Gastric Polyps Research Articles

Helicobacter pylori Eradication and Gastric Cancer Prevention

Since Warren and Marshall demonstrated Helicobacter pylori (H. pylori) as a cause of gastritis in the early 1980s, H. pylori has been associated with various gastric diseases, including gastric ulcer, gastric mucosa-associated lymphoid tissue (MALT) lymphoma, gastric adenoma, gastric adenocarcinoma, and hyperplastic gastric polyps. H. pylori eradication therapy can treat some associated diseases, including low-grade gastric MALT lymphoma, and significantly reduce the risk of peptic ulcer recurrence or progression of atrophic gastritis and intestinal metaplasia. In East Asia, where H. pylori and gastric cancer are prevalent, several studies have been conducted to prove whether the risk of gastric cancer development is reduced through H. pylori eradication therapy. Early studies failed to show the benefits of H. pylori eradication therapy in gastric cancer prevention. However, recent studies with extended follow-up periods have reported reduced risks of gastric cancer after treatment of H. pylori infection. H. pylori eradication therapy effectively prevents gastric cancer even in patients who were treated for early gastric cancer, and can be used in treating hyperplastic gastric polyps. Herein, we reviewed current evidence supporting the benefits of H. pylori eradication therapy to help clinicians understand its impact on gastric cancer prevention and hyperplastic polyp treatment.

A case of a giant gastric hyperplastic polyp in an ESD scar

A case of a giant gastric hyperplastic polyp in an ESD scar

Multiple gastric polyps causing anemia in a patient on a proton-pump inhibitor: a case report

Multiple gastric polyps causing anemia in a patient on a proton-pump inhibitor: a case report

BRAF Mutation Is Associated with Hyperplastic Polyp-Associated Gastric Cancer.

Gastric hyperplastic polyps (GHP) are frequently found to be benign polyps and have been considered to have a low carcinogenic potential. The characteristics of the hyperplastic polyp-associated gastric cancer (HPAGC) remain unclear. Therefore, we analyzed samples from 102 GHP patients and identified 20 low-grade atypical GHPs (19.6%), 7 high-grade atypical GHPs (6.9%), and 5 intramucosal cancer samples (4.9%). GHP atypia was more common in the elderly and increased with increasing polyp size. In particular, polyps larger than 1 cm were associated with a higher grade and cancer. Furthermore, mucus production decreased with increasing atypia. Although no correlation was found between atypia and Helicobacter pylori infection or intestinal metaplasia, enhanced proliferative ability (Ki-67) did correlate with atypia, as did nuclear 8-hydroxy-2’-deoxyguanosine levels. Interestingly, 4-hydroxynonenal levels in granulation tissue and the area ratio of granulation tissue within polyps also correlated with GHP atypia. In five cases of HPAGC, three cases exhibited caudal type homeobox transcription factor (CDX2)-positive cells and a mixed mucin phenotype, which is considered to be related to H. pylori infection. By contrast, two cases were CDX2 negative, with a gastric mucin phenotype, and H. pylori infection was not observed in the tumor or the surrounding mucosa. In these cases, a v-raf murine sarcoma viral oncogene homolog B1 (BRAF) mutation (V600E) was detected. All cancer samples showed high stemness and p53 protein accumulation, but no KRAS mutations. The molecular and phenotypic characteristics of the cases characterized by BRAF mutations may represent a novel subtype of HPAGC, reflecting a conserved pathway to oncogenesis that does not involve H. pylori infection. These findings are worthy of further investigation in a large-scale study with a substantial cohort of HPAGC patients to establish their clinical significance.

Prevalence of neoplasia in solitary and multiple esophago-gastrointestinal polyps: 5 years retrospective histopathological study.

