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Lam SK, Lau GKK. Proton pump inhibitors are not associated with fundic gland polyps - a systematic review that takes into consideration all known confounders. Eur J Gastroenterol Hepatol 2024; 36:831-844. [PMID: 38829941 PMCID: PMC11146189 DOI: 10.1097/meg.0000000000002788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 04/21/2024] [Indexed: 06/05/2024]
Abstract
Sporadic fundic gland polyps (FGPs) progress, albeit rarely, to dysplasia and cancer. Two meta-analyses, including 8 and 11 studies, concluded that proton pump inhibitors (PPIs) were associated with FGPs. Intervention is considered unnecessary when FGPs have a background of PPIs use. Both meta-analyses, however, disregarded known confounders: age, sex, endoscopy indications, study design (prospective or retrospective), duration of PPI use, and H. pylori infection. Confounders are known to invalidate meta-analyses. We followed PRIXMA guidelines and searched the literature for studies on FGPs in PPI-users and PPI-nonusers. In the 22 studies searched, we compared FGPs in PPI-users (n = 6534) and PPI-nonusers (n = 41 115). Heterogeneity was significant (Cochran Q = 277.8, P < 0.0001; I2 = 92.8%), annulling meta-analysis performed by blanket tallying. To offset the above confounders, we matched PPI-users and PPI-nonusers by (a) age and sex (n = 4300 and 29 307, respectively) and (b) their propensity scores derived from the confounders (n = 2950 and 4729, respectively). After both matching, FGPs were not significantly different between PPI-users and PPI-nonusers [odds ratio (OR) = 1.1, P = 0.3078; OR = 0.9, P = 0.3258, respectively]. Furthermore, FGP frequency did not correlate with increasing duration of PPI use (Pearson and Spearman correlation coefficients = 0.1162, 0.0386, P < 0.6064, 0.8646, respectively); it was not significantly different between any of the duration periods of observation, namely, <10, 10-20, 20-40, >40 months, nor was it significantly different between PPI-users and PPI-nonusers within each duration period (P > 0.05). We conclude that PPIs are not associated with FGPs, implying that a background history of PPI use is not a justification for nonintervention in the management of FGPs.
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Affiliation(s)
- Shiu Kum Lam
- Gastroenterology & Hepatology of The Humanity & Health Medical Centre
- Former Chair & Dean of Medicine, The University of Hong Kong
| | - George Ka Kit Lau
- Gastroenterology & Hepatology of The Humanity & Health Medical Centre, Hong Kong, Hong Kong
- Liver Diseases & Transplant Centre, The Fifth Medical Centre of Chinese PLA General Hospital, Beijing, China
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Li F, Zhu H, Tao K, Xia Y, Liu M, Wang Y, Sun Y, Cao T, Chai J, Ni F, Shi B, Xu H. Mucosal microbial microenvironment in early gastric neoplasia and non-neoplastic gastric disease. J Gastroenterol Hepatol 2021; 36:3092-3101. [PMID: 34089623 DOI: 10.1111/jgh.15565] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/31/2021] [Accepted: 06/02/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND AIM The biological characterization of microbial environment in early gastric cancer (EGC), other than Helicobacter pylori, is limited. This study aimed to explore the microbial microenvironment in chronic gastritis (CG), fundic gland polyps (FGPs), low-grade intraepithelial neoplasia (LGIN), and EGC. METHODS 16S-rRNA gene sequencing and bioinformatic analysis were performed on 63 individuals with 252 mucosal biopsies or endoscopic submucosal dissection margin samples from endoscopy. RESULTS The microbiota in gastric LGIN functions analogously to EGC in terms of functional prediction. Neoplastic lesions showed a significant difference to CG or FGPs in beta diversity of the microbiota. Bacteria genera including Paracoccus, Blautia, Barnesiella, Lactobacillus, Thauera, Collinsella were significantly enriched in gastric neoplastic mucosa (LGIN and EGC) compared with non-neoplastic tissues (CG and FGPs). While Pseudomonas and Kingella were depleted in neoplastic tissues. FGPs showed a distinctive microbial network system that negatively interacted with Helicobacter. CONCLUSIONS In terms of the mucosal microbial microenvironment, gastric LGIN and EGC showed no significant difference as early neoplastic lesions. We observed a coordinated microbial microenvironment that correlated negatively with Helicobacter.
