GASTRIC FUNDIC GLAND POLYPS: CAN HISTOLOGY BE USEFUL TO PREDICT PROTON PUMP INHIBITORS USE?

BRITO, Hugo Leite de Farias; BARROS, Cynthia; FREIRE, Marcelle Vieira; SILVA FILHO, Miraldo Nascimento da; NASCIMENTO, Tereza Virgínia

doi:10.1590/S0004-2803.201800000-82

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ORIGINAL ARTICLE • Arq. Gastroenterol. 55 (04) • Oct-Dec 2018 • https://doi.org/10.1590/S0004-2803.201800000-82 linkcopy

GASTRIC FUNDIC GLAND POLYPS: CAN HISTOLOGY BE USEFUL TO PREDICT PROTON PUMP INHIBITORS USE?

Pólipos de glândulas fúndicas: a histologia pode ser utilizada para prever uso de inibidores de bomba de próton?

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

BACKGROUND: Fundic gland polyps allegedly increased in frequency in recent decades, and had attracted great attention due to possible association with prolonged proton pump inhibitor therapy. Prolonged use of this drug could cause parietal cell hyperplasia, obstruction of glandular lumen and cystic dilation of the gland.

OBJECTIVE: This study aims to analyze clinical and pathological features of fundic gland polyps in patients with and without proton pump inhibitor therapy in a selected population from Brazil.

METHODS: It was selected a sample of 101 Brazilian patients (78 females and 23 males), from a five years retrospective search of the files from a private pathology laboratory. The patients had an average age of 57 years and we included patients with a histological diagnosis of fundic gland polyp. The clinical data were obtained from their files and all histological slides were reviewed and examined with hematoxylin and eosin (HE) and Giemsa.

RESULTS: Information about the use or non-use of proton pump inhibitors (PPI) was obtained in 84 patient files. In 17 cases we could not determine if PPI were used or not. Among those in which the information was available, a positive history of anti-acid therapy was observed in 63 (75.0%) patients. Parietal cell hypertrophy/hyperplasia and parietal cell protrusions were detected in most slides. Histological findings were identical in PPI users and PPI negative patients. Helicobacter pylori infection was detected in just two samples. Epithelial dysplasia or adenocarcinoma were not observed in our cases. Histopathological analysis of fundic gland polyps could not distinguish between PPI and non-PPI related cases. Parietal cell cytoplasmic protrusions, an alleged marker of prolonged acid suppression therapy, was detected in both groups.

CONCLUSION: Histological features could not discriminate anti-acid therapy related fundic glands polyps in our patients.

HEADINGS: Gastric mucosa; Polyps, pathology; Proton pump inhibitors

Number of patients	N	%
	101	100
Gender
Male	23	23%
Female	78	77%
Age
0-30	5	5%
31-60	58	57%
>60	38	38%
PPI use
Unknown	17	17%
No use	19	19%
Use	65	64%
< 01 year	16	16%
01-05 years	38	38%
> 05 years	11	11%

Pathological features	A (n=84)		B (n=17)	Total	P-value
	PPI positive (n=63)	PPI negative (N=21)	PPI use unknown	N = 101 (100%)
Cyst lining
Mixed	49	17	13	79 (78.2%)	1.00*
Oxintic	14	4	4	22 (21.8%)
Parietal cell hyperplasia
Positive	61	21	16	98 (97%)	1.00*
Negative	2	0	1	3 (3%)
Parietal cell protrusions
Positive focal	19	8	11	38 (37.6%)	0.3051*
Positive diffuse	28	11	3	42 (41.6%)
Negative	16	2	3	21 (20.8%)
Mucous plug
Positive	28	11	11	50 (49.5%)	0.6165**
Negative	35	10	6	51 (50.5%)
Foveolar hyperplasia
Positive	18	6	3	27 (26.7%)	1.00*
Negative	45	15	14	74 (73.3%)
H. pylori infection
Positive	1	1	0	2 (2%)	0.4398*
Negative	62	20	17	99 (98%)

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Instituto Brasileiro de Estudos e Pesquisas de Gastroenterologia e Outras Especialidades - IBEPEGE. Rua Dr. Seng, 320, 01331-020 São Paulo - SP Brasil, Tel./Fax: +55 11 3147-6227 - São Paulo - SP - Brazil
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[TFN1] A: clinical information regarding PPI use available; B: clinical information regarding PPI use not available. PPI: proton pump inhibitor. *Fisher’s exact test. ** Chi-square test.