Females Have a Higher Prevalence of Severe and Dysplastic Fundic Gland Polyposis: A Case-Control Study

The purpose of this study was to determine risk factors associated with the development of Fundic Gland Polyps (FGP) and its association with gastric cancer.

Gastric cancer incidence is increasing and may be linked to PPIs. FGP are  common and a possible intermediary between PPI use and the risk of gastric cancer.

This single-center retrospective case-control study compared multiple risk factors between cases with FGP and controls between January 1, 2021 and December 31, 2021. Severe FGP was defined by innumerable, diffuse, or >50 polyps by endoscopic reporting and dysplasia by histopathology. Patient outcomes with severe polyposis and dysplasia were reviewed. Gastrectomy specimens and endoscopic reports were reviewed for FGP in an independent cohort of patients with known gastric cancer. Univariate and multivariate models using logistic regression were constructed.

The main logistic regression model included 591 participants (330 cases and 261 controls). Increasing age [OR: 1.02 (1.01 to 1.03)] and >2 years of PPI use [OR: 2.76 (1.72 to 4.47)] were associated with increased risk of FGP whereas smoking was protective [OR: 5.41 (2.58 to 12.24)]. Most patients with severe FGP (87.5%), low-grade (77%), and high-grade dysplasia (80%) were females. No patients developed gastric cancer on follow-up (mean: 13.9 mo). None of the patients within an independent cohort of gastric cancers diagnosed between January 1, 2021 and December 31, 2021 had FGP.

Although FGP are equally common among sexes, severe and dysplastic FGP are more common among females, but none progressed to cancer. These data could be useful to counsel patients with FGP.