Su1517 Prospective Study of Collagenous Colitis Onset Associated With Long-Term Administration of Proton Pump Inhibitors

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Su1517 Prospective Study of Collagenous Colitis Onset Associated With Long-Term Administration of Proton Pump Inhibitors Masakatsu Nakamura, Tomiyasu Arisawa, Tomoyuki Shibata, Tomomitsu Tahara, Masaaki Okubo, Hisakazu Shiroeda, Tomoki Fukuyama, Kazuaki Ozaki, Toshimi Otsuka, Yasunari Takakuwa, Makoto Kuroda, Ichiro Hirata Gastroenterology, Fujita Health University school of medicine, Toyoake, Japan; Gastroenterology, Kanazawa Medical Univesity, Uchinada, Japan; Pathology, Fujita Health University school of medicine, Toyoake, Japan [Background] Growing numbers of reports suggest drugs such as PPIs, NSAIDs, SSRIs, ticlopidine, ranitidine, Cyclo 3 Fort, and acarbose induce collagenous colitis. Although many cases reported in recent years appear attributable to PPIs, especially lansoprazole, no prospective studies have been done. We examined the onset of collagenous colitis in patients on long-term PPI therapy, comparing lansoprazole to rabeprazole. [Subjects and Methods] All 60 subjects had undergone ESD for gastric cancer at our hospital and were prescribed PPI therapy for ulcers. Patients were randomly assigned to one of two groups, a lansoprazole group and a rabeprazole group, with 30 patients per group. Colonoscopy was performed over 21 weeks after the start of PPI therapy to biopsy the colon at ten sites. Given the likelihood of collagenous colitis, immediate colonoscopy was performed in patients exhibiting severe diarrhea within 21 weeks of the start of PPI therapy. We confirmed collagenous colitis histopathologically based on collagen bands measuring 10 m or more in thickness (Azan stain) and compared the numbers of stained specimens for the two groups. We performed a subjective symptom survey before colonoscopy to explore drugs potentially causing collagenous colitis. [Results] We confirmed collagenous colitis in five patients. Only one patient experienced diarrhea, a severe case occurring before the 21st week of administration. Although the onset of collagenous colitis exhibited no correlation to gender or age, all five patients received lansoprazole, and the onset of collagenous colitis was significantly higher when compared to the rabeprazole group (16.6 and 0%, respectively, p 0.020, 2 test). We noted inflammation due to mononuclear cell infiltration in all subjects. The collagenous colitis group reported higher scores for diarrhearelated symptoms, number of monthly incidents of diarrhea, and number of monthly incidents of abdominal pain. Also only two patients took NSAIDs/ aspirin, and one of the two patients developed collagenous colitis, showing a statistically significant risk factor (p 0.030, 2 test). Aspirin was coadministered with lansoprazole, while loxoprofen was coadministered with rabeprazole. [Conclusions] Four cases diagnosed as collagenous colitis in this study would likely be overlooked in routine clinical settings. Thick collagen bands in this study correlated strongly with lansoprazole administration. Collagenous colitis onset was higher than previously thought and varied significantly between two PPIs. Signs of inflammation due to mononuclear cell infiltration were observed in all subjects, indicating that long-term administration of any PPI induces inflammation. These findings have major implications for clinical care. Su1518 Minimum Proximal Colon Serrated Polyp Detection Rate in Average-Risk Males and Females Charles J. Kahi, George J. Eckert, Douglas K. Rex Indiana University, Indianapolis, IN Background and Objectives: The adenoma detection rate is a validated measure of colonoscopy quality and a predictor of the risk of interval colorectal cancer (CRC) after screening colonoscopy. Guidelines specify minimum detection rates of 25% and 15% in average-risk males and females, respectively. Serrated polyps located in the proximal colon may be a significant contributor to interval CRC; however, a corresponding minimum proximal serrated polyp detection rate has not been determined. Methods: We reviewed a prospectively updated colonoscopy database for procedures performed by 15 attending gastroenterologists at a university hospital and associated ambulatory surgery center. Average-risk screening colonoscopies performed between 1/1/00 and 12/31/09 were included. Serrated polyps included hyperplastic polyps, sessile serrated adenomas, and traditional serrated adenomas. The proximal colon was defined as proximal to the splenic flexure. Variances between adenoma, proximal adenoma, and proximal serrated polyp detection rates were tested. Pearson correlation coefficients were calculated to evaluate the associations of adenoma and proximal serrated polyp detection rates for males and females. Results: A total of 6681 screening colonoscopies were included (mean patient age 59 years, male 49%). Adenoma, proximal adenoma, and proximal serrated polyp detection rates were 38 7.8 % (range 17% to 47%), 28 6.7% (13% to 36%), and 13 4.8% (1% to 18%), respectively. There was no significant differen ...

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