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Hemorrhagic polyps formed like fundic gland polyps during long-term proton pump inhibitor administration
Tsutomu Takeda1, Daisuke Asaoka2, Yuzuru Tajima2,3
1Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan. t-takeda@juntendo.ac.jp.
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.
Insights
Long-term use of proton pump inhibitors (PPIs) can rarely cause hemorrhagic gastric polyps, leading to anemia. Discontinuation of PPIs and polyp resection improved the condition, highlighting a potential drug-induced gastrointestinal complication.
Area of Science:
- Gastroenterology
- Pharmacology
- Pathology
Background:
- Proton pump inhibitors (PPIs) are widely used for acid-related disorders.
- Long-term PPI use has been associated with various gastrointestinal side effects.
- Hemorrhagic gastric polyps are a rare complication, often presenting with anemia.
Purpose of the Study:
- To report a rare case of hemorrhagic gastric polyps.
- To investigate the potential link between long-term PPI administration and polyp development.
- To describe the endoscopic and histological findings of these polyps.
Main Methods:
- Case report of a 44-year-old male with anemia and tarry stools.
- Esophagogastroduodenoscopy (EGD) for polyp visualization and biopsy.
- Polypectomy and cessation of PPI therapy.
- Histopathological and immunohistochemical analysis of resected polyps.
Main Results:
- Multiple white, edematous polyps resembling fundic gland polyps (FGPs) were observed.
- Hemorrhage occurred due to polyp fragility and vulnerable gastric mucosa.
- Histology revealed hyperplasia, gland extension, stromal edema, and cell proliferation.
- Immunohistochemistry showed specific cell markers (AQP4, KCNQ1) and dilated mucous glands.
- Cessation of PPIs and polypectomy led to mucosal improvement and no recurrence after 1 year.
Conclusions:
- Long-term PPI administration may induce rare hemorrhagic gastric polyps.
- These polyps can mimic FGPs endoscopically but have distinct histological features.
- Management involves PPI discontinuation and endoscopic resection.
- This case highlights a potential iatrogenic cause of gastric bleeding.
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