Korean J Gastroenterol.  2019 Jul;74(1):17-29. 10.4166/kjg.2019.74.1.17.

Risk Factors of Multiple Gastric Polyps according to the Histologic Classification: Prospective Observational Cohort Study

Affiliations
  • 1Department of Internal Medicine, Seoul National University Bundang Hospital, Seoungnam, Korea. nayoungkim49@empas.com
  • 2Department of Pathology, Seoul National University Bundang Hospital, Seoungnam, Korea.
  • 3Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.

Abstract

BACKGROUND/AIMS
The aim of this study was to determine the risk factors of multiple gastric polyps according to the histological classification of gastric polyps.
METHODS
Subjects with multiple gastric polyps (at least three) during endoscopy were enrolled prospectively. They were assigned to a fundic gland polyp (FGP) group and hyperplastic polyp (HP) group based on a histological classification of gastric polyps. Helicobacter pylori (H. pylori) was confirmed by its histology. Serum gastrin was measured using the radioimmunoassay method. A questionnaire was taken regarding the intake of proton pump inhibitor and nonsteroidal anti-inflammatory drugs, alcohol, smoking history, and diet.
RESULTS
Among the 60 subjects enrolled from 2015 to 2018 at Seoul National University Bungdang Hospital, 47 and 13 subjects were assigned to the FGP and HP groups, respectively. The H. pylori infection rate was 12.8% in the FGP group, which is lower than that in the HP group (69.2%, p<0.001). The gastrin level was higher in the HP group (194.7 pg/dL, range 50.6-387.8 pg/dL) than in the FGP group (57.4 pg/dL, range 24.8-79.0 pg/dL) (p=0.007). Histologically, neutrophil infiltration in the antrum and body of the stomach were higher in the HP group than in the FGP group (p=0.022 and p=0.030, respectively). In contrast, monocyte infiltration in the antrum and body of the stomach were higher in the FGP group than in the HP group (p=0.018 and p<0.001, respectively).
CONCLUSIONS
HPs arise from inflammation caused by H. pylori. On the other hand, the FGP was not associated with H. pylori or environmental factors.

Keyword

Gastric polyps; Helicobacter pylori; Proton pump inhibitors; Gastrin

MeSH Terms

Classification*
Cohort Studies*
Diet
Endoscopy
Gastrins
Hand
Helicobacter pylori
Inflammation
Methods
Monocytes
Neutrophil Infiltration
Polyps*
Prospective Studies*
Proton Pump Inhibitors
Proton Pumps
Radioimmunoassay
Risk Factors*
Seoul
Smoke
Smoking
Stomach
Gastrins
Proton Pump Inhibitors
Proton Pumps
Smoke

Figure

  • Fig. 1 Flow chart showing the selection of patients with multiple gastric polyps classified by histopathology.

  • Fig. 2 Endoscopy findings of a representative fundic gland polyp (FGP) (A) or hyperplastic polyp (HP) (B). (A) Endoscopic view of a FGP showing more than 10 polyps of 1 cm or less throughout the body and antrum. (B) Endoscopic view of a HP showing hyperemic polypoid lesions, approximately 1 cm in size, on the body. Histology findings of representative FGP (C) or HP (D). (C) Representative photomicrograph of a FGP showing the proliferation of oxyntic glands with a cystic dilation and disordered architecture (H&E, ×40). (D) Representative photomicrograph of a HP showing dilated and hyperplastic foveolar glands with edematous and inflamed stroma (H&E, ×40).

  • Fig. 3 Multivariate analysis between the fundic gland polyp group and hyperplastic polyp group. H. pylori, Helicobacter pylori; AG, atrophic gastritis; IM, intestinal metaplasia. aMeans statistical significance.


Cited by  1 articles

Causal Relationship: Development of Gastric Epithelial Polyp in Korea
Hyuk Lee
Korean J Gastroenterol. 2019;74(1):1-3.    doi: 10.4166/kjg.2019.74.1.1.


