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Jaroń K, Pietrzak A, Daniluk J, Adrych K, Gąsiorowska A, Skrzydło-Radomańska B, Małecka-Wojciesko E, Zwolińska-Wcisło M, Waluga M, Reguła J, Rydzewska G. Diagnostic and therapeutic recommendations on Helicobacter pylori infection. Recommendations of the Working Group of the Polish Society of Gastroenterology. PRZEGLAD GASTROENTEROLOGICZNY 2023; 18:225-248. [PMID: 37937106 PMCID: PMC10626381 DOI: 10.5114/pg.2023.131998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 09/27/2023] [Indexed: 11/09/2023]
Abstract
Helicobacter pylori remains a major health problem worldwide, causing considerable morbidity and mortality due to peptic ulcer disease and gastric cancer. These guidelines constitute an update of the previous "Recommendations on the diagnosis and management of Helicobacter pylori infection" issued in 2014. They have been developed by a Task Force organized by the Governing Board of the Polish Society of Gastroenterology. They discuss, with particular emphasis on new scientific data covering papers published since 2014: the epidemiology, clinical presentation, diagnostic principles and criteria for the diagnosis, and recommendations for the treatment of H. pylori infection. The guidelines in particular determine which patients need to be tested and treated for infection. The Task Force also discussed recommended treatment algorithms. Accordingly, a combination of available evidence and consensus-based expert opinion were used to develop these best practice advice statements. It is worth noting that guidelines are not mandatory to implement but they offer advice for pragmatic, relevant and achievable diagnostic and treatment pathways based on established key treatment principles and using local knowledge and available resources to guide regional practice.
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Affiliation(s)
- Krzysztof Jaroń
- Department of Internal Medicine and Gastroenterology and Subdivision for Treatment of Inflammatory Bowel Diseases, the National Medical Institute of the Ministry of Internal Affairs and Administration, Warsaw, Poland
| | - Anna Pietrzak
- Second Gastroenterology Clinic, Medical Centre for Postgraduate Education, Warsaw, Poland
- Gastroenterology Department, Bielański Hospital, Warsaw, Poland
| | - Jarosław Daniluk
- Department of Gastroenterology and Internal Diseases, Medical University of Bialystok, Bialystok, Poland
| | - Krystian Adrych
- Department of Gastroenterology and Hepatology, Medical University of Gdansk, Gdansk, Poland
| | - Anita Gąsiorowska
- Department of Gastroenterology, Central Clinical Hospital of the Medical University, Lodz, Poland
| | | | | | | | - Marek Waluga
- Department of Gastroenterology and Hepatology, Prof. Kornel Gibiński University Clinical Centre, Medical University of Silesia, Katowice, Poland
| | - Jarosław Reguła
- Department of Oncological Gastroenterology, Maria Skłodowska-Curie National Cancer Institute – National Research Institute, Warsaw, Poland
- Department of Gastroenterology, Hepatology and Clinical Oncology, Medical Centre for Postgraduate Education, Warsaw, Poland
| | - Grażyna Rydzewska
- Department of Internal Medicine and Gastroenterology and Subdivision for Treatment of Inflammatory Bowel Diseases, the National Medical Institute of the Ministry of Internal Affairs and Administration, Warsaw, Poland
- Department of Gastrointestinal Disease Prevention, Faculty of Medicine and Health Sciences, Jan Kochanowski University, Kielce, Poland
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Kim Y, Kang S, Ahn JY, Jung HY, Lee GH, Song HJ, Choi KD, Kim DH, Jung KW, Lee JH, Na HK. Risk factors associated with recurrence of gastric hyperplastic polyps: a single-center, long-term, retrospective cohort study. Surg Endosc 2023; 37:7563-7572. [PMID: 37438481 DOI: 10.1007/s00464-023-10194-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 06/01/2023] [Indexed: 07/14/2023]
Abstract
BACKGROUND The likelihood of recurrence of gastric hyperplastic polyps (GHPs) following endoscopic resection and the need for long-term follow-up remain unknown. We, therefore, aimed to investigate the factors associated with the recurrence and cumulative incidence of GHPs over a 10-year period. METHODS Between May 1995 and December 2020, 1,018 GHPs > 1 cm were endoscopically resected from 869 patients. Medical records of these patients were retrospectively reviewed and their clinical features and outcomes were assessed. Groups of GHPs with recurrence and those without recurrence group were compared, and univariate and multivariable analyses were performed to identify the potential risk factors for GHP recurrence. RESULTS A total of 104 (12.0%) patients who underwent endoscopic removal of GHPs experienced recurrence. Compared to patients without recurrent GHPs, those with recurrent GHPs showed considerably larger median polyp size (28 mm vs. 14 mm, P < 0.001), a higher proportion of multiple polyps (41.3% vs. 29.3%, P = 0.020), polyps with lobulation (63.5% vs. 40.3%, P = 0.001), and exudate (63.5% vs. 46.8%, P = 0.001). Compared to the local recurrence (n = 52) group, the metachronous recurrence (n = 52) group had larger median polyp size (20 mm vs. 16 mm, P = 0.006) as well as higher rates of polyp lobulation (86.5% vs. 40.4%, P < 0.001) and exudate (82.7% vs. 44.4%, P = 0.001). After primary GHP excision, the cumulative incidence of recurrence was 7.2%, 12.7%, and 19.6% at 2 years, 5 years, and 10 years, respectively. CONCLUSION The incidence of GHP recurrence following endoscopic excision increased as the follow-up period increased, especially in patients whose GHPs were large-sized, multiple, or characterized by surface exudates/lobulations.
