A Hemorrhagic Duodenal Polyp Disappeared with Gastric Polyps after Discontinuation of Proton Pump Inhibitor.

A 65-year-old man underwent EGD for the first time because of mild anemia. Endoscopy showed spontaneous bleeding from a polyp at the duodenal papilla (A). Two gastric polyps were also found in the lesser curvature of the pylorus (B) and in the anterior wall of the angle. Biopsy was not performed because the patient was receiving dual antiplatelet therapy. These gastric polyps, which were reddish and sessile with smooth or lobular contours, were endoscopically diagnosed as hyperplastic polyps. The duodenal polyp appeared similar to the gastric polyps. Thus, it was endoscopically diagnosed as duodenal hyperplastic polyp arising from gastric metaplasia or heterotopia. The patient’s blood IgG antibody for Helicobacter pylori was negative (<3 U/mL). The patient had been taking rabeprazole for 6 years. Gastric hyperplastic polyps have recently been reported to frequently shrink and sometimes disappear with the discontinuation of proton pump inhibitors. Given that the patient’s anemia was mild and asymptomatic, and he was treated with dual antiplatelet therapy, we decided to discontinue rabeprazole instead of performing an endoscopic resection. Two months later, the polyps had disappeared (C, D). This clinical course supported our endoscopic diagnosis. The polyps showed no recurrence according to the endoscopy performed 21 months later. Anemia did not progress during the course.