The increasing use of endoscopy has led to more discernable abnormalities in the stomach, including polyps. Gastric polyps encompass a spectrum of pathologic conditions that can vary in histology, neoplastic potential, and management. Despite their high prevalence, there is a paucity of literature to support management and treatment decisions for endoscopists. The goal of this review is to summarize clinical, endoscopic, and histopathologic features of various polyps, review syndromes associated with such polyps and provide management recommendations. The present study was carried out for analyzing and comparing the prevalence of neoplasia in polyps (Solitary and multiple) removed endoscopically from the esophagus, stomach, and bowel undergoing screening. Five years retrospective study was done on patients who underwent endoscopy procedures including Oesophagogastroduodenoscopy (OGD) and colonoscopybetween June 2015 and March 2019 in Faruk Medical City Hospital, Sulaimani City. Age and sex of patients, site of occurrence, number of polyps (solitary or multiple), and polyps' histologic type of 369 cases were analyzed in this study. Regarding solitary polyps, out of 279 polyps, 155 were neoplastic (55%) and 124 were non-neoplastic polyps, while multiple polyps, out of a total of 90 cases, 68 were neoplastic (75%) and 22 were non-neoplastic. More than 78% of patients were above the age of 40 years. Tubular adenoma was the most commonly diagnosed polyp. Large bowel was the most commonly involved site and left-sided polyps outnumbered right-sided ones with the sigmoid colon being the most commonly involved site. Screening programs including endoscopy, especially the colon for detecting polyps and particularly the colorectal region can be helpful to reduce morbidity and mortality of patients.

Image Mosaic Algorithm-Based Analysis of Pathological Characteristics of Gastric Polyp Patients Using Computed Tomography Images.

The application value of image mosaic algorithm (IMA) based CT imaging technology in the analysis of pathological characteristics of gastric polyp (GP) patients was explored in this work. 588 cases of GP patients in the hospital were selected as the research objects, and CT images based on IMA were adopted for examination. The patient's basic information, image performance, and gastroscopy results were recorded. The results showed that the absolute mean bright error (AMBE) index and information entropy of the IMA are 0.0625 and 7.0385, respectively. The clinical symptoms of patients were mostly abdominal pain (21.4%), abdominal distension (15.6%), and sour regurgitation (17.8%). The common size of GP was no more than 0.5 cm, and the common type was Yamada type II. There were notable differences between single and multiple GPs of different pathological types (P < 0.05). Proliferative polyps were mostly found in the stomach and antrum, while fundus gland polyps were mostly in the stomach and fundus. There was significant difference between the growth location of the hyperplastic polyp and basal gland polyp (P < 0.05). In summary, the CT images of IMA proposed in this paper can not only realize image splicing effectively but also were superior to the traditional SIFT method in the quality of splicing image and were conducive to the analysis of the pathological characteristics of GP patients, which had significant clinical promotion value.

Cronkhite-Canada syndrome: An investigation in clinical features and pathogenesis.

This study aimed to investigate the clinical features and potential pathogenesis of a rare nonhereditary polyposis syndrome, Cronkhite-Canada syndrome (CCS). Medical records of eight patients with CCS who were admitted to our hospital from January 2005 to November 2019 were reviewed. Transcriptome profiling was performed in one patient to investigate its difference between gastric polyp tissue and normal mucosa. Differentially expressed genes (DEGs) were determined for functional analysis. The expression of inhibin beta A (INHBA) was further assessed by using immunohistochemistry. All patients presented with gastrointestinal polyposis, accompanied by diarrhea, skin hyperpigmentation, hair loss and nail dystrophy. Hyperplastic polyps were observed in seven patients, tubular adenoma in two, inflammatory polyps in one and hamartomatous polyps in one, respectively. All patients underwent comprehensive treatment and five achieved clinical remission. A total of 2107 DEGs, including 1265 upregulated and 842 downregulated, were found in the gastric polyp. Gene ontology analysis showed that upregulated genes were significantly enriched in the positive regulation of cell proliferation, epithelium development and angiogenesis. A protein-protein interaction analysis suggested that INHBA was at the center of the interaction network and might play an important role in CCS. Immunohistochemistry confirmed that INHBA expression was upregulated in CCS gastric polyps. CCS is a rare disease and its diagnosis mainly depends on typical clinical manifestations, endoscopic findings and histological features. INHBA upregulation may contribute to its pathogenesis.

Gastric Adenocarcinoma and Proximal Polyposis of the Stomach in a Hispanic Pediatric Patient With APC Gene Variant c.-191T&gt;G

Gastric adenocarcinoma and proximal polyposis of the stomach (GAPPS) is a rare gastric polyposis syndrome defined by numerous polyps (&gt;100) in the fundus and body of the stomach with sparing of the lesser curvature and antrum. GAPPS is linked to a variant in the promoter 1B region of the APC gene. These variants carry a high risk of developing gastric adenocarcinoma, which can occur at an early age. We report a case of GAPPS discovered in a 16-year-old Hispanic girl after endoscopy detected extensive fundic gland polyposis. Genetic testing revealed a promoter 1B point mutation of the APC gene, variant c.-191T&gt;G. Although similar variants have been reported (i.e., c.-191T&gt;C, c.-195A&gt;C, c.-192A&gt;G) in association with GAPPS, variant c.-191T&gt;G has not nor has GAPPS ever been described in a Hispanic individual before.

