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Gastric polyps and nodules in children receiving long-term omeprazole therapy
Dinesh S Pashankar1, David M Israel
1Division of Gastroenterology, British Columbia Children's Hospital, Vancouver, Canada.
Insights
Long-term omeprazole use in children may lead to benign gastric polyps and nodules. Most nodules resolved spontaneously, but polyps persisted; no dysplastic changes were observed.
Area of Science:
- Pediatric Gastroenterology
- Gastrointestinal Endoscopy
- Pharmacology
Background:
- Omeprazole is a proton pump inhibitor used for acid suppression.
- Gastric polyps are known side effects in adults on omeprazole.
- Limited data exists on these effects in pediatric populations.
Purpose of the Study:
- To investigate the incidence and nature of gastric changes in children on long-term omeprazole therapy.
- To monitor the endoscopic and histologic findings of the stomach in this cohort.
Main Methods:
- Retrospective chart review of children receiving omeprazole for over 6 months.
- Analysis of endoscopic examinations and histological classifications of gastric lesions.
- Follow-up until esophagitis healing and annual examinations thereafter.
Main Results:
- Seven out of 31 children developed gastric polyps/nodules after a mean of 28 months.
- Lesions were located in the gastric body; nodules regressed in most cases.
- Polyps persisted, but all observed gastric changes were benign, with no dysplastic alterations.
Conclusions:
- Long-term omeprazole therapy in children can be associated with benign gastric polyps and nodules.
- These gastric changes appear to be non-dysplastic and generally benign during the observation period.
Objective:
Multiple gastric polyps have been reported to occur in adults receiving omeprazole therapy. There are little published data in children. We report our experience in monitoring the gross and histologic appearance of the stomach in children receiving long-term omeprazole therapy.
Methods:
This was a retrospective review of the charts of children who received omeprazole for more than 6 months for reflux esophagitis between 1989 and 1998. All patients had repeated endoscopic examinations until healing of the esophagitis was confirmed and then annually thereafter. At endoscopy, gastric mucosal swellings were classified as polyps or nodules based on histology.
Results:
Thirty-one children had long-term endoscopic follow-up while receiving omeprazole. Seven of 31 children had gastric polyps and/or nodules, noted between 10 and 48 months (mean = 28 months) of omeprazole therapy. Four had nodules only, one had a sessile hyperplastic polyp, and two had both a polyp (one hyperplastic and one fundic gland polyp) and nodules. All lesions were found in the gastric body. Nodules in four of the six children disappeared spontaneously while the children continued to receive omeprazole. The polyps persisted. There were no dysplastic changes in the gastric mucosa or polyps in any of the patients. There were no significant differences between the 7 children with and the 24 without polyps/nodules with respect to age, gastrin concentrations, or dose and duration of omeprazole therapy.
Conclusions:
Gastric polyps and nodules may be found in children receiving long-term omeprazole therapy. The gastric changes in our patients were benign during the mean observation period of 31 months.