Most patients in whom gastric polyps develop during omeprazole or lansoprazole therapy do not have H pylori infection, and only 2 of 6 patients described by El-Zimaity et al 21 had even moderate elevations of the serum gastrin level. These earlier reports suggested that polyps might be induced by proton pump inhibitor treatment, but the lesions were not clearly distinguished from hyperplastic polyps, and there were no control groups for comparison. Fundic gland polyps are small mucosal excrescences that consist of clusters of disorganized oxyntic glands with scattered small cysts located deep to the mucous neck cells. The cysts are lined by flattened chief, parietal, and mucous cells. This study does not provide information on the development of gastric polyps over time in the untreated group, but the findings support the conclusion that this particular type of gastric mucosal polyp is a complication of treatment with proton pump inhibitors.
Disagreement remains about the significance of treatment-associated fundic gland polyps.
Although Graham 19 cautioned that induction of mucosal polyps during proton pump inhibitor treatment raises questions about long-term safety and suggested that patients undergoing maintenance therapy need continued endoscopic surveillance, these small mucosal bumps are probably harmless. 20 Long-term acid suppression with omeprazole or lansoprazole results in moderate but stable hypergastrinemia, hyperplasia of gastric endocrine cells, alterations in the distribution of H pylori within the stomach, an increased incidence of atrophic gastritis, and the development of benign gastric polyps in a small percentage of patients. From the 1 Department of Pathology and the 2 Department of Gastroenterology, Good Samaritan Hospital, Los Angeles, California. Am J Clin Pathol . Eissele R, Brunner G, Simon B, et al.