Reference

1. Dekker W. Clinical relevance of gastric and duodenal polyps. Scand J Gastroenterol Suppl. 1990; 178:7–12.
Article
2. Lee SW. Diagnosis and management of gastric polyps. Korean J Med. 2016; 90:307–312.
Article
3. Goddard AF, Badreldin R, Pritchard DM, Walker MM, Warren B, British Society. The management of gastric polyps. Gut. 2010; 59:1270–1276.
Article
4. Borch K, Skarsgård J, Franzén L, Mårdh S, Rehfeld JF. Benign gastric polyps: morphological and functional origin. Dig Dis Sci. 2003; 48:1292–1297.
5. Stolte M, Sticht T, Eidt S, Ebert D, Finkenzeller G. Frequency, location, and age and sex distribution of various types of gastric polyp. Endoscopy. 1994; 26:659–665.
Article
6. Sipponen P, Laxén F, Seppälä K. Cystic ‘hamartomatous’ gastric polyps: a disorder of oxyntic glands. Histopathology. 1983; 7:729–737.
Article
7. Lee RG, Burt RW. The histopathology of fundic gland polyps of the stomach. Am J Clin Pathol. 1986; 86:498–503.
Article
8. Haruma K, Sumii K, Yoshihara M, Watanabe C, Kajiyama G. Gastric mucosa in female patients with fundic glandular polyps. J clin gastroenterol. 1991; 13(5):565–569.
Article
9. Odze RD, Marcial MA, Antonioli D. Gastric fundic gland polyps: a morphological study including mucin histochemistry, stereometry, and MIB-1 immunohistochemistry. Hum Pathol. 1996; 27:896–903.
Article
10. Wu TT, Kornacki S, Rashid A, Yardley JH, Hamilton SR. Dysplasia and dysregulation of proliferation in foveolar and surface epithelia of fundic gland polyps from patients with familial adenomatous polyposis. Am J Surg Pathol. 1998; 22:293–298.
Article
11. Jain R, Chetty R. Gastric hyperplastic polyps: a review. Dig Dis Sci. 2009; 54:1839–1846.
Article
12. Han AR, Sung CO, Kim KM, et al. The clinicopathological features of gastric hyperplastic polyps with neoplastic transformations: a suggestion of indication for endoscopic polypectomy. Gut Liver. 2009; 3:271–275.
Article
13. Stolte M. Hyperplastic polyps of the stomach: associations with histologic patterns of gastritis and gastric atrophy. Am J Surg Pathol. 2001; 25:1342–1344.
Article
14. Carmack SW, Genta RM, Graham DY, Lauwers GY. Management of gastric polyps: a pathology-based guide for gastroenterologists. Nat Rev Gastroenterol Hepatol. 2009; 6:331–341.
Article
15. Cao W, Hou G, Zhang X, San H, Zheng J. Potential risk factors related to the development of gastric polyps. Immunopharmacol Immunotoxicol. 2018; 40:338–343.
Article
16. Park DY, Lauwers GY. Gastric polyps: classification and management. Arch Pathol Lab Med. 2008; 132:633–640.
Article
17. Hongo M, Fujimoto K, Gastric Polyps. Incidence and risk factor of fundic gland polyp and hyperplastic polyp in long-term proton pump inhibitor therapy: a prospective study in Japan. J Gastroenterol. 2010; 45:618–624.
Article
18. Burt RW. Gastric fundic gland polyps. Gastroenterology. 2003; 125:1462–1469.
Article
19. Dixon MF, Genta RM, Yardley JH, Correa P. Classification and grading of gastritis. The updated Sydney system. International workshop on the histopathology of gastritis, Houston 1994. Am J Surg Pathol. 1996; 20:1161–1181.
20. Korman MG, Strickland RG, Hansky J. Serum gastrin in chronic gastritis. Br Med J. 1971; 2:16–18.
Article
21. Kim BC, Jung SW, Kim JB, et al. Serum gastrin levels in different stages of distal gastric carcinogenesis: is there a role for serum gastrin in tumor growth? Turk J Gastroenterol. 2014; 25:611–618.
Article
22. Watson SA, Grabowska AM, El-Zaatari M, Takhar A. Gastrin - active participant or bystander in gastric carcinogenesis? Nat Rev Cancer. 2006; 6:936–946.
Article
23. Jalving M, Koornstra JJ, Wesseling J, Boezen HM, DE Jong S, Kleibeuker JH. Increased risk of fundic gland polyps during long-term proton pump inhibitor therapy. Aliment Pharmacol Ther. 2006; 24:1341–1348.
Article
24. el-Zimaity HM, Jackson FW, Graham DY. Fundic gland polyps developing during omeprazole therapy. Am J Gastroenterol. 1997; 92:1858–1860.
25. Tran-Duy A, Spaetgens B, Hoes AW, de Wit NJ, Stehouwer CD. Use of proton pump inhibitors and risks of fundic gland polyps and gastric cancer: systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2016; 14:1706–1719.e5.
Article
