GASTROENTEROLOGY ARTICLE OF THE WEEK
January 8, 2004
Burt RW. Gastric Fundic Gland Polyps. Gastroenterology 2003;125:1462-1469.
1. Characteristics of gastric fundic gland polyps
a. When sporadic, usually 10 or less polyps are found
b. When associated with polyposis syndrome, they occur at an earlier age
c. Are usually associated with gastric atrophy
d. Sporadic gastric fundic gland polyps are more common in males
e. The antrum is frequently involved.
f. Histology shows dilated cystic fundic glands
g. Are frequently pedunculated
h. Are usually associated with H. pylori infection
True or False
2. In >65% of cases, when gastric fundic gland polyposis is found, there is an associated colon polyposis syndrome.
3. Fundic gland polyposis (>10) occurs in 7.5% of those patients taking PPI’s.
4. Sporadic fundic gland polyposis is associated with defects in the same gene as that found in colonic polyposis-associated gastric fundic gland polyposis.
5. FGP (fundic gland polyposis) is found in 12% to 84% of FAP patients
6. Fundic gland polyps may regress after acquisition of H. pylori infection
7. Any person with more than 20 adenomas over time or on a single colonoscopy should be tested for attenuated FAP
8. FGP associated with FAP carries a gastric cancer risk of about <0.6%
9. Patients with attenuated FAP should always undergo a colectomy by age 45.
10. Because the rectum is usually spared in attenuated FAP, colectomy with ileo-rectal anastomosis (instead of ileo-anal anastomosis) is an acceptable surgical approach.
11. Attenuated FAP
a. associated with an average of 30 polyps in the colon
b. later onset of polyposis, colon cancer typically develops at age 55-56
c. life-time risk of colon cancer of 100%
d. more likely to be left-sided colonic polyps