Large Fundic Gland Polyp Associated with Long-Term Proton Pump Inhibitor Administration Mimicking Gastric-Type Neoplasm

Ochiai, Yasutoshi; Kikuchi, Daisuke; Ito, Shinji; Takazawa, Yutaka; Hoteya, Shu

doi:10.1159/000512399

Cited by 7 publications

(7 citation statements)

References 11 publications

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“…Therefore, our case was considered sporadic and probably PPI-related. A report from Japan stated that after rabeprazole was used for 104 weeks, 13.6% of patients developed new fundic gland polyps, predominantly in the gastric corpus, with sizes less than 5 mm [ 8 ]. In this index case, though there were multiple polyps in the fundus and body, a large antral polyp measuring 15 × 10 × 10 mm was seen, larger than the usual FGP.…”

Section: Discussionmentioning

confidence: 99%

Clinicopathologic Correlation of Large Gastric Polyps in an Elderly Female: Case Report and Review of the Literature

Taleb,

Awosusi

2024

Cureus

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Fundic gland polyps (FGPs) are benign epithelial polyps usually located in the gastric body and fundus. Here, we describe the case of an elderly woman who presented with symptomatic anemia, abdominal pain, and weight loss. There was also history of chronic use of proton pump inhibitors for the symptomatic treatment of dyspepsia. Reflux esophagitis, duodenal ulcers, and multiple gastric polyps suspicious of malignancy were found at endoscopy. A large pedunculated antral polyp measuring more than 10mm in the largest dimension and other smaller polyps in the body and fundus were removed completely by cold snare and sent for histopathologic evaluation. The polyps were eventually diagnosed as benign fundic gland polyps. Biopsies taken from the gastric mucosa also showed Helicobacter pylori-associated gastritis. Helicobacter pylori eradication therapy was commenced with the resultant resolution of symptoms. No surveillance is required for FGPs because they are not premalignant lesions. However, large FGPs require excision and thorough histopathologic evaluation to rule out atypia and malignancy. This index case further highlights a possible causal link between the chronic use of proton pump inhibitors and the development of fundic gland polyps.

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Section: Discussionmentioning

confidence: 99%

Clinicopathologic Correlation of Large Gastric Polyps in an Elderly Female: Case Report and Review of the Literature

Taleb,

Awosusi

2024

Cureus

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“…In the current Japanese guideline, it is reported that longterm PPI therapy is generally safe; however, careful observations are required [5]. Regarding PPI-related endoscopic gastric mucosal changes, fundic gland polyps, hyperplastic polyps, multiple white and at elevated lesions, cobblestone-like mucosa, and black spots have been reported [14,15]. The safety of the long-term administration of VPZ remains unknown.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of tapering (STEP down) therapy using vonoprazan for symptomatic mild reflux esophagitis

Ochiai

Kikuchi

Hoteya

2023

Preprint

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Aim: This study aimed to elucidate the efficacy of tapering (STEP down) therapy based on patients’ symptoms using vonoprazan (VPZ) for symptomatic mild reflux esophagitis (RE). Methods: Sixty-three consecutive symptomatic patients with mild RE were enrolled in this study. STEP down therapy was defined as a treatment period of 28 days. VPZ (20 mg) was administered as initial treatment. Patients were allowed to step down to 10 mg VPZ if their symptoms improved, and may discontinue VPZ if their symptoms disappeared. When symptoms worsened, dosage could be increased from 10 mg to 20 mg VPZ, or VPZ restarted at 20 mg following discontinuation. Results: The proportion of the patients whose FSSG scores decreased by three points or more with STEP down therapy was 76.2% (48/63 patients). The median FSSG scores before and after STEP down therapy were 13 (8–35) and 7 (0–29) points, respectively (p<0.01). Overall, 71.4% (45/63) of patients stepped down from 20 mg to 10 mg VPZ, and 46% (29/63) of patients discontinued VPZ. Conclusion: STEP down therapy with VPZ may be a viable treatment option in symptomatic patients with mild RE.

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“…It is well‐known that PPIs could cause changes in the endoscopic appearance of the stomach in the form of side reactions such as fundic gland polyps, GHPs, and PHPs 3 . Regarding the endoscopic findings of PHPs, they were reported as reddish, smooth, and dome‐shaped polyps <10 mm in diameter 4 . On the contrary, some studies made reference to a case of a >20‐mm‐sized polyp in a non‐ HP infected stomach and the difficulty of diagnosing neoplasia endoscopically even when using NBI‐ME 4 .…”

Section: Discussionmentioning

confidence: 99%

“…Regarding the endoscopic findings of PHPs, they were reported as reddish, smooth, and dome‐shaped polyps <10 mm in diameter 4 . On the contrary, some studies made reference to a case of a >20‐mm‐sized polyp in a non‐ HP infected stomach and the difficulty of diagnosing neoplasia endoscopically even when using NBI‐ME 4 . The reduction in the GHPs after the discontinuation of long‐term PPI usage is also well‐known 5 .…”

Section: Discussionmentioning

confidence: 99%

Morphological change of foveolar‐type gastric adenocarcinoma after proton pump inhibitor discontinuation in a short time period: A case report

Igarashi,

Hanabata,

Furusawa

et al. 2023

DEN Open

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A 37‐year‐old man with systemic lupus erythematosus underwent esophagogastroduodenoscopy as a screening examination for anemia and bloody stool. A semi‐pedunculated edematous lobular polyp of 25 mm in size was detected in the greater curvature of the upper gastric body. At that time, a definitive diagnosis of cancer could not be made based on a biopsy specimen from the lesion. Since the patient was on proton pump inhibitor (PPI) for a long time to prevent peptic ulceration due to prolonged prednisolone administration for systemic lupus erythematosus, we diagnosed the lesion as a PPI‐associated hyperplastic polyp and switched lansoprazole to famotidine. Two months later, esophagogastroduodenoscopy revealed that the polyp had decreased in size to 8 mm, whereas the biopsy specimen led to a histological diagnosis of gastric cancer. The polyp was removed by endoscopic submucosal dissection. Immunohistochemistry revealed that the tumor cells were positive for MUC5AC, but negative for MUC2 and MUC6, leading to a final diagnosis of foveolar‐type gastric adenocarcinoma. In conclusion, we may suggest that PPI induces reversible morphological changes in foveolar‐type gastric adenocarcinoma. Furthermore, short‐term follow‐up of polypoid lesions should be prepared, considering tumor comorbidity with morphological changes during long‐term PPI usage.

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Large Fundic Gland Polyp Associated with Long-Term Proton Pump Inhibitor Administration Mimicking Gastric-Type Neoplasm

Cited by 7 publications

References 11 publications

Clinicopathologic Correlation of Large Gastric Polyps in an Elderly Female: Case Report and Review of the Literature

Clinicopathologic Correlation of Large Gastric Polyps in an Elderly Female: Case Report and Review of the Literature

Efficacy of tapering (STEP down) therapy using vonoprazan for symptomatic mild reflux esophagitis

Morphological change of foveolar‐type gastric adenocarcinoma after proton pump inhibitor discontinuation in a short time period: A case report

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