Investigation of the clinical significance and pathological features of lanthanum deposition in the gastric mucosa
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RESEARCH ARTICLE
Investigation of the clinical significance and pathological features of lanthanum deposition in the gastric mucosa Shinya Nishida1,2, Kazuhiro Ota1* , Kimiaki Hattori3,4, Taro Iwatsubo1,2, Shimpei Kawaguchi1, Yuichi Kojima1, Toshihisa Takeuchi1, Tamaki Maeda3, Masahiro Sakaguchi2 and Kazuhide Higuchi1
Abstract Background: There are often specific endoscopic findings caused by deposition of lanthanum (La) in the gastric mucosa of patients taking lanthanum carbonate (LaC), a novel phosphate binder for patients on hemodialysis. We conducted a retrospective study to investigate the clinical significance of La deposition in the gastric mucosa, and the association between endoscopic features and histologic findings in the same population. Methods: We compared background factors in patients taking LaC with and without La deposition in their gastroscopic biopsy specimen. We also investigated the relationship between gastric endoscopic biopsy specimens with La deposition and the concurrent endoscopic images. Results: There was a significant difference in the total dose of LaC between the La-positive and La-negative groups (990 g [180–3150 g] vs. 480 g [225–1328 g]; p = 0.013). In 27 biopsy specimens with specific whitish mucosa, 10 showed mild histiocytic infiltration and 17 showed severe infiltration. In contrast, among 24 specimens with nonwhitish mucosa, 5 showed no histiocytic infiltration, 10 showed mild infiltration, and 9 showed severe infiltration. There was a significant relationship between endoscopic features and the degree of histiocytic infiltration (p = 0.026). Conclusions: We demonstrated that La deposition in the gastric mucosa depended on the total dose of LaC and was not affected by background factors. The specific endoscopic features of La deposition are associated with the infiltration of histiocytes, which represents the body’s normal response to foreign bodies. Trial registry The protocol was registered in the University Hospital Medical Information Network Clinical Trial Registry (UMIN000038929, https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000044393). Keywords: Lanthanum, Phosphate binder, Histiocytic infiltration, Whitish lesion Background The number of dialysis patients in Japan reached 329,609 in 2016 [1]. For dialysis patients, hyperphosphatemia is one of the critical complications because it significantly increases cardiovascular disease and mortality. To control the blood concentration of phosphoric acid, several types *Correspondence: [email protected] 1 Second Department of Internal Medicine, Osaka Medical College, 2‑7, Daigaku‑machi, Takatsuki, Osaka 569‑8686, Japan Full list of author information is available at the end of the article
of oral phosphate binders have been developed, including lanthanum carbonate (LaC) (Fosrenol®; Shire Pharmaceuticals, Hampshire, UK), which has been authorized by the Ministry of Health, Labor and Welfare in Japan. LaC is the first non-calcium, non-resin phosphate binder for hyperphosphatasemia
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