Proton-Pump Inhibitors and Fundic-Gland Polyps
In a recent study, investigators in the Netherlands prospectively evaluated 599 consecutive patients who underwent upper endoscopy. The presence or absence of fundic-gland polyps was noted in each patient; gastric mucosa and polyp biopsy specimens were collected. Survey answers about PPI use (dosage and duration) were validated using office or hospital records.
The conclusion: Acid suppression produces parietal-cell hyperplasia. Parietal cells are large peripheral cells of the mucous membrane of the stomach that secrete hydrochloric acid. Hyperplasia means an increase in the number of the cells. This study suggests that, during acid suppression with PPIs, such hyperplasia can lead to fundic-gland polyps in a time-dependent fashion. However, as the authors point out, fundic-gland polyps have little, if any, clinical significance, as they generally are not dysplastic and do not progress to premalignant or malignant lesions.
For more information on this study, you can read this abstract.
Comments
I am surprised that no comments have been made. I have been researching and experimenting since polyps were sporadically detected in my stomach about 5 years ago about 1 year after start of a PPI. Even the linked articles to your comment show controversy. Individual case reports have found adenomas of the gastric mucosa in sporadic fundic gland polyposis only when the WHOLE polyp was removed. Associations to colonic polyps have also been made. The fundal polyps have been considered trivial but in North America the chances of finding EARLY gastric cancer are almost neglible. We are just now regularly screening for colonic polyps in those >50y because of the evidence (diet,and genetic connections) No one truly knows because the surveillance data for GASTRIC polyps is not there. The PPI use has expanded to the OTC market so we have yet to see the outcomes.
So far I have shown improvement by changing and reducing the dose of my PPI. The drug safety department of the manufacturer knows about my experience but neither further endoscopic surveillance or genetic testing is planned by my gastroenterologist at this time. I have had symptoms and changes to my iron indicies which have improved. I am hopeful that this is a good sign and pray that I have nothing further to expect. More information has come out of Japan where gastric cancer is more prevalent and where early detection by gastric surveillance has become as common as colonic surveillance here. Five years ago I could find little on this topic - now there is experience, assessments and judgements being made.
I have been taking PPIs (Prevacid) for many years and I was recently diagnosed with multiple stomach polyps. Some were also large >2cm. My doctor took biopsies of several, but none of them came back for any type of cancer. She did say she was concerned because of the number and size, so I opted to quit taking the PPIs and started using Zantac instead (doesn’t work as well). The reason I did this though was because I had read that when others stopped taking the PPIs, the polyps went away. I’m going to stop for 3 months and then they’re going to do another endoscopy to check. I have my fingers crossed!
I was recently diagnosed with Fundic Gland Polyps of the Gastric Mucos. These are a result of long-term PPI therapy. I am wondering why this is not listed in side effects. I have been told by my internist (presently I live in Germany) that I should be scoped yearly.