The most appropriate next step in management is reassurance. Fundic gland polyps (FGPs) are among the most commonly found gastric polyps and are reported to be diagnosed in up to 5% of patients undergoing upper endoscopy. Sporadic FGPs are usually 1 to 5 mm in size and fewer than 10 in number. Sporadic FGPs have been associated with proton pump inhibitor (PPI) use; the exact mechanism of this association is not known. Sporadic FGPs do not have malignant potential; therefore, this patient does not require PPI cessation, excision of the remaining polyps, or surveillance.

It is important to distinguish sporadic FGPs from those related to a hereditary colon cancer syndrome. Familial adenomatous polyposis (FAP) is an autosomal dominant hereditary colon cancer syndrome caused by an APC gene mutation. It is associated with the near-universal presence of gastric fundic gland polyposis, duodenal adenomas, and a personal or family history of early-onset colonic adenomas or colorectal cancer. FAP-related FGPs frequently harbor dysplasia. APC gene testing is not warranted because this patient does not have dysplastic FGPs, a personal history of duodenal or colonic adenomas, or a family history of colorectal cancer.

Colonoscopy is recommended in patients with dysplastic FGPs or in those younger than 40 years of age with fundic gland polyposis; neither of these characteristics is present in this patient, so colonoscopy is not necessary at this time.

This patient's esophageal ring is an acid-related complication of gastroesophageal reflux disease that requires esophageal dilation and ongoing use of a PPI. Therefore, stopping PPI therapy is not appropriate at this time.