A case of osseous metaplasia in a gastric hyperplastic polyp: An unexpected finding in a common polyp

Abstract Introduction/Objective Foveolar hyperplastic polyp is a common gastric polyp characterized by foveolar hyperplasia with erosion, acute and chronic inflammation, granulation tissue formation, and smooth muscle strands extending from the muscularis mucosae. Although foveolar hyperplastic polyps may rarely contain foci of dysplasia or invasive carcinoma, osseous metaplasia/heterotopic bone formation in foveolar hyperplastic polyps of the stomach is extremely rare with a few case reports. Methods/Case Report A 63-year-old female with a history of hypertension, sick sinus syndrome, and Hashimoto’s thyroiditis was referred to our facility for evaluation of a mass in segment eight of the liver. The liver biopsy showed a moderately differentiated adenocarcinoma, most consistent with intrahepatic cholangiocarcinoma. A screening gastrointestinal endoscopy revealed a 7-mm sessile polyp in the antrum. The polyp was removed with a cold snare. No other abnormalities were identified in the stomach. Sections of the polyp showed fragments of antral-type gastric mucosa with foveolar hyperplasia, erosion, acute and chronic inflammation, and focal granulation tissue formation. In addition, multiple foci of woven bone formation without bone marrow surrounding dilated gastric foveolae were identified. No Helicobacter infection, intestinal metaplasia, dysplasia or malignancy was identified histologically. Osseous metaplasia/heterotopic bone formation is a well-known finding reported in various neoplastic and non- neoplastic conditions. However, osseous metaplasia in foveolar hyperplastic polyps of the stomach is extremely rare. There have been only four previous case reports published in English language. Our current case shows clinicopathologic features similar to those of the previous case reports including the findings of small-sized polyp found incidentally in middle-aged patients with no clinical history of hypercalcemia or any other abnormalities causing heterotopic bone formation. Results (if a Case Study enter NA) N/A Conclusion Although the pathogenesis of osseous metaplasia in a gastric hyperplastic polyp remains unknown, the finding of osseous metaplasia in a gastric hyperplastic polyp is very intriguing.

Differences between sporadic hyperplastic gastric polyps and portal hypertensive gastric polyps: a review.

Portal hypertension (PH) is one of the most severe complications of chronic liver diseases. It is defined as an increase in pressure in the portal venous system which results in a portosystemic gradient >5 mmHg. In the western world, cirrhosis is the most frequent cause of PH, mainly due to nonalcoholic fatty liver disease and alcoholic liver disease. Patients with PH have esophageal varices in 68-73% of cases, portal hypertensive gastropathy in 51-73% and hyperplastic polyps (HPs) in 0.9-2%. Recent studies have shown that HPs found in PH patients are different from classical HPs. They constitute a new entity called portal hypertensive polyps (PHPs). The main difference between sporadic HPs and PHP is the presence of larger and more numerous vascular capillaries in the lamina propria. The clinical course of PHPs is unknown. Their physiopathology seems different from HPs: the increased congestion caused by higher portal pressure in the stomach may induce capillaries proliferation and neoangiogenesis. PHPs may be responsible for symptoms, such as pyloric obstruction, iron deficiency and anemia. Their prevalence in portal hypertensive and cirrhotic patients is from 1% to 8%. PHPs can be single or numerous, in the antrum or the gastric corpus. Their size ranges from 2 to 3 cm. PHPs seem to disappear or shrink with the treatment of PH. They should be resected in case of symptom and if >10 mm, after Helicobacter pylori eradication if present. However, their recurrence is frequent (40-79%), thus surveillance endoscopy is mandatory, at the same time as esophageal varices.

