Gastric fundic gland polyps and their relationship to colorectal neoplasia in Koreans: a 16-year retrospective study

Retrospective cohort study investigating association between precancerous gastric lesions and colorectal neoplasm risk

Background

Colorectal cancer (CRC) is considered the most prevalent synchronous malignancy in patients with gastric cancer. This large retrospective study aims to clarify correlations between gastric histopathology stages and risks of specific colorectal neoplasms, to optimize screening and reduce preventable CRC.

Methods

Clinical data of 36,708 patients undergoing gastroscopy and colonoscopy from 2005-2022 were retrospectively analyzed. Correlations between gastric and colorectal histopathology were assessed by multivariate analysis. Outcomes of interest included non-adenomatous polyps (NAP), conventional adenomas (CAs), serrated polyps (SPs), and CRC. Statistical analysis used R version 4.0.4.

Results

Older age (≥50 years) and Helicobacter pylori infection (HPI) were associated with increased risks of conventional adenomas (CAs), serrated polyps (SPs), non-adenomatous polyps (NAP), and colorectal cancer (CRC). Moderate to severe intestinal metaplasia specifically increased risks of NAP and CAs by 1.17-fold (95% CI 1.05-1.3) and 1.19-fold (95% CI 1.09-1.31), respectively. For CRC risk, low-grade intraepithelial neoplasia increased risk by 1.41-fold (95% CI 1.08-1.84), while high-grade intraepithelial neoplasia (OR 3.76, 95% CI 2.25-6.29) and gastric cancer (OR 4.81, 95% CI 3.25-7.09) showed strong associations. More advanced gastric pathology was correlated with progressively higher risks of CRC.

Conclusion

Precancerous gastric conditions are associated with increased colorectal neoplasm risk. Our findings can inform screening guidelines to target high-risk subgroups, advancing colorectal cancer prevention and reducing disease burden.

Clinical features of fundic gland polyps and their correlation with colorectal tumors

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.

Relationship between gastric polyps and Helicobacter pylori infection

AIM

To explore the relationship between the clinicopathological features of gastric polyps and the infection status of Helicobacter pylori (H. pylori).

METHODS

Data for gastric polyps detected by gastroscopy at the Endoscopy Center of Air Force General Hospital from January 2013 to December 2016 were collected, and their clinical and pathological features were analyzed. The difference in age was analyzed by t test. The distributions of age, sex, H. pylori infection status, number of polyps, and location were analyzed by χ² test.

RESULTS

In 39572 cases of endoscopic examinations, 2445 cases of gastric polyps were detected. After excluding some cases according to the inclusion criteria, a total of 1339 cases of gastric polyps were included in this study. There were 771, 559 and 9 cases of hyperplastic, fundic gland and adenomatous polyps, respectively. Multiple polyps were detected in 991 cases. Fundic gland polyps tended to affect females and have a lower positive rate of H. pylori and more multiple lesions, and involve the fundus and body of the stomach (P < 0.05). There was no significant difference in age distribution between the two groups. The positive rate of H. pylori for multiple lesions was lower than that for single lesion (P < 0.05).

CONCLUSION

Fundic gland polyps have a low H. pylori positive rate and tend to be multiple and occur in the fundus and the body of the stomach. The detection rate of fundic gland polyps increases, which may lead to a lower H. pylori positive rate in multiple polyps than in single polyp.

Correlation between fundic gland polyps and colorectal neoplasms

AIM

To investigate the correlation between fundic gland polyps (FGPs) and colorectal neoplasms.

METHODS

Clinical data of patients who underwent both gastroduodenoscopy and colonoscopy during the period from May 2013 to May 2016 at the First Hospital of Jilin University were retrospectively analyzed. The patients were divided into either an FGPs group (243 cases) or a control group (n = 486). SPSS17.0 software was used for statistical analysis to assess the correlation between FGPs and colorectal neoplasms.

