Gastroesophageal reflux is associated with an increased risk of gastric cardiac polyps: a case-control study of 140 cases

The pathogenesis of gastric cardiac polyps is not yet clear, and there is little research on their clinical and histopathologic characteristics and correlation with gastroesophageal reflux. Early detection and treatment of premalignant lesions in this area can prevent the development of cancer. We aimed to evaluate the clinical and histopathologic characteristics and risk factors of gastric cardiac polyps to improve the current understanding of the disease.

Patients diagnosed with gastric cardiac polyps at the Third Affiliated Hospital of Sun Yat-Sen University between January 1, 2010, and December 31, 2019, were sought for the study. The exclusion criteria were missing clinical data, insufficient pathological reports, gastric malignancy, or a previous history of gastroduodenal surgery. Ultimately, 140 patients were included in the case group, while 140 patients diagnosed with chronic superficial gastritis from the same 10-year period were identified randomly and selected as a control group. The exclusion criteria for this group were the same as those for the case group. Patients in both groups were matched in age and gender to ensure comparability between the two groups. We evaluated and compared the demographic and clinical data and endoscopic impressions of each group and analyzed the endoscopic, histologic features of gastric cardiac polyps.

Gastroesophageal reflux was significantly associated with a higher risk of gastric cardiac polyps after adjustment for other covariates [adjusted odds ratio (OR) =2.809; 95% confidence interval (CI): 1.178-6.697; P=0.020]. Most gastric polyps were single (97.9%), sessile (92.8%), and small polyps with a diameter less than 1 cm (88.6%). Most were located in the gastroesophageal junction region (65.0%) with a smooth surface (56.4%) or surface congestion (30.0%). Hyperplastic (inflammatory) polyps (88.0%) were the most common pathological type and comprised gastric-type foveolar epithelium, squamous epithelium, or admixture of the two epithelia, with a minority showing intestinal metaplasia, mild, or moderate epithelial dysplasia.

Gastroesophageal reflux was associated with a significantly higher incidence of gastric cardiac polyps with a 2.8-fold increased risk. Most gastric cardiac polyps were found to be benign lesions and had a favorable prognosis in the clinic despite their malignant potential.