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Affiliation(s)
- Yuri Kim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Seokin Kang
- Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Ji Yong Ahn
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea.
| | - Hwoon-Yong Jung
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Gin Hyug Lee
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Ho June Song
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Kee Don Choi
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Do Hoon Kim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Kee Wook Jung
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Jeong Hoon Lee
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Hee Kyong Na
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
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Xing Y, Han H, Wang Y, Sun Z, Wang L, Peng D, Guo X, Yao N, Yuan Y, Zhang W, Mao T, Liu Y. How to improve the diagnosis of neoplastic transformation of gastric hyperplastic polyps in the context of autoimmune gastritis?: A case report and lierature review. Medicine (Baltimore) 2022; 101:e32204. [PMID: 36482631 PMCID: PMC9726335 DOI: 10.1097/md.0000000000032204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
RATIONALE Gastric hyperplastic polyp (GHP) commonly arises in the abnormal background mucosa, which makes it easy to be misdiagnosed and missed, and has a potential risk of malignant transformation over time. Here, we present a case of neoplastic transformation of GHP in a context of autoimmune gastritis (AIG). PATIENT CONCERNS In 2020, a 67-year-old woman was admitted for endoscopic review 6 years after gastric polyp resection, the histological diagnosis of gastric polyp was neoplastic transformation of GHP as before. The patient had undergone multiple polypectomies at the same part. Then histological examination revealed that partial epithelial hyperplasia and dysplasia, and the neoplastic areas were interlaced with normal mucosa. DIAGNOSES AND INTERVENTIONS We further found that the background diagnosis was AIG. These results supported the diagnosis of neoplastic transformation of GHP in a context of AIG. With the doubt of missed diagnose, we retrospectively analyzed the medical history in 2014, 2015 and 2016, confirmed the presence of AIG. Unfortunately, serological tests and special treatment were not performed. OUTCOMES The correct diagnosis was eventually confirmed in 2020, which enables patients to receive normal treatment and monitoring, and avoids further deterioration of the disease. LESSONS The purpose of this case report is to increase clinical awareness of neoplastic transformation of GHP in a context of AIG, and hope promise for early diagnosis and treatment.
