Skip to main content

Advertisement

Log in

Fundic Gland Polyps and Association with Proton Pump Inhibitor Intake: A Prospective Study in 1,780 Endoscopies

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Background and Aims

Fundic gland polyps (FGPs) are incidentally found when an endoscopy is performed for a non-related indication. Some authors suggested a relationship with proton pump inhibitor (PPI) intake. We aimed to determine their prevalence and association with PPI intake.

Methods

We prospectively studied 1,780 patients who underwent a gastroduodenal endoscopy at our ambulatory care center between June 2007 and August 2008. PPI intake during a period of at least 12 months, female gender and age were statistically evaluated as risk factors for the presence of FGPs. Then, a multiple logistic regression analysis was applied to these variables.

Results

Gastric polyps were found in 129 patients (7.2%) and 77 (4.33%) were FGPs. Five patients with no available histology were excluded for the assessment of risk factors. PPI intake was detected in 49 patients with FGPs (63.6%) and 264 without FGPs (15.5%) (P < 0.0001). Fifty-nine patients with FGPs (76.7%) and 987 without FGPs (58.1%) were women (P < 0.001). The mean age was 58.91 ± 11.82 years in patients with FGPs and 50.34 ± 15.04 years in patients without FGPs (P < 0.0001). The three variables remained significant in the multiple model: PPI intake: P < 0.0001, OR 9.00 (95% CI 5.44–14.89); female gender: P = 0.0001, OR 2.95 (95% CI 1.69–5.15); age: P = 0.001, OR 1.03 (95% CI 1.01–1.05).

Conclusions

In our population, the prevalence of FGPs was high. Although female gender and age were also significant, PPI intake was the strongest risk factor associated with the presence of FGPs.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. Archimandritis A, Spiliadis C, Tzivras M, et al. Gastric epithelial polyps: a retrospective endoscopic study of 12,974 symptomatic patients. Ital J Gastroenterol. 1996;28:387–390.

    PubMed  CAS  Google Scholar 

  2. Carmack SW, Genta RM, Schuler CM, Saboorian MH. The current spectrum of gastric polyps: A 1-year national study of over 120,000 patients. Am J Gastroenterol. 2009;104:1524–1532.

    Article  PubMed  Google Scholar 

  3. Marcial MA, Villafaña M, Hernandez-Denton J, Colon-Pagan JR. Fundic gland polyps: Prevalence and clinicopathologic features. Am J Gastroenterol. 1993;88:1711–1713.

    PubMed  CAS  Google Scholar 

  4. Ally MR, Verappan GR, Maydonovitch CL, et al. Chronic proton pump inhibitor therapy associated with increased development of fundic gland polyps. Dig Dis Sci. 2009;54:2617–2622.

    Article  PubMed  CAS  Google Scholar 

  5. Papa A, Cammarota G, Tursi A, et al. Histologic types and surveillance of gastric polyps: A 7 year clinico-pathological study. Hepatogastroenterology. 1998;45:579–582.

    PubMed  CAS  Google Scholar 

  6. Bertoni G, Sassatelli R, Nigrisoli E, et al. Dysplastic changes in gastric fundic gland polyps of patients with familial adenomatous polyposis. Ital J Gastroenterol Hepatol. 1999;31:192–197.

    PubMed  CAS  Google Scholar 

  7. Attard TM, Cuffari C, Tajouri T, et al. Multicenter experience with upper gastrointestinal polyps in pediatric patients with familial adenomatous polyposis. Am J Gastroenterol. 2004;99:681–686.

    Article  PubMed  Google Scholar 

  8. Jalving M, Koornstra JJ, Wesseling J, Boezen HM, de Jong S, Kleibeuker JH. increased risk of fundic gland polyps during long-term proton pump inhibitor therapy. Alim Pharmacol Ther. 2006;24:1341–1348.

    Article  CAS  Google Scholar 

  9. Carmack SW, Genta RM, Graham DY, Lauwers GY. Management of gastric polyps: A pathology-based guide for gastroenterologists. Nat Rev Gastroenterol Hepatol. 2009;6:331–341.