RESULTS

Colorectal neoplasms were detected in 19.8% (48/243) of patients with FGPs, while only in 8.8% (43/486) of the control group. The incidence of colorectal cancer was not significantly different (P = 0.67), while the incidence of colorectal adenoma was significantly different between the two groups (P < 0.001). Stratified analysis showed that the incidence of colorectal neoplasms in the FGPs group was higher than in the control group in females and in patients aged more than 50 years (P < 0.001 for both). Stratified analysis of different parts of colorectal neoplasms suggested that the incidence of colorectal neoplasms in patients who were female or aged over 50 years in the FGPs group was significantly higher than that in the control group, regardless of the proximal colon, distal colon or rectum (P < 0.05).

CONCLUSION

Patients with FGPs, especially females or those aged over 50, have a higher risk for colorectal neoplasms. Colonoscopy is necessary in this group of patients.

Do we need colonoscopy verification in patients with fundic gland polyp?

Background/Aims

The aim of this study was to evaluate the prevalence of colorectal neoplasia in subjects with fundic gland polyps (FGPs) and the relationship between FGPs and colorectal neoplasia in Korea.

Methods

We analyzed 128 consecutive patients with FPGs who underwent colonoscopy between January 2009 and December 2013. For each case, age- (±5 years) and sex-matched controls were identified from among patients with hyperplastic polyps, gastric neoplasms, and healthy controls. Clinical characteristics were reviewed from medical records, colonoscopic findings, pathologic findings, and computed tomography images. The outcome was evaluated by comparison of advanced colonic neoplasia detection rates.

Results

Of the 128 patients, seven (5.1%) had colon cancers and seven (5.1%) had advanced adenomas. A case-control study revealed that the odds of detecting a colorectal cancer was 3.8 times greater in patients with FGPs than in the age- and sex-matched healthy controls (odds ratio [OR], 3.80; 95% confidence interval [CI], 1.09–13.24; P =0.04) and 4.1 times greater in patients with FGPs than in healthy controls over 50 years of age (OR, 4.10; 95% CI, 1.16–14.45; P =0.04). Among patients with FGPs over 50 years old, male sex (OR, 4.83; 95% CI, 1.23–18.94; P =0.02), and age (OR, 9.90; 95% CI, 1.21–81.08; P =0.03) were associated with an increased prevalence of advanced colorectal neoplasms.

Conclusions

The yield of colonoscopy in colorectal cancer patients with FGPs was substantially higher than that in average-risk subjects. Colonoscopy verification is warranted in patients with FGPs, especially in those 50 years of age or older.

Clinical significance of colonoscopy in patients with upper gastrointestinal polyps and neoplasms: a meta-analysis

BACKGROUND

Some authors have studied the relationship between the presence of polyps, adenomas and cancers of upper gastrointestinal tract (stomach and duodenum) and risk of colorectal polyps and neoplasms; however, the results are controversial, which may be due to study sample size, populations, design, clinical features, and so on. No meta-analysis, which can be generalized to a larger population and could provide a quantitative pooled risk estimate of the relationship, of this issue existed so far.

METHODS

We performed a meta-analysis to evaluate risk of colorectal polyps or neoplasms in patients with polyps, adenomas or cancers in upper gastrointestinal tract comparing with controls. A search was conducted through PubMed, EMBASE, reference lists of potentially relevant papers, and practice guidelines up to 27 November 2013 without languages restriction. Odd ratios (ORs) were pooled using random-effects models.

RESULTS

The search yielded 3 prospective and 21 retrospective case-control studies (n = 37152 participants). The principal findings included: (1) OR for colorectal polyps was 1.15 (95% CI, 1.04-1.26) in the gastric polyps group comparing with control groups; (2) Patients with gastric polyps and neoplasms have higher risk (OR, 1.31 [95% CI, 1.06-1.62], and 1.72 [95% CI, 1.42-2.09], respectively) of colorectal neoplasms comparing with their controls; and (3) Positive association was found between the presence of colorectal neoplasms and sporadic duodenal neoplasms (OR, 2.59; 95% CI, 1.64-4.11).

CONCLUSIONS

Findings from present meta-analysis of 24 case-control studies suggest that the prevalence of colorectal polyps was higher in patients with gastric polyps than in those without gastric polyps, and the risk of colorectal neoplasms increases significantly in patients with gastric polyps, neoplasms, and duodenal neoplasms. Therefore, screening colonoscopy should be considered for patients with upper gastrointestinal polyps and neoplasms.