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Affiliation(s)
- Yunqi Xing
- Dongfang hospital, Beijing University of Chinese Medicine, Beijing, P.R China
- Graduate School, Beijing University of Chinese Medicine, Beijing, P.R. China
| | - Haixiao Han
- Dongfang hospital, Beijing University of Chinese Medicine, Beijing, P.R China
| | - Yuxuan Wang
- Dongfang hospital, Beijing University of Chinese Medicine, Beijing, P.R China
| | - Zhongmei Sun
- Dongfang hospital, Beijing University of Chinese Medicine, Beijing, P.R China
| | - Linheng Wang
- Dongfang hospital, Beijing University of Chinese Medicine, Beijing, P.R China
| | - Dan Peng
- Dongfang hospital, Beijing University of Chinese Medicine, Beijing, P.R China
| | - Xiaoyuan Guo
- Dongfang hospital, Beijing University of Chinese Medicine, Beijing, P.R China
| | - Na Yao
- Dongfang hospital, Beijing University of Chinese Medicine, Beijing, P.R China
| | - Yali Yuan
- Dongfang hospital, Beijing University of Chinese Medicine, Beijing, P.R China
| | - Wenji Zhang
- Dongfang hospital, Beijing University of Chinese Medicine, Beijing, P.R China
| | - Tangyou Mao
- Dongfang hospital, Beijing University of Chinese Medicine, Beijing, P.R China
- * Correspondence: Yuyue Liu, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing 100078, China (e-mail: ) and Tangyou Mao, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing 100078, China (e-mail: )
| | - Yuyue Liu
- Dongfang hospital, Beijing University of Chinese Medicine, Beijing, P.R China
- * Correspondence: Yuyue Liu, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing 100078, China (e-mail: ) and Tangyou Mao, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing 100078, China (e-mail: )
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Mohapatra SSG, Agarwal BD, Gupta M. Case Report- A rare case of giant hyperplastic polyp. Radiol Case Rep 2021; 17:355-359. [PMID: 34917220 PMCID: PMC8646053 DOI: 10.1016/j.radcr.2021.10.061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 10/25/2021] [Accepted: 10/27/2021] [Indexed: 11/18/2022] Open
Abstract
Giant gastric hyperplastic polyps are the most common benign epithelial tumors in the stomach. These are non-neoplastic epithelial proliferations of the stomach which are strongly associated with inflammatory conditions like chronic gastritis, helicobacter pylori gastritis, reactive or chemical gastritis. A 60 years old gentleman presented with history of two bouts of hematemesis preceded by multiple intermittent episodes of epigastric pain, nausea and few episodes of non-bilious vomiting without any history of previous gastrointestinal bleed, loss of appetite or significant weight loss. Work up with ultrasonography of abdomen, upper gastrointestinal endoscopy, contrast enhanced computed tomography abdomen, laboratory investigations followed by biopsy and histopathology was done which confirmed the diagnosis. Giant hyperplastic polyps are benign epithelial tumor of stomach often resulting from excessive regenerative hyperplasia in areas of chronic inflammation with no site predilection and nearly no malignant potential. Usually asymptomatic, these are incidentally detected on upper gastrointestinal endoscopy with characteristic appearance of such polyps on double contrast barium study followed by upper gastrointestinal endoscopy and biopsy is definitive for diagnosis.
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BRAF Mutation Is Associated with Hyperplastic Polyp-Associated Gastric Cancer. Int J Mol Sci 2021; 22:ijms222312724. [PMID: 34884530 PMCID: PMC8657452 DOI: 10.3390/ijms222312724] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 11/21/2021] [Accepted: 11/22/2021] [Indexed: 12/24/2022] Open
Abstract
Gastric hyperplastic polyps (GHP) are frequently found to be benign polyps and have been considered to have a low carcinogenic potential. The characteristics of the hyperplastic polyp-associated gastric cancer (HPAGC) remain unclear. Therefore, we analyzed samples from 102 GHP patients and identified 20 low-grade atypical GHPs (19.6%), 7 high-grade atypical GHPs (6.9%), and 5 intramucosal cancer samples (4.9%). GHP atypia was more common in the elderly and increased with increasing polyp size. In particular, polyps larger than 1 cm were associated with a higher grade and cancer. Furthermore, mucus production decreased with increasing atypia. Although no correlation was found between atypia and Helicobacter pylori infection or intestinal metaplasia, enhanced proliferative ability (Ki-67) did correlate with atypia, as did nuclear 8-hydroxy-2'-deoxyguanosine levels. Interestingly, 4-hydroxynonenal levels in granulation tissue and the area ratio of granulation tissue within polyps also correlated with GHP atypia. In five cases of HPAGC, three cases exhibited caudal type homeobox transcription factor (CDX2)-positive cells and a mixed mucin phenotype, which is considered to be related to H. pylori infection. By contrast, two cases were CDX2 negative, with a gastric mucin phenotype, and H. pylori infection was not observed in the tumor or the surrounding mucosa. In these cases, a v-raf murine sarcoma viral oncogene homolog B1 (BRAF) mutation (V600E) was detected. All cancer samples showed high stemness and p53 protein accumulation, but no KRAS mutations. The molecular and phenotypic characteristics of the cases characterized by BRAF mutations may represent a novel subtype of HPAGC, reflecting a conserved pathway to oncogenesis that does not involve H. pylori infection. These findings are worthy of further investigation in a large-scale study with a substantial cohort of HPAGC patients to establish their clinical significance.
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