    Article  PubMed  Google Scholar 

  10. Jalving M, Koornstra JJ, Götz JM, et al. High-grade dysplasia in sporadic fundic gland polyps: A case report and review of the literature. Eur J Gastroenterol Hepatol. 2003;15:1229–1233.

    Article  PubMed  Google Scholar 

  11. Vieth M, Stolte M. Fundic gland polyps are not induced by proton pump inhibitor therapy. Am J Clin Pathol. 2001;116:716–720.

    Article  PubMed  CAS  Google Scholar 

  12. Abraham SC, Park SJ, Mugartegui L, Hamilton SR, Wu TT. Sporadic fundic gland polyps with epithelial dysplasia: evidence for preferential targeting for mutations in the adenomatous polyposis coli gene. Am J Pathol. 2002;161:1735–1742.

    Article  PubMed  CAS  Google Scholar 

  13. Graham JR. Gastric polyposis: Onset during long-term therapy with omeprazole. Med J Austr. 1992;157:287–288.

    CAS  Google Scholar 

  14. Freeman HJ. Proton pump inhibitors and an emerging epidemic of gastric fundic gland polyposis. World J Gastroenterol. 2008;14:1318–1320.

    Article  PubMed  Google Scholar 

  15. Turner JR, Odze RD. Polyps of the stomach. In: Odze RD, Goldblum JR, eds. Surgical pathology of the GI tract, liver, biliary tract and pancreas. Philadelphia, PA: Saunders Elsevier; 2009:415–445.

  16. Lee RG, Burt RW. The histopathology of fundic gland polyps of the stomach. Am J Clin Pathol. 1986;86:498–503.

    PubMed  CAS  Google Scholar 

  17. Burt RW. Gastric fundic gland polyps. Gastroenterology. 2003;125:1462–1469.

    Article  PubMed  Google Scholar 

  18. Park DY, Lauwers GY. Gastric polyps. Classification and management. Arch Pathol Lab Med. 2008;132:633–640.

    Google Scholar 

  19. Morson BC, Sobin LH, Grundmann E, Johansen A, Nagayo T, Serck-Hanssen A. Precancerous conditions and epithelial dysplasia in the stomach. J Clin Pathol. 1980;33:711–721.

    Article  PubMed  CAS  Google Scholar 

  20. Hosmer DW, Lemeshow S. Applied logistic regression. New York, NY: John Wiley & Sons, Inc; 2000.

    Book  Google Scholar 

  21. Niv Y, Bat L. Gastric polyps—a clinical study. Isr J Med Sci. 1985;21:841–844.

    PubMed  CAS  Google Scholar 

  22. Deppisch LM, Rona VT. Gastric ephitelial polyps. A 10-year study. J Clin Gastroenterol. 1989;11:110–115.

    Article  PubMed  CAS  Google Scholar 

  23. Roseau G, Ducreux M, Molas G, et al. Ephitelial gastric polyps in a series of 13,000 gastroscopies. Presse Med. 1990;19:650–654.

    PubMed  CAS  Google Scholar 

  24. Stolte M, Sticht T, Eidt S, Ebert D, Finkenzeller G. Frequency, location, and age and sex distribution of various types of gastric polyp. Endoscopy. 1994;26:659–665.

    Article  PubMed  CAS  Google Scholar 

  25. Ljubicic N, Kujundzic M, Roic G, et al. Benign epithelial gastric polyps—frequency, location, and age and sex distribution. Coll Antropol. 2002;26:55–60.

    PubMed  CAS  Google Scholar 

  26. Gencosmanoglu R, Sen-Oran E, Kurtkaya-Yapicier O, Avsar E, Sav A, Tozun N. Gastric polypoid lesions: analysis of 150 endoscopic polypectomy specimens from 91 patients. World J Gastroenterol. 2003;9:2236–2239.

    PubMed  Google Scholar 

  27. Morais DJ, Yamanaka A, Zeitune JM, Andreollo NA. Gastric polyps: a retrospective analysis of 26,000 digestive endoscopies. Arq Gastroenterol. 2007;44:14–17.