S3136 Metastatic Renal Cell Carcinoma Presenting as a Gastric Polyp – A Case Report

Introduction: Patients with renal cell carcinoma are metastatic in 1/3rd of the cases, however, metastasis to gastrointestinal tract is uncommon. We present a case of rare finding of metastatic renal cell carcinoma presenting as gastric polyp in a patient who presented with gastrointestinal bleeding. Case Description/Methods: A 70-year-old man with history of clear cell renal cell carcinoma (ccRCC) with metastatic mediastinal lymphadenopathy presented with melena and anemia. The patient had received Nivolumab and Ipilimumab in the past and was currently on Cabozatinib for the past fourteen months. Patient denied any use of non-steroidal anti-inflammatory drugs. Laboratory data was significant for a hemoglobin of 6.8 g/dL. An esophagogastroduodenoscopy showed two friable gastric polyps ranging from 8-10 mm in the body. Polyps were removed using a cold snare and endoclips were placed. Histopathological analysis demonstrated portions of gastric mucosa with central area of fibrinoid necrosis covering clusters of epithelial cells with pale to clear cytoplasm, with immunostains Pax2/8 consistent with metastatic renal cell carcinoma. Discussion: Metastasis of RCC to stomach presenting as gastric polyps is exceedingly rare. The gross appearance of these polyps appears to have a smooth surface and can be friable to contact. The size of the polyp can be variable. Clinical presentation includes gastrointestinal bleeding and abdominal pain as was the case in our patient. Small gastric polyps are often not biopsied, however, our case highlights that in patients with RCC, gastric polyps should be biopsied to rule out metastasis.Figure 1.: CT Abdomen: A, B revealed 2.9cm gastric ulcer in lesser curvature, fused distal body and tail of pancreas with stomach. Endoscopy: C, normal esophagus. D-H, ischemic ulceration with nodularity, blackened mucosa, non-obstructing, clean-based gastric ulcers in the entire stomach. I, normal duodenum. J Gastric lymphoma pathology, Lymphoma cells diffusely infiltrate between the gastric glands. Separation of gastric cells with architectural disruption. Round, oval, and irregular nuclei are present with scant cytoplasm. K. Concomitant component of low-grade marginal zone lymphoma (seen in 1/3 of cases). These cells arise from large cell transformation.

S2807 Portal Hypertensive Polyps as a Unique Cause of Bleeding in Cirrhosis

Introduction: Portal hypertension is due to resistance to portal blood flow commonly due to a fibrotic, cirrhotic liver. This leads to a multitude of complications including esophageal varices, portal hypertensive gastropathy, and ascites. Portal hypertensive polyps (PHP) is a recently described entity with prevalence estimated to be 1-3% of all gastric polyps found in cirrhotics especially since gastric polyps in the general population is already a relatively uncommon finding. We present a patient with complications due to PHP. Case Description/Methods: A 60-year-old male with a history of alcoholic liver cirrhosis (MELD 8) and esophageal varices that were previously banded, presented to the ED with melena and a hemoglobin of 5.9 gm/dl. The first EGD showed gastric antral-pyloric polyps, likely thought to be portal hypertensive polyps, with active minor oozing. There was one large polyp 2.5 cm in size and multiple smaller polyps in the surrounding area. The decision was made to intervene on these polyps during a repeat EGD. Argon plasma coagulation (APC) was used to coat the polyps with successful hemostasis. A subsequent outpatient EGD showed stable polyps without bleeding. The patient was referred for transjugular intrahepatic portosystemic shunt (TIPS) placement in hopes to reduce portal hypertension to limit future episodes of GI bleeding. Discussion: Being a relatively new phenomenon, the diagnostic criteria/clinical relevance for PHP is not yet clear. The histological characteristics of PHP are similar to hyperplastic polyps with foveolar hyperplasia and proliferating ectatic capillaries in the lamina propria. Furthermore, most cases of PHP involve multiple lesions. However, studies have shown that they do not degenerate to malignancy. Independent predictors of PHP include Child-Pugh > 6, MELD > 16, and rubber band ligation of varices. Variceal ligation is thought to be due to increased formation of portosystemic shunts leading to increase portal pressure in the gastric wall inducing proliferation/angiogenesis; our patient did have a history of banded varices. Studies have also shown no active bleeding from the PHP in any of the endoscopies, but our instance of PHP did have active bleeding. Recurrence after polypectomy is common and it is not recommended to routinely remove the polyps, but APC can be used for bleeding polyps. Ultimately TIPS has shown to reverse portal hypertensive gastropathy but there is no studies on its utility in treating PHP; as this area of focus demands further study.Figure 1.: Portal Hypertensive Polyp in Gastric Antrum.