26. Zelter A, Fernández JL, Bilder C, et al. Fundic gland polyps and association with proton pump inhibitor intake: a prospective study in 1,780 endoscopies. Dig Dis Sci. 2011; 56:1743–1748.
Article
27. Martin FC, Chenevix-Trench G, Yeomans ND. Systematic review with meta-analysis: fundic gland polyps and proton pump inhibitors. Aliment Pharmacol Ther. 2016; 44:915–925.
Article
28. Masaoka T, Suzuki H, Hibi T. Gastric epithelial cell modality and proton pump inhibitor. J Clin Biochem Nutr. 2008; 42:191–196.
Article
29. Ally MR, Veerappan GR, Maydonovitch CL, et al. Chronic proton pump inhibitor therapy associated with increased development of fundic gland polyps. Dig Dis Sci. 2009; 54:2617–2622.
Article
30. Cats A, Schenk BE, Bloemena E, et al. Parietal cell protrusions and fundic gland cysts during omeprazole maintenance treatment. Hum Pathol. 2000; 31:684–690.
Article
31. Abraham SC, Singh VK, Yardley JH, Wu TT. Hyperplastic polyps of the stomach: associations with histologic patterns of gastritis and gastric atrophy. Am J Surg Pathol. 2001; 25:500–507.
Article
32. Dirschmid K, Platz-Baudin C, Stolte M. Why is the hyperplastic polyp a marker for the precancerous condition of the gastric mucosa? Virchows Arch. 2006; 448:80–84.
Article
33. Abraham SC, Nobukawa B, Giardiello FM, Hamilton SR, Wu TT. Fundic gland polyps in familial adenomatous polyposis: neoplasms with frequent somatic adenomatous polyposis coli gene alterations. Am J Pathol. 2000; 157:747–754.
34. Toyooka M, Konishi M, Kikuchi-Yanoshita R, Iwama T, Miyaki M. Somatic mutations of the adenomatous polyposis coli gene in gastroduodenal tumors from patients with familial adenomatous polyposis. Cancer Res. 1995; 55:3165–3170.
35. Koch A, Denkhaus D, Albrecht S, Leuschner I, von Schweinitz D, Pietsch T. Childhood hepatoblastomas frequently carry a mutated degradation targeting box of the beta-catenin gene. Cancer Res. 1999; 59:269–273.
36. Abraham SC, Nobukawa B, Giardiello FM, Hamilton SR, Wu TT. Sporadic fundic gland polyps: common gastric polyps arising through activating mutations in the beta-catenin gene. Am J Pathol. 2001; 158:1005–1010.
37. Foley EF, Jazaeri AA, Shupnik MA, Jazaeri O, Rice LW. Selective loss of estrogen receptor beta in malignant human colon. Cancer Res. 2000; 60:245–248.
38. Singh S, Paraskeva C, Gallimore PH, Sheppard MC, Langman MJ. Differential growth response to oestrogen of premalignant and malignant colonic cell lines. Anticancer Res. 1994; 14:1037–1041.
39. Woodson K, Lanza E, Tangrea JA, et al. Hormone replacement therapy and colorectal adenoma recurrence among women in the polyp prevention trial. J Natl Cancer Inst. 2001; 93:1799–1805.
Article
40. Graham JR. Gastric polyposis: onset during long-term therapy with omeprazole. Med J Aust. 1992; 157:287–288.
Article
41. Choudhry U, Boyce HW Jr, Coppola D. Proton pump inhibitor-associated gastric polyps: a retrospective analysis of their frequency, and endoscopic, histologic, and ultrastructural characteristics. Am J Clin Pathol. 1998; 110:615–621.
Article
42. Vieth M, Stolte M. Fundic gland polyps are not induced by proton pump inhibitor therapy. Am J Clin Pathol. 2001; 116(5):716–720.
Article
43. Peura DA, Metz DC, Dabholkar AH, Paris MM, Yu P, Atkinson SN. Safety profile of dexlansoprazole MR, a proton pump inhibitor with a novel dual delayed release formulation: global clinical trial experience. Aliment Pharmacol Ther. 2009; 30(10):1010–1021.
Article
44. Hsu WH, Wu IC, Kuo CH, et al. Influence of proton pump inhibitor use in gastrointestinal polyps. Kaohsiung J Med Sci. 2010; 26:76–83.
Article
45. Cao H, Qu R, Zhang Z, et al. Sporadic fundic gland polyps are not associated with proton pump inhibitors therapy but negatively correlate with Helicobacter pylori infection in China. Chin Med J. 2014; 127:1239–1243.
46. Huang CZ, Lai RX, Mai L, Zhou HL, Chen HJ, Guo HX. Relative risk factors associated with the development of fundic gland polyps. Eur J Gastroenterol Hepatol. 2014; 26:1217–1221.
Article
47. Wang FW, Young SC, Chen RY, et al. The Prevalence and risk factors of gastric polyp in asymptomatic patients receiving health examination. Gastroenterol Res Pract. 2018; 2018:9451905.
Article
Full Text Links
  • KJG
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr