Long Term Proton Pump Inhibitor Therapy and its Association with Fundic Gastric Polyps

Abstract

Purpose: Proton pump inhibitors (PPI) have been effectively used to treat acid peptic disease for a few decades now. Recent studies have associated long term PPI use with osteoporosis, increased incidence of Clostridium difficile colitis, Vitamin B12 deficiency and more recently with development of Fundic Gastric Polyps (FGPs). The association of PPIs with FGPs continues to be controversial and poorly understood. The purpose of this study was to present in detail a series of three cases that developed FGPs with long term PPI therapy and had complete resolution after discontinuation of the PPI. Methods: In this longitudinal study, three patients (average 57 years; range 52 to 66 years) with documented Gastroesophageal Reflux Disease (GERD) with long term PPI therapy (average 9 years; range 6 to 13 years) were included. Each patient had well documented endoscopy with mucosal biopsies prior to PPI therapy, during and following discontinuation of PPI therapy. Helicobacter pylori testing was performed on the mucosal biopsies using standard techniques. Results: No polyps were observed in the body of the stomach in all three cases prior to PPI therapy. After long term PPI therapy (6 to 12 years), a follow-up endoscopy performed to evaluate persistent GERD symptoms revealed presence of multiple sessile polyps. At this point of time, association of FGPs with PPI use was considered and therefore PPI therapy was discontinued. Repeat endoscopies 1 to 2 years after discontinuation of PPI therapy revealed near complete disappearance of these FGPs in all three cases. All three cases were negative for Helicobacter pylori infection. Conclusion: These observations suggest that long term use of PPI therapy in a select group of patients may be associated with development of numerous fundic polyps in the stomach. This phenomenon seems to be reversible with discontinuation of PPI therapy.