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The prevalence of gastric polyps in the general population is approximately 0.8% to 2.4%.214,215 Gastric polyps consist predominantly of fundic gland polyps (≈50%), hyperplastic polyps (≈40%), and adenomatous polyps (≈10%).215,216
The clinical course of fundic gland polyps is generally benign, and they are detected with increasing frequency in the era of PPI use. In a series of 599 consecutive patients who underwent upper endoscopy, use of PPIs for more than 5 years was associated with a nearly 4-fold increased risk of fundic gland polyps.217 The rate of malignant transformation of these polyps is generally quite low (≈1%) and confined to polyps larger than 1 cm.218 One notable exception to the benign nature of fundic gland polyps is in FAP. In this group, the prevalence of fundic gland polyps ranges from 51% to 88%, with dysplasia present in over 40% of cases.130,131
Hyperplastic polyps are generally benign, often multiple, and are typically observed in the setting of chronic inflammatory conditions (e.g., chronic atrophic gastritis), pernicious anemia, chronic antral gastritis, adjacent to ulcers and erosions, and especially at sites of gastroenterostomies. Over time, the polyps may regress, remain stable, or increase in size, and they often regress following Hp eradication. Men and women are equally affected, and the polyps typically appear in mid- to late-adult life.219 The rare hyperplastic polyps that undergo malignant transformation often have areas of dysplasia or intestinal metaplasia and typically form a well-differentiated intestinal-type cancer.218
In contrast to other polyps of the stomach, gastric adenomas undergo malignant transformation at a high rate. When gastric adenomas were followed by serial endoscopy with biopsy, progression through dysplasia to carcinoma in situ developed within 4 years in approximately 11% of cases.220 Endoscopic biopsy of gastric polyps can be associated with significant sampling error.221 The British Society of Gastroenterology published guidelines in 2010 regarding the management of gastric polyps.222 Among the recommendations were: (1) all gastric polyps should be at least biopsied; (2) all gastric adenomas, symptomatic polyps, and polyps with dysplasia should be removed; and (3) Hp, if present, should be eradicated in patients with hyperplastic or adenomatous polyps. Decisions regarding surveillance intervals should be made on an individual basis.