ENDOSCOPIC DIAGNOSIS OF DRUG-INDUCED GASTRIC MUCOSAL LESIONS

Abstract

Drug-induced gastric mucosal injury is a common gastrointestinal condition encountered in clinical practice. Various medications can damage the gastric mucosa through distinct mechanisms, resulting in characteristic endoscopic findings and histopathological features. This review highlights the endoscopic findings associated with several representative drugs, including nonsteroidal anti-inflammatory drugs (NSAIDs), proton pump inhibitors (PPIs), vonoprazan, bisphosphonates, iron supplements, antibiotics, zinc acetate, immune checkpoint inhibitors, olmesartan, and lanthanum carbonate. NSAIDs are a major cause of drug-induced gastric injury, often presenting endoscopically as erosions, ulcers, and bleeding predominantly in the antrum and pyloric regions. Risk factors include the concomitant use of corticosteroids or bisphosphonates, as well as Helicobacter pylori infection. PPIs and vonoprazan can induce unique changes, such as multiple white and flat elevated lesions, cobblestone-like mucosa, and enlargement of hyperplastic or fundic gland polyps. Notably, web-like mucus may impair visualization, necessitating a thorough examination. Bisphosphonates and iron supplements frequently cause direct mucosal irritation resulting in erosive lesions. Zinc acetate has been reported to induce gastric mucosal changes, including erythema, erosions, and a white coating, particularly in the gastric body. Immune checkpoint inhibitors, widely used in cancer immunotherapy, can result in immune-related gastric injuries. Lanthanum carbonate deposits in the gastric mucosa appear whitish on endoscopy. This review emphasizes the importance of recognizing drug-specific endoscopic findings to improve the diagnostic accuracy and guide appropriate management. Familiarity with these distinctive patterns is crucial for endoscopists to deliver optimal care to patients with drug-induced gastric mucosal lesions.