What are the other Names for this Condition? (Also known as/Synonyms)

• Cystic Hamartomatous Epithelial Polyps of Stomach
• Elster Glandular Cysts of Stomach
• Gastric FGPs

What is Gastric Fundic Gland Polyps? (Definition/Background Information)

• Gastric Fundic Gland Polyps are benign polyps that arise in the stomach. These are considered to be cystic hyperplastic proliferation of oxyntic glands of stomach
• Fundic gland polyps (FGPs) are usually detected during endoscopy as incidental findings
• The polyps are usually asymptomatic and detected in young patients

Incidence:

• Gastric Fundic Gland Polyps are the most common type of gastric polyps noted. It is estimated that approximately 5% of individuals undergoing endoscopy present these benign polyps
• Usually detected in the 5th or 6th decade (between ages 40-60 years) in sporadic cases; and in the 3rd decade (20-30 years), when associated with familial adenomatous polyposis syndrome
• Both males and females are at risk; the risk is slightly higher in female populations

Risk factors and Cause:

The cause of formation of Gastric Fundic Gland Polyps is unknown. These may develop from hyperplasia and dilatation of oxyntic glands of the stomach.

• A vast majority of the polyps occur sporadically. Sporadic FGPs may have mutations in the CTNNB1 gene (encoding β-catenin)
• The risk factors include the use of certain medications, such as proton pump inhibitors, for gastric reflux
• The polyps may be associated with polyposis syndromes, such as familial adenomatous polyposis (FAP) or gastric adenocarcinoma and proximal polyposis of stomach (GAPPS)
• Individuals who have been diagnosed with Helicobacter pylori gastritis have a lower incidence of fundic gland polyps

Signs and symptoms:

• Many are asymptomatic and do not cause any significant signs and symptoms
• Usually, there are less than 5 polyps observed during an endoscopy. Sometimes, greater than 20 polyps can be noted. In such cases, the possibility of polyposis syndrome should be ruled out

Diagnosis:

• Most polyps are diagnosed incidentally when an endoscopy is performed for other health conditions. These are the most common type of polyps noted during endoscopy
• When numerous polyps are noted in the presence of duodenal adenomas, it should raise a suspicion for familial polyposis syndrome. In such cases, a colonoscopy is recommended
• Tissue biopsy of the polypoid mass can help achieve a definitive diagnosis. The polyps are usually biopsied and sent for pathological examination to rule out a possibility of malignancy or adenomatous changes
• Pathology microscopic features: When examined under the microscope by a pathologist, cystic dilatation of gastric glands lined by chief cells, parietal cells, and mucinous foveolar cells are noted
• Hyperplastic paratubal cells may have apocrine snouting especially in patients taking proton pump inhibitors
• The main differential diagnosis during a pathological examination is oxyntic gland adenoma. In oxyntic gland adenomas, there are anastomoting cords of oxyntic cells instead of dilated cysts.  Oxyntic gland adenomas are lined with mucus cells rather than foveolar cells

Complications:

• Usually, no dysplasia or malignancy is noted in Gastric Fundic Gland Polyps, especially when these occur in a sporadic manner
• Very rarely, dysplasia may be noted, especially in younger patients, who present multiple polyps (greater than 20) during an endoscopic exam
• FGPs that occur in a background of syndromes may be associated with malignancies

Treatment:

• Presently, there are no treatment guidelines for Gastric Fundic Gland Polyps
• When FGPs occur in a background of gastric adenocarcinoma and proximal polyposis of stomach, gastrectomy (surgical procedure) may be indicated
• Sporadic polyps that occur in a background of proton pump inhibitor treatment usually disappear on discontinuation of the treatment

Prevention: Presently, it is not possible to prevent the formation of these polyps.

Prognosis:

• Since the polyps are usually benign, the prognosis is typically excellent
• There is no consistent reports of finding a malignant transformation in Gastric Fundic Gland Polyps occurring in a sporadic background
• In case the polyps are associated with a genetic syndrome, the overall outcomes are dependent upon the severity of the underlying syndrome