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Incidence and risk factor of fundic gland polyp and hyperplastic polyp in long-term proton pump inhibitor therapy: a prospective study in Japan

  • Original Article—Alimentary Tract
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Abstract

Goal

To investigate the development of fundic gland polyp (FGP) and gastric hyperplastic polyp (HPP) during long-term proton pump inhibitor (PPI) therapy and risk factors of each polyp via patient status in a multicenter prospective study.

Background

The risk of developing FGP may increase during long-term PPI therapy. However, the association with PPI-induced hypergastrinemia is unclear. Helicobacter pylori (Hp) infection (which there is a high rate of in Japan) may influence the development of HPP.

Methods

Reflux esophagitis patients on PPI maintenance therapy were enrolled. At baseline, the presence of protruding lesion (gastric polyps) and mucosal atrophy was examined endoscopically. The serum gastrin level (SGL) and Hp infection status were noted. The patients took rabeprazole 10 mg/day for 104 weeks and endoscopy was performed at weeks 24, 52, 76, and 104 to check for newly developed FGPs and HPPs. The hazard ratios (HRs) of risk factors were calculated.

Results

191 patients were analyzed. The distribution of patients with baseline SGLs (pg/mL) of <200, ≥200 to <400, and ≥400 was 118 (61.8%), 51 (26.7%), and 22 (11.5%), respectively. 78 (40.8%) patients were Hp-positive, and gastric polyps were found in 70 (36.6%) patients. By the end of rabeprazole therapy, 26 (13.6%) and 17 (8.9%) patients had developed new FGPs and HPPs. In terms of risk factors, Hp-positive was significantly lower (HR = 0.288; 95% CI, 0.108–0.764) for FGP while SGL ≥400 pg/mL was significantly higher (HR = 4.923; 95% CI, 1.486–16.31) for HPP.

Conclusion

During long-term PPI therapy, FGP development was associated with absence of Hp infection. Meanwhile, Hp infection and high SGL may influence HPP development.

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Acknowledgments

This study was funded by Eisai Co., Ltd., Tokyo, Japan. We would like to thank Dr. Jun Miwa and Dr. Tomoki Inaba for providing the endoscopic and histological images of polyps. We also would like to thank five staff of Eisai Co., Ltd. (Yasuhiro Marukawa, Toshihisa Arai, Kazutaka Matsuo, Toshiyuki Tamai, and Yukinori Sakata) for their kind assistance in preparing the manuscript.

Author information

Authors and Affiliations

  1. Departments of Comprehensive Medicine and Psychosomatic Medicine, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba, Sendai, Miyagi, 980-8574, Japan

    Michio Hongo

  2. Department of Internal Medicine, Saga Medical School, Saga, Japan

    Kazuma Fujimoto

Authors
  1. Michio Hongo
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  2. Kazuma Fujimoto
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Consortia

Gastric Polyps Study Group

Corresponding author

Correspondence to Michio Hongo.

Additional information

Members of the Gastric Polyps Study Group are listed in the Appendix.

Appendix

Appendix

Members of Gastric Polyps Study Group

Tsuyoshi Yabana, Takeaki Kobayashi, Doto Hospital, Sapporo; Masashi Nomura, Masafumi Yoshida, Shinya Mitsui, Akio Katanuma, Teine Keijinkai Hospital, Sapporo; Masafumi Komatsu, Akira Zeniya, Akita City Hospital, Akita; Kazutoshi Fukase, Katsuhiro Mabe, Chieko Kato, Yasukuni Suzuki, Yamagata Prefectural Central Hospital, Yamagata; Yasutoshi Saito, Jizankai Medical Foundation Tsuboi Cancer Center Hospital, Koriyama; Nobuo Toda, Susumu Kurosawa, Rei Kashima, Tetsuo Ebihara, Teikyo University Chiba Medical Center, Ichihara; Toshihide Maruyama, Juntendo University Urayasu Hospital, Urayasu; Ryoichi Wada, Tokuhisa Sezaki, Nobuto Hirata, Kameda Medical Center, Kamogawa; Yasushi Kuyama, Taro Ishii, Takatsugu Yamamoto, Teikyo University School of Medicine, Tokyo; Jun Miwa, Yasuo Matsubara, Toshiba General Hospital, Tokyo; Nobuyuki Matsuhashi, Yukihiro Sakurai, Masako Asayama, Koji Higa, Tomohiko Hasue, Kanto Medical Center NTT EC, Tokyo; Hirokazu Komatsu, Kiyoko Imamura, Shigeru Yamanaka, Yoshio Hosaka, Yuriko Hara, Shuichi Nagakubo, Yokohama Municipal Citizen’s Hospital, Yokohama; Sotaro Fujimoto, Hiromu Kutsumi, Nobuaki Yagi, Masahiro Arai, Kyoto First Red Cross Hospital, Kyoto; Kenjiro Yasuda, Masatoshi Miyata, Munehiro Sakata, Moose Ueda, Mami Ogawa, Kyoto Second Red Cross Hospital, Kyoto; Toshiki Takemura, Hideto Inokuchi, Masataka Matsushita, Kengo Takimoto, Hideyuki Shiomi, Ijinkai Takeda General Hospital, Kyoto; Takama Maekawa, National Hospital Organization Kyoto Medical Center, Kyoto; Yukimasa Yamashita, Toko Kaneshiro, Masamichi Nasu, Miki City Hospital, Miki; Kazuhiko Inoue, Osamu Mihara, Matsue Red Cross Hospital, Matsue; Shiro Okamoto, Kanji Kodama, Kure Kyosai Hospital, Kure; Toru Hidaka, Hiroshima City Asa Hospital, Hiroshima; Akira Tari, Hiroshi Tani, Hiroshima Red Cross Hospital & Atomic Bomb Survivors Hospital, Hiroshima; Tomoki Inaba, Masaki Wato, Kagawa Prefectural Central Hospital, Takamatsu; Shuji Inoue, Sae Kujime, Kozo Fuke, National Hospital Organization Kochi Hospital, Kochi; Masahito Nakauchi, Chiaki Watanabe, Kazuo Nakajo, Jinsei-kai Hosogi Hospital, Kochi; Yozo Iida, Noboru Maetani, Kokura Memorial Hospital, Kitakyusyu; Ryuichiro Maekawa, Shinichi Iwanaga, Masaru Sasaki, Hajime Aino, Social Insurance Tagawa Hospital, Tagawa; Kazuma Fujimoto, Ryuichi Iwakiri, Hiroyuki Sakata, Akifumi Ootani, Saga Medical School, Saga.

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Hongo, M., Fujimoto, K. & Gastric Polyps Study Group. Incidence and risk factor of fundic gland polyp and hyperplastic polyp in long-term proton pump inhibitor therapy: a prospective study in Japan. J Gastroenterol 45, 618–624 (2010). https://doi.org/10.1007/s00535-010-0207-7

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  • DOI: https://doi.org/10.1007/s00535-010-0207-7

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