Regression of fundic gland polyps following acquisition of Helicobacter pylori

Abstract

The prevalence of Helicobacter pylori infection is very low in patients with fundic gland polyps (FGPs) of the stomach. We report here two cases with multiple FGPs that regressed following new H pylori acquisition. Patient Nos I and II had multiple FGPs in normal fundic mucosa without inflammatory changes or atrophy. Both were not infected with H pylori. Following acquisition of H pylori infection however, all FGPs in both patients completely disappeared except for one FGP in patient No I. Although the size of the remaining polyp in patient No I was greatly reduced after H pylori acquisition, it became enlarged again after eradication. Interestingly, in the remaining polyp, we found an activating beta-catenin gene mutation whereas no such mutations were detected in FGPs of patient No II. Thus H pylori infection may have an inhibitory effect on the development of FGPs.

Figure 1

Endoscopic and microscopic findings in patient No I. Sessile polyps were seen in the normal gastric corpus in February 1999 (A). Biopsies revealed that the polyps consisted of fundic gland hyperplasia with cystic dilatation of glandular ducts—typical morphology of fundic gland polyps (FGPs) (B). Endoscopy one year later showed erythematous mucosa of the corpus and disappearance of FGPs except for one polyp (arrow), the size of which was markedly reduced (C). On histological examination, the remaining polyp showed oedematous changes and neutrophilic infiltration concentrated in the foveolar compartment whereas less inflammatory cells infiltrated the fundic gland compartment (D). Two months after completion of Helicobacter pylori eradication therapy, endoscopy showed reduction of erythematous mucosa and no recurrence of polyps (E). Biopsy demonstrated marked reduction of active inflammation in the remaining polyp (F). Six months after completion of eradication, endoscopy demonstrated enlargement of the remaining polyp (arrow) (G). Biopsy of the polyp revealed hyperplasia of the fundic glands with microcysts, suggesting FGP morphology (H). Endoscopic photographs (top) show the same view in the corpus. (Haematoxylin-eosin staining; original magnifications: lower panels 100×.)

Figure 2

Endoscopic and microscopic findings in patient No II. Multiple sessile polyps were seen in the normal gastric corpus in July 1998 (A). Biopsies confirmed hyperplasia of the fundic gland with microcysts (B). Endoscopy two years later revealed diffuse erythematous mucosa with complete disappearance of all polyps (C). Biopsy specimens showed neutrophilic infiltration concentrated in the foveolar compartment (D). Two months after completion of Helicobacter pylori eradication, endoscopy demonstrated resolution of erythematous change of the fundic mucosa and no recurrence of polyps (E). On histological examination, gastritis was reduced and the fundic glands had hyperplastic changes (F). Endoscopic photographs (top) show the same view in the corpus. (Haematoxylin-eosin staining; original magnifications: lower panels 100×.)