GASTRIN IN SERUM AND MORPHOLOGICAL STATE OF GASTRIN-SECRETING CELLS IN PATIENTS WITH GASTRIC POLYPOSIS

Objective. Numerous studies regarding gastric hormones and their regulation have been performed until now. However, the effect of the hormones on the formation and malignisation of gastric polyps still remains not clear. Our aim was to identify the relation between the level of gastrin in the blood, gastric mucosa, polyp tissue, gastric juice and pathogenesis of gastric polyposis. Materials and methods. A thorough investigation of gastrointestinal hormones in serum and gastric juice, in polyp’s tissue and mucosa, gastrin-secreting cells and proteolytic activity of gastric juice was carried out in 40 patients with gastric polyps. These patients were divided into groups, depending on the location, number, and malignancy of the polyps. As a control group, 10 healthy individuals were used to determine the normal values of the studied indicators. Results: A significant increase (more than two times) in the gastrinemia level before the surgery was noted in patients with polyp recurrence, and gastrin level increased to more significant digits of 227.0+37.4 pg/ml (p&lt;0.05) in one year after polypectomy. Conclusion. Gastrin is apparently involved in the process of polyp formation since polyp’s growth is accompanied by elevation of serum gastrin. This is confirmed by a response of gastrin in the blood to a test meal in individuals with different duration of the disease: a marked increase in gastrinemia appears in patients suffering from gastric polyposis for more than three years. Therefore, evaluation of gastrin level in the patients’ blood can be used to predict a recurrence potential of polyps. This is evidenced by more pronounced hypergastrinemia before polypectomy in patients who had a further recurrence of the disease within one year after the surgery

S1681 Malignant Peritoneal Mesothelioma (PeM) With Rhabdoid Features Masquerading as Idiopathic Necrotizing Pancreatitis With Mucinous Ascites: A Case Report and Literature Review

Introduction: Malignant Mesothelioma (MM) is a great masquerader, presenting as infection, metastasis, other cancers or as a paraneoplastic syndrome. Malignant peritoneal mesothelioma (PeM) accounts for about 10-15% of all cases of mesothelioma. MM presenting with malignant gastrointestinal (GI) polyps is also rare, with only 16 reported cases of mesothelioma presenting as metastatic disease in the GI tract. Here, we present the clinicopathologic findings of a case of a malignant peritoneal rhabdoid mesothelioma presenting as a necrotizing pancreatic mass, recurrent deep vein thrombosis (DVT), chylous ascites, and late onset weight loss. Case Description/Methods: A 76-year-old female initially presenting with idiopathic necrotizing pancreatitis. She continued to report persistent vague lower and mid abdominal pain. Six months after her initial admission the patient developed a DVT and pulmonary embolism (PE) requiring thrombectomy and anticoagulation with a recurrent DVT requiring IVC filter placement. She continued to have recurrent ascites and an enlarging peripancreatic fluid collection. Multiple paracenteses were performed with studies negative for infection and cytology negative for malignancy; however, most samples could not be analyzed due to fluid viscosity. An endoscopic retrograde cholangiopancreatography was performed with pancreatic and biliary stents placed. Almost one year after the patient’s initial admission, cross-sectional abdominal imaging showed omental caking with enlargement of the proximal pancreas. An endoscopic ultrasound with fine needle aspiration was performed was non-diagnostic. Lymphangiogram performed chylous nature of ascites. MRI showed a large fluid volume surrounding the pancreas and extended into the pararenal spaces. There was a mass effect leading to displacement of the surrounding structures. Diagnostic laparoscopy showed abdominal wall and peritoneal implants in addition to a large, firm, and highly vascularized epigastric mass. Pathology showed peritoneal mesothelioma. Discussion: We have presented a case of PeM with rhabdoid features present in the peritoneum and in gastric polyps. PeMs are rare tumors with a non-specific clinical presentation. These lesions are also difficult to diagnose and definitive diagnosis of MPM requires surgically obtained tissue. To our knowledge, this is the first case with these features.

