of proton pump inhibitors (PPIs) has been reported to be strongly associated with the development of fundic gland polyps (FGPs). Conversely, a few cases of gastric hyperplastic polyps (GHPs) associated with PPI use have been reported. We experienced a case of PPI-associated multiple GHPs with uncontrollable bleeding. CASE REPORT: A 64 year old man with a history of rheumatoid arthritis presented to the hospital with complaints of vertigo and black stools. Blood tests revealed anemia and hypoproteinemia. Esophagogastroduodenoscopy (EGD) showed blood and black residue accumulated in the stomach. The source of the bleeding was multiple hyperplastic polyps. Bleeding could be stopped even with fasting, and total blood transfusions amounted to 28 units of RBCs were required in 18 days. After the cessation of PPI, EGD showed that the polyps had almost disappeared. Pathological diagnosis of resected polyp was hyperplastic polyp, which was characterized by capillary hyperplasia and edema. Gastrin receptors were over-expressed in the foveolar epithelium and not in the capillaries. Methotrexate (MTX)-induced portal hypertensive gastroenteropathy was revealed during follow-up. We consider that the effect of portal hypertension may have caused the capillary hyperplasia. CONCLUSION: Although PPI-related polyps are usually fundic gland polyps and do not cause life-threatening adverse events, we experienced PPI-related GHPs in which hemostasis was difficult to control.

Usefulness of the SPACE pulse sequence at 1.5T MR cholangiography: comparison of image quality and image acquisition time with conventional 3D-TSE sequence.

PURPOSE: To prospectively evaluate the image quality and image acquisition time at 3D magnetic resonance cholangiopancreatography (MRCP) using sampling perfection with application optimized contrasts (SPACE) and conventional turbo-spin-echo (TSE) sequences. MATERIALS AND METHODS: We acquired navigator-triggered SPACE and conventional 3D-TSE MRCP images using the same parameters where possible for 30 patients and compared the image acquisition time, contrast, and contrast-to-noise ratio (CNR) of the common bile duct (CBD). Two radiologists performed qualitative analyses using a 4-point scale. RESULTS: Image acquisition time was 31% shorter with the SPACE than the conventional TSE sequence (248.9 ± 73.0 sec vs. 360.5 ± 99.9 sec, P < 0.01). The contrast and CNR was significantly higher with the SPACE technique than conventional TSE (39.4 ± 14.7 vs. 33.5 ± 14.2, P < 0.01 and 18.6 ± 7.8 vs. 15.5 ± 9.3, P = 0.03). All visual scores were higher for the SPACE than the conventional TSE sequence; there was a significant difference in motion artifacts and the depiction of the CBD and the left hepatic and main pancreatic duct (P < 0.05). CONCLUSION: On the 1.5T MR scanner, 3D-MRCP with the SPACE sequence significantly improved the contrast and CNR of CBD. In addition, it yielded images of better quality at 30% shorter acquisition time than constant refocusing pulse flip angle TSE.