Long-term PPI use at typical doses doesn’t cause achlorhydria. But with the very large doses (e.g. quadruple+) — used in the rare Zollinger-Ellison syndrome — it might.

Fundic gland polyps do occur in chronic PPI use — an incidental finding and of no great clinical significance. We see more and more of these polyps at endoscopy these days. I biopsy them to confirm diagnosis and reassure the patient. There are no guidelines on follow-up. I personally don’t follow these patients with repeat endoscopy, etc.

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