Proton Pump Inhibitor‐Induced Fundic Gland Polyps With Massive Bleeding Regressed on Alternative Histamine 2 Receptor Antagonist Therapy

TL;DR

A patient with PPI-induced stomach polyps experienced severe bleeding, which stopped and improved after switching to a different type of acid-reducing medication.

Contribution

This case is the first to demonstrate regression of PPI-induced fundic gland polyps and cessation of bleeding after switching to H2RA therapy.

Findings

Massive bleeding from PPI-induced fundic gland polyps was successfully controlled with vitamin K and H2RA therapy.

Switching from PPI to H2RA led to gradual and significant regression of the polyps over 6 months.

PPI-induced FGPs can cause severe bleeding, especially in patients on anticoagulant therapy.

Abstract

We report a case of massive bleeding from proton pump inhibitor (PPI)‐induced fundic gland polyps (FGPs) that regressed after switching to a histamine‐2 receptor antagonist (H2RA). A 46‐year‐old man with antiphospholipid syndrome had been receiving warfarin and lansoprazole for 4 years. Esophagogastroduodenoscopy (EGD) revealed multiple enlarged, edematous FGPs compared to those observed 3 years earlier. One month later, the patient presented with melena, anemia, and transient loss of consciousness. Laboratory data revealed anemia and a prolonged prothrombin time/international normalized ratio (PT‐INR). Emergency EGD showed refractory oozing from the FGPs caused by insufflation and water jet stimulation. The bleeding was successfully controlled with vitamin K administration. After PT‐INR normalization, no further bleeding occurred, and a follow‐up EGD 3 days later showed no bleeding recurrence. We considered that PPI therapy might lead to recurrent bleeding from the FGPs and switched therapy to an H2RA. Follow‐up EGD at 2 and 6 months revealed gradual and marked regression of the FGPs. This case demonstrates that PPI‐induced FGPs can result in massive bleeding, particularly in patients receiving anticoagulant therapy. Furthermore, FGP regression following the switch to H2RA suggests that H2RA therapy may be an alternative treatment when discontinuation of PPI therapy is not feasible.

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