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Background: Fundic gland polyps (FGPs) are usually associated with familial adenomatous polyposis (FAP) or can be sporadic, but recently it is frequently observed among patients receiving long-term proton-pump inhibitor (PPI) therapy without H. pylori gastritis. Spontaneous regression of FGPs was reported with association of H. pylori acquisition or after PPI therapy stopped.
Material: Among 2349 gastroscopies performed during the last year in the authors' gastroenterological ambulance there were 7 patients having fundic gland polyposis, 4 middle-aged women of them under long-term PPI therapy, the remaining 3 young patients (1 woman and 2 men) suffering from FAP. Endoscopic morphology and localization of gastric polyps were similar in both group, difference was found in the number of polyps. Histological examination showed in every cases fundic gland hyperplasia with cystic dilatation.
Case report: A 48-year-old woman under a 2-year-long term intermittent PPI therapy underwent repeated upper endoscopy for complicated gastroesophageal reflux disease (GERD). Gastroscopy demonstrated development of severe gastric polyposis with numberless small polypoid lesion of the gastric corpus and fundus. The histological examination of polypectomy and biopsy specimens confirmed the typical morphology of FGPs, H. pylori infection was not observed. No evidence of FAP was found in the patient's family history or during colonoscopy performed. PPI therapy was stopped, but because of recurrence of GERD symptoms it was reinstated in reduced dosage. Follow up endoscopy after 6 months showed a complete disappearance of FGPs, H. pylori reinfection was not found.
Conclusions: Fundic gland polyposis from PPI therapy may mimic that observed in FAP, therefore a careful study of every new cases strongly recommended ruling out polyposis syndromes. Disappearance of our patient's fundic polyposis without H. pylori reinfection and with continuation PPI therapy suggests spontaneous regression behavior of FGPs.