Overview
Fundic gland polyps (FGPs) are the most common gastric polyps, typically benign lesions arising in the oxyntic mucosa and most often located in the gastric fundus or body.
Etiology and associations
- Proton‑pump inhibitor (PPI) exposure: Sporadic FGPs are strongly associated with long‑term PPI therapy and have increased in prevalence since widespread PPI use.
- Hereditary syndromes: Multiple or early‑onset FGPs raise concern for familial adenomatous polyposis (FAP) or gastric adenocarcinoma and proximal polyposis of the stomach (GAPPS).
- Helicobacter pylori: Epidemiologic inverse association; FGPs are less common in populations with high H. pylori prevalence.
Pathology and malignant potential
- Histology: cystically dilated oxyntic glands lined by chief, parietal, and foveolar cells; epithelial architecture is typically bland.
- Malignant risk: sporadic FGPs rarely display dysplasia and malignant transformation is extremely uncommon; FGPs in FAP/GAPPS have higher dysplasia/neoplasia risk.
Clinical significance
- Incidental, solitary small FGP: usually benign; no routine polypectomy or intensified surveillance required when histology confirms benign FGP and no risk factors are present.
- Multiple or early‑onset FGPs: prompt consideration of genetic evaluation for FAP/GAPPS and colonoscopic assessment for colonic polyposis.
- Dysplasia or atypia: biopsy or removal is indicated; management guided by pathology and genetics consultation.
- PPI review: assess indication and duration of PPI therapy; consider dose minimization or stopping when clinically feasible, recognizing regression is not guaranteed.
When to biopsy, remove, or surveil
- Biopsy or remove polyps that are large, symptomatic, or show suspicious endoscopic features.
- Obtain histologic confirmation for atypical lesions or when multiple polyps are found.
- No routine surveillance is required for a single, diminutive sporadic FGP without dysplasia or syndromic features.
Practical steps for clinicians
- Document number, size, and gastric location of FGPs at endoscopy.
- Obtain targeted biopsies for atypical or large lesions and when multiple polyps are present.
- Review medication history for long‑term PPI use and reassess ongoing need.
- Refer for genetic counseling and colonoscopy when multiple polyps, dysplasia, or early age at presentation suggest FAP or GAPPS.