Hemorrhagic Fundic Gland Polyps Associated with Proton Pump Inhibitor Use and Anticoagulation

Abstract

Introduction: Fundic gland polyps (FGP) are the most commonly found gastric polyps in Western countries and are often incidental findings on upper endoscopic examinations. FGPs have a known association with chronic proton pump inhibitor (PPI) use, however they are rarely associated with iron deficiency anemia and GI bleeding. We present a case of hemorrhagic FGPs that resolved with discontinuation of PPI therapy. Case: A 72 year-old female underwent upper endoscopy and colonoscopy after being hospitalized with severe iron deficiency anemia. Her past medical history included insulin-dependent diabetes mellitus and coronary artery disease with coronary artery bypass graft, for which she was on c lopidogrel. The upper endoscopy showed multiple, large bleeding gastric polyps. The largest polyps were removed by snare polypectomy and endoclips were placed to achieve hemostasis. Pathology revealed fundic gland polyps with focal ulceration and without dysplasia. Her colonoscopy revealed no additional polyps. The PPI and clopidogrel were stopped, and the patient was discharged home. Healing and incomplete resolution of the fundic gland polyps was noted during three month followup EGD. Upper endoscopy revealed normal appearing gastric mucosa three years after the initial presentation. Discussion: Fundic gland polyps are the most commonly found gastric polyps in Western countries where Helicobacter pylori prevalence is low and PPI use is common. They are generally categorized as non-neoplastic and are found in up to 2% of all upper gastrointestinal endoscopy examinations performed. Unlike hyperplastic polyps, FGPs are often asymptomatic and rarely associated with gastrointestinal bleeding. While sporadic FGPs have been theorized to be the result of activating mutations of beta catenin genes, there has been a noticeable increase in FGPs associated with long-term proton pump inhibitor use in developed countries worldwide; in some studies PPI use of greater than 12 months incurs a fourfold increase in incidence of FGPs. We describe a rare case of bleeding fundic gland polyps that resolved completely with the discontinuation of proton pump inhibitors and antiplatelet medication.Figure 1Figure 2Figure 3