Hemorrhagic polyps formed like fundic gland polyps during long-term proton pump inhibitor administration

Abstract

We report a rare case of hemorrhagic gastric polyps resulting in anemia during long-term proton pump inhibitor (PPI) administration that endoscopically looked like a fundic gland polyp (FGP). A 44-year-old man presented complaining of anemia and tarry stools. Esophagogastroduodenoscopy (EGD) demonstrated multiple white edematous polyps in the corpus and antrum, which were considered to be FGPs. We attempted endoscopic hemostasis but hemorrhaging increased because of hemorrhagic polyps and vulnerable gastric mucosa. Re-bleeding occurred several times. Polyp resection was performed at 24 polyp sites. We also ceased the administration of PPI. Microscopically, polyps showed characteristics of hyperplasia in the foveolar epithelium, extensions of fundic glands, and edema of the stroma. The proliferation of parietal and chief cells was also observed. Immunohistochemically, aquaporin-4 (AQP4) and KCNQ1-positive parietal cells and dilated mucous glands were found from the basal side to the apical side of the mucosa. These findings were compatible with the development of lesions associated with the long-term administration of PPI. EGD revealed an improvement in the vulnerability of gastric mucosa and the development of polyps, with no further gastric polyps observed 1 year after discharge. Bleeding from polyps resembling FGPs is generally rare, with indications that long-term PPI administration may induce such bleeding.

Study of the Inhibitory Effects of Enteral Nutrition Formula on Indomethacin-Induced Gastric Lesions in Mice

“…Elderly patients are generally on more drugs than young patients [8], and therefore at greater risk of experiencing interactions between prophylactic drugs and other co-administered drugs [9]. Recent research has associated long-term oral PPI use with increased incidence of fundic gland polyps [10], increased risk of Clostridium difficile infections [11,12], and chronic diarrhea and collagenous colitis [13][14][15][16][17], suggesting that PPIs exert various negative effects on the digestive tract. Patients on PG drugs often experience diarrhea [6,7].…”

Hyperplastic Gastric Polyp Causing Upper Gastrointestinal Hemorrhage and Acute Blood Loss Anemia

“…It is worth mentioning that our patient had a history of long-term PPI administration for his gastroesophageal reflux disease. In recent years, the increased risk of gastric polyps during long-term PPI administration has been a growing concern [10].…”

Magnified Endoscopic Findings of Multiple White Flat Lesions: A New Subtype of Gastric Hyperplastic Polyps in the Stomach

“…Previous studies on PPI-related gastric lesions have reported fundic gland polyps, hyperplastic polyps, and hemorrhagic polyps formed like fundic gland polyps [6,7]. Furthermore, diffuse changes associated with PPI use, specifically gastric cracked and cobblestone-like mucosa, have also been reported in the region of the gastric corpus glands [8].…”