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Is Use of PPIs Related to Increased Intraepithelial Lymphocytes in the Colon?

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Abstract

Background

The use of proton pump inhibitors (PPIs) is thought to increase the incidence of microscopic colitis (MC), although the exact mechanisms are not fully understood. Increased infiltration of intraepithelial lymphocytes (IELs) is a pathologic finding of MC (including collagenous or lymphocytic colitis).

Aims

We investigated whether PPI use is associated with increased IEL infiltration and inflammation in the lamina propria.

Methods

We retrospectively reviewed the medical records and histological reports of 78 patients receiving PPIs who had no symptoms of diarrhea, and their age- and gender- matched controls. The levels of IELs and inflammation in the lamina propria were assessed independently by two pathologists using H&E and immunohistochemical staining for CD3 and CD8.

Results

The IEL count was significantly higher in the PPI group than in controls (12.92 ± 6.27 vs. 8.10 ± 4.21 per 100 epithelial cells, p < 0.001), as was the extent of inflammation (1.74 ± 0.90 vs. 0.86 ± 0.78, p < 0.001). PPI use was associated with increased IEL infiltration in a multivariate analysis (OR, 3.232; 95 % CI, 1.631–6.404, p < 0.001). Within the PPI group, however, the IEL count was not significantly associated with gender, age, type of PPI, or duration of PPI use.

Conclusions

The use of PPIs has a significant association with increased IEL infiltration for subjects without symptoms of diarrhea. This finding suggests that changes such histological alterations seen in the early phage seen in MC possibly represent the stage of the disease even before the onset of symptoms.

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Acknowledgment

This work was supported by the research fund of Hanyang University (HY2010-MC).

Conflict of interest

The authors declare that they have no conflicts of interest.

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Authors and Affiliations

  1. Department of Pathology, Hanyang University College of Medicine, Guri, Korea

    Young Ha Oh & Ju Yeon Pyo

  2. Division of Gastroenterology, Department of Internal Medicine, Hanyang University Guri Hospital, 249-1, Gyomun-dong, Guri-si, Gyunggi-do, 471-701, Korea

    Yeon Hwa Yu, Dong Soo Han, Eun Young Choi, Hye Sun Park, Jae Yoon Jeong & Chang Soo Eun

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  1. Yeon Hwa Yu
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  2. Dong Soo Han
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  7. Young Ha Oh
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Correspondence to Dong Soo Han.

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Yu, Y.H., Han, D.S., Choi, E.Y. et al. Is Use of PPIs Related to Increased Intraepithelial Lymphocytes in the Colon?. Dig Dis Sci 57, 2669–2674 (2012). https://doi.org/10.1007/s10620-012-2315-0

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  • DOI: https://doi.org/10.1007/s10620-012-2315-0

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