American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the relationship between proton pump inhibitors and sporadic fundic gland polyps?

1. They increase the risk of cancer

2. They are a causative factor

3. They have no association

4. They are used to treat the polyps

The correct answer is: They are a causative factor

Sporadic fundic gland polyps are often associated with long-term use of proton pump inhibitors (PPIs). These polyps occur in the gastric fundus and typically arise in individuals who have been on PPIs for an extended period. The mechanism underlying this association is believed to involve the hypergastrinemia that is stimulated by the reduction of gastric acidity caused by PPIs. When gastric acid secretion is inhibited, the body compensates by producing more gastrin, which can lead to the development of these polyps. While fundic gland polyps themselves are generally benign and not precursors to cancer, the link to proton pump inhibitors highlights a critical aspect of their long-term use. Understanding this relationship is essential for clinicians to monitor patients on PPIs, as they should be aware of potential changes in the gastric mucosa over time. The other options would suggest implications that are not directly supported by current evidence or understanding of the pathophysiology related to PPIs and fundic gland polyps.