Endoscopic features of oxyntic gland adenoma and gastric adenocarcinoma of the fundic gland type differ between patients with and without Helicobacter pylori infection: a retrospective observational study

Abstract

Background The endoscopic features of oxyntic gland adenoma and gastric adenocarcinoma of the fundic gland type have not been fully investigated in relation to Helicobacter pylori infection status. We compared the morphology, color, and location of these lesions between patients with and without H. pylori infection. Methods We retrospectively enrolled 165 patients (180 lesions) from 10 institutions. We divided the patients into the (i) Hp group (patients with current H. pylori infection [active gastritis, n = 13] and those with past infection [inactive gastritis, n = 76]) and (ii) uninfected group (H. pylori-uninfected patients, n = 52). We compared the clinical and endoscopic features of the two groups. We also performed an analysis between (i) lesions with atrophy of the surrounding gastric mucosa (atrophy group) and (ii) lesions without atrophy of the surrounding gastric mucosa (non-atrophy group). Results The average age was older in the Hp group than in the uninfected group (68.1 ± 8.1 vs. 63.4 ± 8.7 years, p < 0.01). Although the difference was not statistically significant (p = 0.09), multiple lesions were observed in 9 of 89 patients (10.1%) in the Hp group and in only 1 of 52 patients (1.9%) in the uninfected group. Meanwhile, significant differences were observed in the prevalence of lesions located in the gastric fornix or cardia (uninfected group: 67.3% vs. Hp group: 38.0%, p < 0.01), with an elevated morphology (80.0% vs. 56.0%, p < 0.01), with a subepithelial-like appearance (78.2% vs. 42.0%, p < 0.01), and with a color similar to that of the peripheral mucosa (43.6% vs. 25.0%, p = 0.02). The male-to-female ratio, lesion size, and presence or absence of vascular dilatation or black pigmentation on the surface were not different between the two groups. In the analysis comparing lesions with and without mucosal atrophy, the prevalence of multiple lesions was significantly higher (p = 0.02) in the atrophy group (5/25 patients, 20.0%) than in the non-atrophy group (7/141 patients, 5.0%). Conclusions The endoscopic features of oxyntic gland adenoma and gastric adenocarcinoma of the fundic gland type differ between patients with and without H. pylori infection.

Gastric epithelial neoplasm of fundic-gland mucosa lineage: representative of the low atypia differentiated gastric tumor and Ki67 may help in their identification

“…Recently, the incidence of early gastric cancer has increased significantly with the application of narrow-band imaging (NBI) magnifying endoscopy [10]. Many H. Pylorinegative gastric adenocarcinomas, including GEN-FGML, have been reported [2,6,[10][11][12][13][14][15][16][17]. In 2021, GEN-FGML was classified into OGA, GA-FG, and GA-FGM, based on cell differentiation and histological features [4].…”

Oxyntic Gland Adenoma in a Patient With Refractory Reflux

“…A recent study on 165 patients investigated whether there are distinct endoscopic findings in patients with a current or prior history of H. pylori infection in comparison to those without the infection. The study revealed that H. pylori infection was significantly associated with tumors that were flat or in atypical locations of the stomach [ 11 ]. However, in our study, the patient presented with a typical lesion despite his prior H. pylori infection status.…”

Lesion size, elevated morphology, and non or closed-type atrophy are predictive factors for gastric adenocarcinoma of the fundic gland type rather than oxyntic gland adenoma

“…This study is a subgroup analysis of our recently published article reporting the clinicopathologic features of 165 patients with 180 oxyntic gland adenomas and GA-FG lesions ( 15 ). We excluded 24 patients for whom H .…”

“…Histological diagnoses were based on endoscopic biopsy, endoscopic mucosal resection, endoscopic submucosal dissection, or surgical resection ( 14 , 15 ). We compared the patient’s sex, age at diagnosis, H .…”