Proton pump inhibitor injury leading to Fundic gland polyp
- Proton Pump Inhibitor therapy may produce changes in parietal cells, gastrin producing G cells, and Enterochromaffin like (ECL) cells
- Mild ECL cell or G cell hyperplasia occur and may be diffuse linear or micro nodular
- Parietal cell changes include increase in cell number, size, leading to swelling and convex bulging of the atypical cell membrane into the glandular lumen which gives a serrated appearance to the normal round or tubular glandular lumen.
- These changes occur in 90% of patients treated for 1 year with daily doses of 20 to 40 years of omeprazole
- Parietel cell proliferation are related to hyper gastrinemia
- Grossly patient develops tiny fundic gland polyp like lesions. They contain glandular cysts measuring between 0.25 and 7mm in diameter. These are lined by flattened parietal and chief cells. They may also contain foveolar cells.
- Lesions disappear after Proton pump inhibitor therapy is withdrawn and appear after the reintroduction of therapy.
Fundic gland polyp (PPI Injury) – lamina propira shows cystically dilated glands lined by flattened cells and some of them lined by parietal and foveolar cells (H&E, X400)
Fundic gland polyp (PPI Injury) – . lamina propira shows cystically dilated glands lined by flattened cells and some of them lined by parietal cells (H&E, X400)
Fundic gland polyp (PPI Injury) – . lamina propira shows cystically dilated glands lined by flattened cells (H&E, X400)
Fundic gland polyp (PPI Injury) – . lamina propira shows cystically dilated glands lined by flattened cells and some of them lined by parietal cells (H&E, X400)