Gastric Fundic Gland Polyps: Can Histology Be Useful to Predict Proton Pump Inhibitors Use?

Abstract

BACKGROUND: Fundic gland polyps allegedly increased in frequency in recent decades, and had attracted great attention due to possible association with prolonged proton pump inhibitor therapy. Prolonged use of this drug could cause parietal cell hyperplasia, obstruction of glandular lumen and cystic dilation of the gland. OBJECTIVE: This study aims to analyze clinical and pathological features of fundic gland polyps in patients with and without proton pump inhibitor therapy in a selected population from Brazil. METHODS: It was selected a sample of 101 Brazilian patients (78 females and 23 males), from a five years retrospective search of the files from a private pathology laboratory. The patients had an average age of 57 years and we included patients with a histological diagnosis of fundic gland polyp. The clinical data were obtained from their files and all histological slides were reviewed and examined with hematoxylin and eosin (HE) and Giemsa. RESULTS: Information about the use or non-use of proton pump inhibitors (PPI) was obtained in 84 patient files. In 17 cases we could not determine if PPI were used or not. Among those in which the information was available, a positive history of anti-acid therapy was observed in 63 (75.0%) patients. Parietal cell hypertrophy/hyperplasia and parietal cell protrusions were detected in most slides. Histological findings were identical in PPI users and PPI negative patients. Helicobacter pylori infection was detected in just two samples. Epithelial dysplasia or adenocarcinoma were not observed in our cases. Histopathological analysis of fundic gland polyps could not distinguish between PPI and non-PPI related cases. Parietal cell cytoplasmic protrusions, an alleged marker of prolonged acid suppression therapy, was detected in both groups. CONCLUSION: Histological features could not discriminate anti-acid therapy related fundic glands polyps in our patients.

Pre-Operative Screening of Helicobacter Pylori in Bariatric Patients: Is Histopathological Analysis Necessary?

“…Likewise, there was previous evidence that the prevalence of fundic gland polyps was inversely related to H. pylori infection, in contrast to hyperplastic polyps. It is believed that the activity of proteases produced by bacteria act in the degradation of gastric mucus and prevent cystic gland dilatation in these patients (16)(17)(18)(19) . Furthermore, the prevalence of H. pylori-related abnormalities in the current study was evident; in a context of patients who will undergo bariatric surgery, especially gastric bypass, pre-operative screening followed by eradication should be considered mandatory by our group, in order to avoid post-operative complications, improve dyspeptic symptoms (abdominal pain, reflux and nausea and vomiting) and because of the increased anatomical difficulty for endoscopic evaluation after the procedure, since most of the stomach will be excluded from food transit in gastric bypass procedures.…”

Proton pump inhibitors are not associated with fundic gland polyps – a systematic review that takes into consideration all known confounders

“…has not been associated with FGP development after 48 weeks [109]. Histological studies have shown that PPI lead to hypertrophy of parietal cells [66,104,113,114], but not to FGP [26,33,34]. There is, therefore, no demonstrable mechanism to support that PPIs can induce FGPs.…”

“…Absence of a dose-response relationship [61,94], and no predictable dose of PPI that would lead to FGP development [18]. Plausibility Histological studies have shown that PPI lead to hypertrophy of parietal cells [66,[104][105][106], but not to FGP [26,33,34]…”

“…The association between PPIs and fundic gland polyps (FGPs) has been controversial since it was first proposed in 1992 [14]; and there have been reports for [15][16][17][18][19][20][21][22][23][24][25] and against [26][27][28][29][30][31][32][33][34][35][36]. Two meta-analyses [37,38] in 2016 supported the association.…”

Idiopathic multitudinous fundic gland polyposis: A new disease and a management dilemma

“…They are either sporadic or syndromic in origin. 1 Sporadic fundic gland polyps, including those associated with the prolonged use of proton pump inhibitors (PPIs) [although the association remains controversial 2 ], are mostly fewer than 10 in number, [3][4][5][6] and a practical approach is to remove all the polyps for pathological examination to exclude dysplasia. In syndromic fundic gland polyposis, including familial adenomatous polyposis, MUTYH (MYH) gene-associated polyposis, gastric adenocarcinoma and proximal polyposis of the stomach (GAPPS), and autosomal dominant familial gastric polyposis, 1 polyps are invariably numerous 7 and carry a malignant potential in the form of dysplasia in 50-100%.…”