S3187 Gastric Hyperplastic Polyp, Stubborn and Recurrent,

S3187 Gastric Hyperplastic Polyp, Stubborn and Recurrent,

Gastrointestinal hemorrhage from a bleeding gastric polyp: an initial manifestation of metastatic testicular choriocarcinoma in a young adult

article: Gastrointestinal hemorrhage from a bleeding gastric polyp: an initial manifestation of metastatic testicular choriocarcinoma in a young adult - Gazzetta Medica Italiana - Archivio per le Scienze Mediche 2021 July-August;180(7-8):387-90 - Minerva Medica - Journals

S3703 The Land of Polyps; A Case of Fundic Gastric Polyps Secondary to PPI Use

S3703 The Land of Polyps; A Case of Fundic Gastric Polyps Secondary to PPI Use

S1415 Gastric Polyps: Prevalence and Underlying Mucosal Background

S1415 Gastric Polyps: Prevalence and Underlying Mucosal Background

S3080 Metastatic Renal Cell Carcinoma as a Cause of Solitary Gastric Polyp

Introduction: Renal Cell Carcinoma (RCC) is the most common cancer originating from the kidney, accounting for 80-85% of all primary renal neoplasms. Clear cell carcinoma represents the most common histopathological subtype. About 30% percent of RCC cases have metastasized at the time of initial presentation. The classical sites of metastasis include the lungs, bones, liver, and brain. RCC metastasis to the stomach is extremely rare, occurring in approximately 0.2% of RCC cases. We present a rare case of solitary gastric polyp due to metastatic RCC. Case Description/Methods: A 64-year-old female with a past medical history of hypertension and gastroesophageal reflux disease presented to the clinic with a 4-month history of post-prandial intermittent right-sided abdominal pain denied hematuria or melena. Vital signs were normal. On examination, she had right-sided fullness. Labs were significant for hemoglobin of 9 g/dL. Abdominal ultrasound revealed a 13-cm mass in the right upper quadrant arising from the pole of the right kidney. This was confirmed by MRI which showed significant parasitic vessels in and around the mass. The patient underwent esophagogastroduodenoscopy for evaluation of anemia that showed a solitary 5-mm sessile polyp in the gastric body with no evidence of active bleeding. The pathology of the polyp removed indicated clear cell carcinoma, consistent with metastatic RCC. Chest CT showed subcarinal lymphadenopathy with a conglomerate measuring 5.3 cm x 3.1 cm, evidence of multiple 4-7 mm lung nodules – two on the right and one on the left. The patient was referred to the medical oncologist and systemic immunotherapy was commenced. Discussion: This report highlights the rarity of stomach metastasis in RCC, which likely occurred by hematogenous spread due to an abundant renal blood supply. Other routes of metastasis include lymphangitic spread and contiguous spread via the renal capsule, renal pelvis, and ureter (3). The Stomach metastasis can present as solitary/multiple polyps or an ulcer. Lesions are usually asymptomatic and occur in the gastric fundus or body. When symptomatic, gastrointestinal bleeding and anemia are the most common presentation. Patients with RCC and gastric metastasis usually have metastatic lesions in other organ systems, as seen in our patient, and the prognosis for such patients is poor. Therefore, this rare entity should be considered in a patient with gastrointestinal symptoms in the setting of underlying Renal cell carcinoma.

Epithelial gastric polyps

Gastric polyps are lesions projected above the mucosal surface, which are detected in approximately 1–6% of upper gastrointestinal endoscopies. Based to their shape, polyps are classified as pedunculate, semi-pedunculate, sessile and flat. Depending on the histopathological type, some of them have the potential to transform into adenocarcinoma. Polyps can be of epithelial and non-epithelial origin. The first group, which is discussed in greater detail in this paper, includes fundic gland polyps, hyperplastic, adenomatous and hamartomatous polyps. Non-epithelial polyps include stromal tumours, leiomyomas, fibrous inflammatory polyps, fibroids, fibromyomas, lipomas, ectopic pancreas, neuroendocrine tumours, neuromas, and some vascular lesions. Multiple polyps in patients under the age of 40 years require more extensive diagnosis for hereditary polyposis syndromes, which are associated with an increased risk of gastric cancer, as well as other gastrointestinal and extra-gastrointestinal malignancies. In recent years, there has been a clear decrease in the proportion of hyperplastic polyps and an increase in the proportion of fundic gland polyps among all gastric polyps, which is probably related to the increased use of proton pump inhibitors and a reduced incidence of Helicobacter pylori infections. About 90% of gastric polyps are detected accidentally and usually do not cause clinical symptoms, but large polyps may be responsible for anaemia, bloody stools, abdominal pain, and even pyloric obstruction, which may be manifested by vomiting, severe flatulence, lack of appetite or progressive weight loss.