Current Guidelines and Advances in the Management of Fundic Gland Polyps

Fundic gland polyps (FGPs) are the most common type of gastric polyps, predominantly benign and associated with long-term proton pump inhibitor (PPI) use and familial adenomatous polyposis (FAP). FGPs are primarily found in the gastric fundus and body, with higher prevalence in individuals over 50 and previously thought to have been a consequence of prolonged PPI therapy. Although most FGPs are sporadic and carry minimal malignancy risk, FAP-associated FGPs may exhibit dysplastic changes, warranting closer surveillance. This review provides a comprehensive overview of the current guidelines and recent advances in the management of FGPs, focusing on diagnostic approaches, including endoscopic and imaging techniques, as well as histopathological evaluation. It discusses the pathophysiology of FGP formation, highlighting the role of PPI use, the inverse relationship with Helicobacter pylori infection, and the genetic alterations in the APC and β-catenin genes. Recommendations for the management of FGPs vary by patient population; for those with FAP or on long-term PPI therapy, surveillance strategies include endoscopic monitoring and possible polypectomy in cases of dysplasia. For most patients with sporadic FGPs, conservative management is appropriate. This review aims to provide clarity on the management of FGPs, emphasizing the need for individualized approaches based on risk factors and polyp characteristics.