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 (SWS) as an endoscopic finding of chronic acid suppression in the duodenum and aimed to confirm this association. Patients and Methods: In this single-centre, two-arm, retrospective study, we reviewed 200 patients who underwent outpatient oesophagogastroduodenoscopy (OGD): 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. SWS 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 analysed. The acid suppression group included 58 PPI users and 42 P-CAB users. SWS-positive rates were significantly higher in the acid-suppression group than the non-suppression group (47% vs. 15%; OR 4.33; 95% 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 PPI and P-CAB are under-recognised, and further studies are warranted to determine their clinical significance.