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Affiliation(s)
- Fudong Li
- Department of Gastroenterology and Endoscopy Center, The First Hospital of Jilin University, Changchun, China
| | - He Zhu
- Department of Gastroenterology and Endoscopy Center, The First Hospital of Jilin University, Changchun, China
| | - Ke Tao
- Department of Gastroenterology and Endoscopy Center, The First Hospital of Jilin University, Changchun, China
| | - Yan Xia
- Department of Gastroenterology and Endoscopy Center, The First Hospital of Jilin University, Changchun, China
| | - Mingqing Liu
- Department of Gastroenterology and Endoscopy Center, The First Hospital of Jilin University, Changchun, China
| | - Yu Wang
- Department of Gastroenterology and Endoscopy Center, The First Hospital of Jilin University, Changchun, China
| | - Yu Sun
- Department of Gastroenterology and Endoscopy Center, The First Hospital of Jilin University, Changchun, China
| | - Tingting Cao
- Department of Gastroenterology and Endoscopy Center, The First Hospital of Jilin University, Changchun, China
| | - Jiannan Chai
- Department of Clinical Laboratory, The First Hospital of Jilin University, Changchun, China
| | - Fengming Ni
- Department of Gastroenterology and Endoscopy Center, The First Hospital of Jilin University, Changchun, China
| | - Bing Shi
- Department of Gastroenterology and Endoscopy Center, The First Hospital of Jilin University, Changchun, China
| | - Hong Xu
- Department of Gastroenterology and Endoscopy Center, The First Hospital of Jilin University, Changchun, China
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Orr CE, Beneck D, Jessurun J, Qin L, Tyryshkin K, Yantiss RK, Chen YT. High interobserver variability and frequent overdiagnosis of dysplasia in fundic gland polyps can be improved by detecting atypia on the surface epithelium and an abrupt transition to non-neoplastic cells. Histopathology 2021; 80:314-321. [PMID: 34424570 DOI: 10.1111/his.14549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/16/2021] [Accepted: 08/20/2021] [Indexed: 11/29/2022]
Abstract
AIMS Fundic gland polyps (FGPs) arise sporadically and in combination with familial adenomatous polyposis (FAP). Criteria for distinguishing low-grade dysplasia (LGD) from regenerative atypia in FGPs are not well established. The aims of study were to determine: (i) interobserver variability in diagnosing LGD in FGPs; (ii) bias in diagnosing LGD in FAP patients; and (iii) stringent criteria for LGD in FGPs. METHODS AND RESULTS Five senior pathologists who were blinded to the clinical history reviewed 72 FAP-associated FGPs and 34 sporadic FGPs. Cases were classified as negative (score = 0) or positive (score = 1) for LGD. Each case was assigned a 'combined dysplasia score' (CDS) ranging from 0 to 5 to reflect all five opinions. Fleiss' kappa showed only moderate interobserver agreement (κ = 0.46). Forty-one FGPs were classified as negative for dysplasia by consensus (CDS = 0-1), including 10 (24%) originally diagnosed as LGD. In contrast, all 37 cases classified as LGD by consensus (CDS = 4-5) were originally diagnosed as LGD, indicating that overdiagnosis of dysplasia is more common than underdiagnosis (P = 0.0012). Cytological atypia in the surface epithelium and an abrupt transition between atypical and normal-appearing epithelium were the most sensitive (97% and 100%, respectively) and specific (100% and 98%, respectively) features of dysplasia (P < 0.0001 for both comparisons). Very good agreement was achieved when a diagnosis of dysplasia was based on the presence of both features (κ = 0.85). CONCLUSIONS There is high interobserver variability and a tendency to overdiagnose LGD in FGPs. Strict criteria requiring both surface atypia and abrupt transition for LGD in FGPs result in low interobserver variability.
