Changing Prevalence of Gastric Fundic Gland Polyps: Current Scenario in North India.

Abstract

Introduction: The prevalence and histopathological type of gastric polyp vary between populations. In the recent past aggressive treatment of Helicobacter pylori (H. pylori) and the excessive use of proton pump inhibitors (PPIs) have altered the prevalence of specific types of gastric polyp. This study was designed to evaluate the prevalence and histopathology background of gastric mucosa in cases with fundic gland polyps (FGP). Material and Methods: The medical record of patients who underwent esophagogastroduodenoscopy in 2 centers in Northern India from 2011-2018 were reviewed. Results: The prevalence of gastric polyps was 5%, of which 900 (50%) were fundic gland polyps (FGP). Mean age of presentation was 51.42 years, 70% were located in fundus/ corpus, 62% had dyspepsia, chronic inactive gastritis (CIG) was present in 60%, 95% were multiple and 27% were more than 1cm in size. Conclusions: As a result of anti-H. pylori treatment and the excessive use of PPIs, FGP are most common in Northern India. CIG, H. pylori gastritis and Intestinal metaplasia were seen in gastric histology of the cases. These results are interesting and provide new perspective to look for pathogenesis of gastric polyps.

Chance that matter or matter of chance: changing prevalence of fundic gland polyps and proton pump inhibitors

“…1,2,17 Given the possible widespread use of PPI in Northern India especially in Jammu Kashmir because of typical spicy dietary habits, over the counter use and free availability of PPI even in remote areas of this state, and probably increased H. pylori eradication in previous decade can be possible explanations. 6,7 In 1989 FGP represented 17% of all gastric polyps in United States 17 and 10% in France. 18 The highest relative prevalence in the literature is 47% reported in a 20year German study.…”

“…[1][2][3][4][5] Similarly Asian literature also start accumulating, showing FGP as most common type of gastric polyps. 6,7 located usually in the proximal stomach. Surface color of FGP is translucent or hypermic and usually matches normal gastric mucosa.…”

“…10,11 It is believed that changing trend in FGP was due to aggressive use of proton pump inhibitors (PPI) in both western and Asian countries. [3][4][5]7 Still researchers are trying to find out definitive histological, elaborative genetic and environmental differences between non-PPI and PPI associated FGP.…”