Systematic review with meta‐analysis: fundic gland polyps and proton pump inhibitors

Martin, Felicity C; Chenevix-Trench, Georgia; Yeomans, Neville D

doi:10.1111/apt.13800

Cited by 71 publications

(52 citation statements)

References 50 publications

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“…PPI treatment also induces foveolar epithelial cell hyperplasia and foveolar hyperplastic polyps . Furthermore, recent studies have shown that patients on PPIs have a larger size and a higher incidence of FGPs than those not on PPIs . Two systematic reviews showed an increased risk of FGPs with long‐term PPI treatment .…”

Section: Introductionmentioning

confidence: 99%

“…[14][15][16][17] Furthermore, recent studies have shown that patients on PPIs have a larger size and a higher incidence of FGPs than those not on PPIs. 14,16,[18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] Two systematic reviews showed an increased risk of FGPs with long-term PPI treatment. 34,35 Even though these reports showed the association between PPIs and FGPs, they did not clarify the histological changes of FGPs after PPI treatment.…”

Section: Introductionmentioning

confidence: 99%

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Histological analysis of fundic gland polyps secondary to PPI therapy

et al. 2019

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Aims The aim of this study was to clarify the histopathological features of fundic gland polyps (FGPs) in patients treated with proton pump inhibitors (PPIs) and to investigate the mechanism of enlargement of FGPs after PPI treatment. Methods and results A total of 196 biopsy specimens of FGPs, which consisted of 87 FGPs in patients treated with PPIs (PPI group) and 109 FGPs in patients treated without PPIs (non‐PPI group) were compared histologically using haematoxylin and eosin staining, Ki67 immunohistochemistry and multiplex immunohistochemical stain with Ki67, MUC5AC and MUC6. The significant histological features of FGPs in the PPI group were: larger size of dilated fundic gland cysts, larger number of foveolar and mixture type fundic gland cysts, foveolar cell hyperplasia, parietal cell protrusion, mononuclear cell infiltration and a higher percentage of Ki67‐positive cells in the deeper layers of the glands. Multiplex immunohistochemical stain showed that Ki67‐positive cells were also positive for MUC5AC, and the Ki67‐positive rate was significantly higher in MUC5AC‐positive cells of the PPI group than of the non‐PPI group. Gene mutations of β‐catenin were found in only 9.7% of FGPs in the PPI group. Conclusions Enlargement of fundic gland cysts due to foveolar cell proliferation and parietal cell protrusion might promote the enlargement of FGPs in patients treated with PPIs. β‐catenin gene mutations might not be associated with these histological changes of FGPs after PPI treatment.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Histological analysis of fundic gland polyps secondary to PPI therapy

et al. 2019

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“…However, a recent meta-analysis revealed an increase in FGP's amongst PPI users compared to controls (OR 2.46, 95% CI 1.42-4.27, P = 0.001). Especially if the drugs were taken for a longer period of time [7].…”

Section: Resultsmentioning

confidence: 99%

Presence of Fundic Gland Polyps in Patients Undergoing Upper Gastrointestinal Endoscopy: Incidence and the Relation with the Use of Proton Pump Inhibitors

Loffeld¹

2017

J Clin Gastroenterol Treat

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“…They are found in up to 23% of endoscopies, and dysplasia is found in < 1% of these polyps [28]. The mechanism involved in the increased prevalence of FGP in PPI users is still uncertain, but one hypothesis is that fundic gland cysts are caused by mucus blocking of the fundic pits [29]. …”

Section: Proposed Side Effects Of Ppismentioning

confidence: 99%

Proton Pump Inhibitors: Are They a Real Threat to the Patient?

Xavier¹,

Magalhães²,

Cotter³

2018

GE Port J Gastroenterol

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Background: Proton pump inhibitors are among the most frequently prescribed drugs in the world and are generally considered safe. However, there is growing concern regarding their safety. Summary: A nonsystematic review of the current literature was performed regarding proton pump inhibitors and their adverse effects. Proton pump inhibitors seem to be associated with fundic gland polyp development (without clinical relevance) and Clostridium difficile infection. Also, in cirrhotic patients, their prescription should be carefully reviewed. Regarding their association with other enteric infections, micronutrient deficiency, dementia, and chronic kidney disease, current evidence is still of low quality, and further studies are needed. Key Messages: Considering the current evidence, most patients with a clear clinical indication for proton pump inhibitor treatment should probably benefit from the maintenance of their treatment without significant adverse effects. However, higher-quality studies are needed to confirm or dismiss most of the proposed adverse effects.

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Systematic review with meta‐analysis: fundic gland polyps and proton pump inhibitors

Abstract: Proton pump inhibitor usage is associated with a significantly increased prevalence of fundic gland polyps, and there is a trend for this to increase with longer length of PPI exposure. However, the meta-analysis is limited mainly to cohort studies.

Cited by 71 publications

References 50 publications

Histological analysis of fundic gland polyps secondary to PPI therapy

Histological analysis of fundic gland polyps secondary to PPI therapy

Presence of Fundic Gland Polyps in Patients Undergoing Upper Gastrointestinal Endoscopy: Incidence and the Relation with the Use of Proton Pump Inhibitors

Proton Pump Inhibitors: Are They a Real Threat to the Patient?

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