internal medicine

53-year-old woman with persistent reflux symptoms despite PPI

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Med-Challenger
Dec 9, 2024
internal medicine Personal Education Question of the Week quick quiz

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53-year-old woman with persistent reflux symptoms despite PPI

You are evaluating a 53-year-old woman for reflux symptoms that have persisted for the last year despite proton pump inhibitor (PPI) therapy. She denies dysphagia, early satiety, or weight loss, and laboratory studies do not demonstrate anemia.

She underwent screening colonoscopy 3 years ago that was complete to the cecum, and no polyps or lesions were identified.

Upper endoscopy is performed, and several small polyps are found in the body of the stomach (see Figure).

image (37)

Figure.

Biopsy was performed of the mild erythema in the body and antrum, the findings of which are negative for the presence of Helicobacter pylori–like organisms. Biopsy is also performed on several of the polyps, and the results are consistent with fundic gland polyps (FGPs).

What should you recommend with regard to the management of these FGPs?

  • No further work-up or testing is indicated.
  • Refer the patient for a clinical genetics evaluation.
  • Schedule the patient for polypectomy.
  • Repeat upper endoscopy in 6 months.
The correct answer is:

No further work-up or testing is indicated.

 

Educational Objective:

Recognize that fundic gland polyps are benign.

Key Point:

FGPs are incidental findings in endoscopy. They carry very low risk for malignant transformation and do not require follow-up.

Explanation:

FGPs are usually small, incidentally found, and are of little clinical significance in the average patient because FGPs have a very low risk for malignant transformation. They generally do not arise in the setting of background injury, as is often the case with other gastric polyps (eg, adenomas, hyperplastic polyps).

Sporadic FGPs may be associated with PPI use. FGPs are the most common gastric polyp in patients with familial adenomatous polyposis. Large or numerous FGPs should prompt investigation to assess a patient’s risk for familial adenomatous polyposis and should include a detailed family history and consideration for colonoscopy.

References:

Abraham SC. Fundic gland polyps: common and occasionally problematic lesions. Gastroenterol Hepatol (N Y). 2010;6(1):48-51.

Genta RM, Schuler CM, Robiou CI, Lash RH. No association between gastric fundic gland polyps and gastrointestinal neoplasia in a study of over 100,000 patients. Clin Gastroenterol Hepatol. 2009;7:849-854.

 

This question appears in Med-Challenger Internal Medicine Exam Review with CME

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