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Affiliation(s)
- Christine E Orr
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Debra Beneck
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Jose Jessurun
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Lihui Qin
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Kathrin Tyryshkin
- Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada
| | - Rhonda K Yantiss
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Yao-Tseng Chen
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
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Sano W, Inoue F, Hirata D, Iwatate M, Hattori S, Fujita M, Sano Y. Sporadic fundic gland polyps with dysplasia or carcinoma: Clinical and endoscopic characteristics. World J Gastrointest Oncol 2021. [DOI: 10.4251/wjgo.v13.i7.487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Sano W, Inoue F, Hirata D, Iwatate M, Hattori S, Fujita M, Sano Y. Sporadic fundic gland polyps with dysplasia or carcinoma: Clinical and endoscopic characteristics. World J Gastrointest Oncol 2021; 13:662-672. [PMID: 34322195 PMCID: PMC8299935 DOI: 10.4251/wjgo.v13.i7.662] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 04/25/2021] [Accepted: 06/02/2021] [Indexed: 02/06/2023] Open
Abstract
Fundic gland polyps (FGPs) are the most common gastric polyps and have been regarded as benign lesions with little malignant potential, except in the setting of familial adenomatous polyposis. However, in recent years, the prevalence of FGPs has been increasing along with the widespread and frequent use of proton pump inhibitors (PPIs). To date, several cases of FGPs with dysplasia or carcinoma (FGPD/CAs) have been reported. In this review, we evaluated the clinical and endoscopic characteristics of sporadic FGPD/CAs. Majority of the patients with sporadic FGPD/CAs were middle-aged women receiving PPI therapy and without Helicobacter pylori (H. pylori) infection. Majority of the sporadic FGPD/ CAs occurred in the body of the stomach and were sessile and small with a mean size of 5.4 mm. The sporadic FGPs with carcinoma showed redness, irregular surface structure, depression, or erosion during white light observation and irregular microvessels on the lesion surface during magnifying narrow-band imaging. In addition, sporadic FGPs, even with dysplasia, are likely to progress to cancer slowly. Therefore, frequent endoscopy is not required for patients with sporadic FGPs. However, histopathological evaluation is necessary if endoscopic findings different from ordinary FGPs are observed, regardless of their size. In the future, the prevalence of FGPs is expected to further increase along with the widespread and frequent use of PPIs and decreasing infection rate of H. pylori. Currently, it is unclear whether FGPD/CAs will also increase in the same way as FGPs. However, the trends of these lesions warrant further attention in the future.
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Affiliation(s)
- Wataru Sano
- Gastrointestinal Center, Sano Hospital, Kobe 655-0031, Hyogo, Japan
| | - Fumihiro Inoue
- Gastrointestinal Center, Sano Hospital, Kobe 655-0031, Hyogo, Japan
| | - Daizen Hirata
- Gastrointestinal Center, Sano Hospital, Kobe 655-0031, Hyogo, Japan
| | - Mineo Iwatate
- Gastrointestinal Center, Sano Hospital, Kobe 655-0031, Hyogo, Japan
| | - Santa Hattori
- Gastrointestinal Center, Sano Hospital, Kobe 655-0031, Hyogo, Japan
| | - Mikio Fujita
- Gastrointestinal Center, Sano Hospital, Kobe 655-0031, Hyogo, Japan
| | - Yasushi Sano
- Gastrointestinal Center, Sano Hospital, Kobe 655-0031, Hyogo, Japan
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Yang XM, Xu H. Clinical features of fundic gland polyps and their correlation with colorectal tumors. Shijie Huaren Xiaohua Zazhi 2020; 28:1036-1041. [DOI: 10.11569/wcjd.v28.i20.1036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Fundic gland polyps (FGPs) are multiple, sessile polypoid bumps formed by the gastric mucosa of the fundus and body, which are the most common type of gastric polyps and generally tend to be benign. Studies have shown that patients with FGPs have a higher risk of developing colorectal tumors (adenoma and cancer) than the general population, but their correlation is still controversial. This article is aimed to review the clinical features of FGPs and their correlation with colorectal tumors.
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Affiliation(s)
- Xue-Mei Yang
- Endoscopy Center, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Hong Xu
- Endoscopy Center, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
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