Gastric acid secretion therapy: long-term effects on gastric mucosa and polyp formation

Most reported mucosal alterations, including fundic gland polyps, hyperplastic polyps, multiple white and flat elevated lesions, cracked or cobblestone-like mucosa, black spots, gastric mucosal redness, white spots, and web-like mucus, are considered benign. Although endoscopic surveillance is not currently supported by evidence, awareness of these findings may be useful in patients receiving therapy for several decades. Endoscopic features,-associated with hypergastrinemia and parietal- or enterochromaffin-like cell proliferation, may serve as tools to guide individualized prescribing and deprescribing strategies. Further research should include decade-long cohort studies, studies comparing PPIs and P-CABs, and trials evaluating on-demand and continuous regimens to optimize long-term safety.