CASES OF GASTRIC FUNDIC GLAND POLYPS INCREASING IN THE SIZE DURING THE LONG-TERM THERAPY WITH PROTON PUMP INHIBITOR

Abstract

It is reported that gastric fundic gland polyps (FGPs) increase in the size during the long-term therapy with PPI. To clarify the mechanism of such enlargement, we studied the clinical and pathological features of 13 patients (3 men and 10 women, mean age 70.5 years old) in whom FGPs grew up during PPI treatment. PPI was given for treatment of GERD in 12 patients and for prevention of peptic ulcer in 1 patient. The duration (mean±2SE) between the initiation of the therapy and the time when enlargement of FGP was diagnosed was 29.9±8.3 months. The diameters of FGP were smaller than 5 mm in all patients before the initiation of the therapy, but they ranged between 5 and 15 mm after the long-term therapy. Enlarged FGPs showed the blister-like appearance on endoscopy. All patients were negative for H. pylori infection. Serum gastrin level was elevated in 4 of 8 patients. Light microscopic examination of FGP excised by endoscopic mucosal resection revealed cystic dilatation of many fundic glands with mucous cell and parietal cell hyperplasia. There existed no histological finding showing endocrine cell micronests or carcinoid tumor. It is suggested that the long-term administration of PPI inhibited secretion of gastric acids, leading to provoke hyperplastic cystic changes in the fundic glands in cases of H. pylori-negative patients.