Original articles—alimentary tract
No Association Between Gastric Fundic Gland Polyps and Gastrointestinal Neoplasia in a Study of Over 100,000 Patients

https://doi.org/10.1016/j.cgh.2009.05.015Get rights and content

Background & Aims

Fundic gland polyps (FGPs), the most common type of gastric polyps, have been associated with prolonged proton pump inhibitor therapy and an increased risk of colon cancer. The presence of FGPs has been inversely correlated with Helicobacter pylori infection. We evaluated the prevalence of H pylori-associated gastritis, colonic polyps, and carcinomas in subjects with and without FGPs.

Methods

We analyzed data collected from community-based endoscopy centers in 36 states (plus Washington DC and Puerto Rico) on patients who underwent esophagogastroduodenoscopy (EGD) and colonoscopy between April 2007 and March 2008. Of the 103,385 patients who underwent EGD during this time period, gastric biopsy samples were collected from 78,801 and colonic biopsies from 26,017. Slides of samples from Helicobacter-infected FGPs and FGPs with dysplasia were reviewed.

Results

FGPs were detected in 6081 patients (67.8% women). Helicobacter infection was present in less than 0.5% patients with FGPs and 13.0% of those without FGPs (odds ratio [OR], 29.05; 95% confidence interval [CI], 20.4–41.4; P < .0001). Colonic adenomas were detected in 42.3% of women with FGPs and 33.8% of those without (OR, 1.43; 95% CI, 1.26–1.63; P < .001); there was no significant difference in colonic adenomas between men with and without FGPs.

Conclusions

Women had a higher prevalence of FGPs. FGPs were associated with gastroesophageal reflux disease symptoms, gastric heterotopia, hyperplastic colonic polyps (only in men), and colonic adenomas (only in women, especially those over 60 years of age). The presence of FGPs was inversely correlated with H pylori infection, active gastritis, and gastric neoplasia.

Section snippets

Study Setting

This study was conducted at Caris Diagnostics, a specialized gastrointestinal laboratory receiving specimens from gastroenterologists operating in outpatient endoscopy centers in 36 states, Puerto Rico, and the District of Columbia. Biopsies are interpreted by an experienced group of gastrointestinal pathologists who share a common approach to biopsy evaluation and maintain a relative uniformity through internally standardized specimen handling, diagnostic criteria, and terminology.

Prevalence of FGPs

The database contained 121,564 unique patient encounters which included an EGD with biopsies; after excluding patients whose biopsies had not been diagnosed at the Caris Diagnostics Irving laboratory, those who had cytologic specimens only, and external consults, there remained a total of 103,385 unique patients (61,007 women, or 59.0%). Of these, 78,801 patients had one or more gastric biopsies, whereas the remaining 24,584 patients had biopsies from the esophagus or the duodenum, but not from

Discussion

The prevalence of FGPs has been reported to lie between 0.21% (in Italy)19 and 2.0% (in Northern Ireland).10 In the Irish study Dickey et al showed considerable foresight by commenting that “it is too early to say that their prevalence will increase as H pylori incidence falls and proton pump inhibitor use grows, but improving endoscopic resolution will be sufficient in itself to bring their attention to the endoscopist more often.” Twelve years later, in our study of almost 80,000 patients who

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    Conflicts of interest The authors disclose no conflicts.

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