CC BY-NC-ND 4.0 · Endosc Int Open 2018; 06(07): E830-E837
DOI: 10.1055/a-0611-4825
Original article
Owner and Copyright © Georg Thieme Verlag KG 2018

White opaque substance visualized by magnifying narrow-band imaging is associated with intragastric acid conditions

Kazumi Togo
1  Department of Gastroenterology, Oita Red Cross Hospital, Japan
,
Tetsuya Ueo
1  Department of Gastroenterology, Oita Red Cross Hospital, Japan
,
Kenshi Yao
2  Department of Endoscopy, Fukuoka University Chikushi Hospital, Japan
,
Kurato Wada
1  Department of Gastroenterology, Oita Red Cross Hospital, Japan
,
Hideho Honda
1  Department of Gastroenterology, Oita Red Cross Hospital, Japan
,
Syotaro Inoue
1  Department of Gastroenterology, Oita Red Cross Hospital, Japan
,
Masahide Fukuda
1  Department of Gastroenterology, Oita Red Cross Hospital, Japan
,
Yuka Yanai
1  Department of Gastroenterology, Oita Red Cross Hospital, Japan
,
Hirotoshi Yonemasu
3  Department of Pathology, Oita Red Cross Hospital, Japan
,
Kazunari Murakami
4  Department of Gastroenterology, Faculty of Medicine, Oita University, Japan
› Author Affiliations
Further Information

Publication History

submitted 27 November 2017

accepted after revision 28 March 2018

Publication Date:
04 July 2018 (online)

Abstract

Background and study aims The presence of white opaque substance (WOS) is an endoscopic marker of intestinal metaplasia. Considering that the nature of WOS is absorbed lipid droplets, lipase plays an important role in the lipid absorption process and is inactivated at strong acidity. WOS may only be present in a hypochlorhydria state following Helicobacter pylori infection, and, thus, may not be highly sensitive marker, especially in H. pylori-eradicated patients. We investigated the relationship between WOS and gastric acid conditions.

Patients and methods A total of 501 patients were retrospectively evaluated for the presence of WOS at 2 regions of interest using magnifying narrow-band imaging. The pH level of collected gastric juice was also measured. Study end points were (1) prevalence of WOS and its relationship with gastric juice pH in 3 groups: H. pylori-uninfected, H. pylori-infected, and H. pylori-eradicated; (2) the relationship between prevalence of WOS and gastric juice pH before and after proton pump inhibitor (PPI) administration in 29 H. pylori-eradicated cases.

Results Prevalence of WOS was 0 % (0 /206), 28.4 % (31/109), and 3.2 % (6/186) in the H. pylori-uninfected, H. pylori-infected, and H. pylori-eradicated groups, respectively. Mean gastric juice pH was significantly higher in WOS-positive cases than in WOS-negative cases in the H. pylori-infected and H. pylori-eradicated groups (P < 0.0001). Mean gastric juice pH increased from 1.1 to 6.9 after PPI administration and WOS prevalence increased from 0 % (0/29) to 45 % (13/29) of cases.

Conclusion The prevalence of WOS is closely associated with the neutralization of intragastric pH.