Chronic proton pump inhibitor therapy associated with increased development of fundic gland polyps.
BACKGROUND
Fundic gland polyps (FGP) have been implicated with long-term proton pump inhibitor (PPI) use.


OBJECTIVE
We attempted to investigate the impact of length and dosage of PPI therapy on the development of FGP.


METHODS
A retrospective cohort study of all patients who had gastric polyps removed during elective upper endoscopy between March and September 2007 as part of a prior prospective study protocol was carried out. FGP were determined histologically. Prior to endoscopy, all patients completed a questionnaire regarding PPI use and length of therapy (no PPI use, 1-48 months, >48 months). The dosage of PPI was obtained via a thorough chart review of electronic medical records.


RESULTS
Three hundred and eighty-five patients completed upper endoscopy and a questionnaire reporting PPI use (252 [65.4%] patients on PPI). On endoscopy, 55 patients had polyps, with the majority (43/55, 78%) being FGP, resulting in an overall prevalence of 11.1% (43/385). On univariate analysis, FGP were associated with Caucasian race (15 vs. 6%; P=0.009) and chronic PPI therapy (>48 months) (31.9 vs. 7.5%, P<0.001). There was a significant linear-by-linear association between PPI dosage and FGP prevalence (no PPI use, 7.5%; once daily, 10.8%; twice daily 17.4%, P=0.026). On logistic regression, the only independent predictor of FGP was duration of PPI use >48 months (P=0.001, odds ratio [OR] 4.7 [2.0-12.9]).


CONCLUSIONS
The only independent predictor of FGP development in our study was duration of PPI therapy greater than 48 months. Increased dosage of therapy did not significantly impact the development of FGP.
Ally
Mazer R
MR
Gastroenterology Service, Department of Medicine, Walter Reed Army Medical Center, 6900 Georgia Avenue, NW, Washington, DC 20307-5001, USA.
Veerappan
Ganesh R
GR
Maydonovitch
Corinne L
CL
Duncan
Timothy J
TJ
Perry
Joseph L
JL
Osgard
Eric M
EM
Wong
Roy K H
RK
D000328:Adult; D000368:Aged; D004219:District of Columbia; D004334:Drug Administration Schedule; D005260:Female; D005748:Gastric Fundus / Q000187:drug effects* / Q000473:pathology / Q000601:surgery; D005773:Gastroscopy; D006772:Hospitals, Military; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011127:Polyps / Q000139:chemically induced* / Q000473:pathology / Q000601:surgery; D054328:Proton Pump Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013272:Stomach Diseases / Q000139:chemically induced* / Q000473:pathology / Q000601:surgery; D011795:Surveys and Questionnaires; D013997:Time Factors
D054328:Proton Pump Inhibitors