    Article  PubMed  Google Scholar 

  28. Genta RM, Schuler CM, Robiou CI, Lash RH. No association between gastric fundic gland polyps and gastrointestinal neoplasia in a study of over 100,000 patients. Clin Gastroenterol Hepatol. 2009;7:849–854.

    Article  PubMed  Google Scholar 

  29. Van Vlierberghe H, De Vos M, De Cock G, Cuvelier C, Elewaut A. Fundic gland polyps: Three other case reports suggesting a possible association with acid suppressing therapy. Acta Gastroenterol Belg. 1997;60:240–242.

    PubMed  Google Scholar 

  30. el-Zimaity HM, Jackson FW, Graham DY. Fundic gland polyps developing during omeprazole therapy. Am J Gastroenterol. 1997;92:1858–1860.

    PubMed  CAS  Google Scholar 

  31. Choudry U, Boyce HW, Coppola D. Proton pump inhibitor-associated gastric polyps: A retrospective analysis of their frequency, and endoscopic, histologic, and ultrastructural characteristics. Am J Clin Pathol. 1998;110:615–621.

    Google Scholar 

  32. Masaoka T, Suzuki H, Hibi T. Gastric epithelial cell modality and proton pump inhibitor. J Clin Biochem Nutr. 2008;42:191–196.

    Article  PubMed  CAS  Google Scholar 

  33. Kh TJ, Chen D. Gastrin as a growth factor in the gastrointestinal tract. Regul Pept. 2000;93:37–44.

    Article  Google Scholar 

  34. Fossmark R, Jianu CS, Martinsen TC, Qvigstad G, Syversen U, Waldum HL. Serum gastrin and chromogranin A levels in patients with fundic gland polyps caused by long-term proton-pump inhibition. Scand J Gastroenterol. 2008;43:20–24.

    Article  PubMed  CAS  Google Scholar 

  35. Cats A, Schenk BE, Bloemena E, et al. Parietal cell protrusions and fundic gland cysts during omeprazole maintenance treatment. Hum Pathol. 2000;31:684–690.

    Article  PubMed  CAS  Google Scholar 

  36. Krishnamurthy S, Dayal Y. Parietal cello protrusions in gastric ulcer disease. Hum Pathol. 1997;28:1126–1130.

    Article  PubMed  CAS  Google Scholar 

  37. Shand AG, Taylor AC, Banerjee M, et al. Gastric fundic gland polyps in south-east Scotland: Absence of adenomatous polyposis coli gene mutations and a strikingly low prevalence of Helicobacter pylori infection. J Gastroenterol Hepatol. 2002;17:1161–1164.

    Article  PubMed  CAS  Google Scholar 

  38. Olmos JA, Ríos H, Higa R. Prevalence of Helicobacter pylori infection in Argentina: Results of a nationwide epidemiologic study. Argentinean Hp epidemiologic study group. J Clin Gastroenterol. 2000;31:33–37.

    Article  PubMed  CAS  Google Scholar 

  39. Hofgärtner WT, Thorp M, Ramus MW, et al. Gastric adenocarcinoma associated with fundic gland polyps in a patient with attenuated familial adenomatous polyposis. Am J Gastroenterol. 1999;94:2275–2281.

    PubMed  Google Scholar 

  40. Zwick A, Munir M, Ryan CK, et al. Gastric adenocarcinoma and dysplasia in fundic gland polyps with attenuated adenomatous polyposis coli. Gastroenterology. 1997;113:659–663.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

We thank Lic. Laura Marangunich and Lic. Virginia López, for the logistic regression analysis; Mrs Liliana Noe, for the secretarial support; and Translator María Laura Devincenzi, for the revision of the English manuscript.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Luis Alberto Viola.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Zelter, A., Fernández, J.L., Bilder, C. et al. Fundic Gland Polyps and Association with Proton Pump Inhibitor Intake: A Prospective Study in 1,780 Endoscopies. Dig Dis Sci 56, 1743–1748 (2011). https://doi.org/10.1007/s10620-010-1493-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-010-1493-x

Keywords

Navigation