Association between Gastric Acid Suppression Therapy and Scattered White Spots in the Duodenum: A Retrospective Observational Study.

Background and Study Aims Endoscopic duodenal findings remain undescribed after long-term use of antacids despite their known effects on duodenal physiology. We identified scattered white spots (SWSs) as an endoscopic finding of chronic acid suppression in the duodenum and aimed to confirm this association. Patients and Methods In this single-center, two-arm, retrospective study, we reviewed 200 patients who underwent outpatient esophagogastroduodenoscopy: 100 consecutive patients receiving continuous acid-suppression (proton pump inhibitors [PPI] or potassium-competitive acid blockers [P-CAB] ≥ 8 weeks) and 100 consecutive patients with no history of acid-suppression therapy. Two blinded expert endoscopists independently reviewed all white-light endoscopic images of the descending duodenum. SWSs were graded 0 (absent/minimal), 1 (present) or 2 (dense). SWS positive was defined as a combined score ≥2 of the two independent evaluators. Results A total of 648 images from 200 patients (mean age 62 years, 62.5% male) were analyzed. The acid-suppression group included 58 PPI users and 42 P-CAB users. The SWS-positive rates were significantly higher in the acid-suppression group than the non-suppression group (47% vs. 15%; OR 4.33; 95% confidence interval [CI], 2.20-8.50; P < 0.0001). Interobserver agreement was substantial (weighted κ = 0.77; 95% CI, 0.68-0.85). Multivariate logistic regression analysis revealed acid-suppression therapy as an independent factor for SWS (adjusted OR 6.10; 95% CI, 2.89-13.7; P < 0.0001). Conclusions Long-term gastric acid suppression is significantly associated with the presence of duodenal SWS. Duodenal SWS associated with PPIs and P-CABs are under-recognized, and further studies are warranted to determine their clinical significance.