Reply: Is there any association between proton pump inhibitors and fundic gland polyps?
Réplica: ¿Existe asociación entre los inhibidores de la bomba de protones y los pólipos glandulares fúndicos?
Key words: Fundic gland polyps. Proton pump inhibitors. Endoscopy. Gastrointestinal.
Palabras clave: Pólipos glandulares fúndicos. Inhibidores de la bomba de protones. Endoscopia. Gastrointestinal.
]]> Dear Editor,
The association between proton pump inhibitor (PPI) intake and the development of fundic gland polyps (FGPs) is a controversial issue and it has been challenged by García-Alonso et al. in a paper recently published in the Spanish Journal of Gastroenterology (1). On the other hand, we performed a prospective study in 1,780 upper gastrointestinal endoscopies and we demonstrated that PPI intake is the strongest risk factor for the development of FGPs, with an odds ratio of 9.00 in the multiple logistic regression analysis (95% confidence interval 5.44-14.89, p < 0.0001) (2).
Several reasons may have led García-Alonso et al. to opposite conclusions than ours. First, their study was retrospective and the number of FGPs that they found was very low, representing only 7.4% of gastric polyps. This figure is only comparable to those from three series from, France, Italy and Croacia (9.97%, 3.31% and 9.68%, respectively) (3-5), but differs from those observed in two American series and in our own series (77%, 78% and 62.1%, respectively) (2,6,7). The small number of 19 analyzed FGPs may have introduced a type II error in the statistical analysis. Other methodological aspect to be considered is the choice of the control group that, for a study on predictive factors, should have included all the patients with no FGPs and not only those with polyps of a different etiology. An appropriate measure of association, such as the odds ratio, was neither used. Finally, three months of PPI intake is a too short period to evaluate a possible development of FGPs (7,8).
In summary, we want to point out that our data support a significant association between PPI intake and FGPs, while those by García-Alonso et al. seem to be insufficient to rule it out.
José Luis Fernández and Luis Alberto Viola
Centro Integral de Gastroenterología. Buenos Aires, Argentina
References
1. García-Alonso FJ, Martín-Mateos RM, González-Martín JA, Foruny JR, Vázquez-Sequeiros E, Boixeda de Miquel D. Gastric polyps: analysis of endoscopic and histological features in our center. Rev Esp Enferm Dig 2011;103:416-20. [ Links ]
2. Zelter A, Fernández JL, Bilder C, Rodríguez P, Wonaga A, Dorado F, et al. Fundic gland polyps and association with proton pump inhibitor intake: a prospective study in 1,780 endoscopies. Dig Dis Sci 2011;56: 1743-8. [ Links ]
3. Roseau G, Ducreux M, Molas G, Ponsot P, Amouyal P, Palazzo L, et al. Ephitelial gastric polyps in a series of 13,000 gastroscopies. Presse Med 1990;19:650-4. [ Links ]
4. Papa A, Cammarota G, Tursi A, Montalto M, Cuoco L, Certo M, et al. Histologic types and surveillance of gastric polyps: A 7 year clinico-pathological study. Hepatogastroenterology 1998;45:579-82. [ Links ]
5. Ljubicic N, Kujundzic M, Roic G, Banic M, Cupic H, Doko M, et al. Benign epithelial gastric polyps -frequency, location, and age and sex distribution. Coll Antropol 2002;26:55-60. [ Links ]
6. Carmack SW, Genta RM, Schuler CM, Saboorian MH. The current spectrum of gastric polyps: a 1-year national study of over 120,000 patients. Am J Gastroenterol 2009;104:1524-32. [ Links ]
7. Ally MR, Veerappan GR, Maydonovitch CL, Duncan TJ, Perry JL, Osgard EM, et al. Chronic proton pump inhibitor therapy associated with increased development of fundic gland polyps. Dig Dis Sci 2009;54:2617-22. [ Links ]
8. Jalving M, Koornstra JJ, Wesseling J, Boezen HM, De Jong S, Kleibeuker JH. Increased risk of fundic gland polyps during long-term proton pump inhibitor therapy. Aliment Pharmacol Ther 2006;24:1341-8. [ Links ]
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