Dig Liv Dis. 2023 Sep;55(9):1201-1207. doi: 10.1016/j.dld.2023.02.008.
* Gastric polyp은 전체 EGD에서 약 1~6%에서 발견됩니다. 85% 이상에서 양성 병변이며, inflammatory hyperplastic polyps, fundic glandular polyps, adenomatous polyps, gastric neuroendocrine neoplasms (gNENs), inflammatory fibroid polyps, hamartomatous polyps 등이 있습니다. 정상 점막에서는 거의 드물게 나타나고, atrophic mucosa나 Helicobacter pylori (H. Pylori)-related chronic atrophic gastritis 에서 주로 나타나며, 최근에는 PPI를 오랫동안 사용한 경우 hypergastrinemia로 인한 hyperplastic polyps이나 fundic gland polyps도 발견됩니다. 하지만, chronic autoimmune atrophic gastritis (CAAG)와 gastric polyps 와의 연관성은 덜 알려져 있으며, 이번 논문은 incidental gastric polyps 에 대한 frequency와 histopathologic predictors에 대한 연구 입니다.
* CAAG의 진단은 update Sydney system을 통한 조직검사를 시행하여 body-fundus-predominant atrophic gastritis를 기본으로 하였으며, 동반된 APCA나 anti-IF antibodies의 양성률, circulating gastrin levels을 함께 고려하여 진단하였습니다.
Table 1. Anthropometric, clinical, biochemical, and histological features of the overall population included.
Figure 1. Patients with chronic atrophic autoimmune gastritis and endoscopically detected lesions.
Figure 2. Histotypes of detected polyps in patients with chronic atrophic autoimmune gastritis.
Table 2. Anthropometric, clinical, biochemical, and histological differences between patients with diagnosed chronic atrophic autoimmune gastritis (CAAG) and detected gastric polyps and patients with CAAG without gastric polyps.
* Gastrin (668 pg/mL, IQR=340–1200 vs 893 pg/mL, IQR=481–1300, p = 0.0237)
Figure 3. Differences in circulating gastrin levels in patients with chronic atrophic autoimmune gastritis (CAAG) with or without endoscopic lesions.
* CgA (146 ng/mL, IQR=106–219 vs 207 ng/mL, IQR=126–360, p = 0.0027)
Figure 4. Differences in circulating Chromogranin A (CgA) levels in patients with chronic atrophic autoimmune gastritis (CAAG) with or without endoscopic lesions.
<Abstract>
Background: Gastric polyps represent an abnormal proliferation of the gastric mucosa. Chronic atrophic autoimmune gastritis (CAAG) targets parietal cells and results in hypo-achlorhydria and hypergastrinemia, which exerts a proliferative effect on the gastric mucosa.
Aims: We investigate the incidence of gastric polyps in CAAG patients.
Methods: This is a single-center retrospective study examining patients with confirmed CAAG from January 1990 until June 2022. Demographic, clinical, biochemical, and serological data were collected for each included patient. The histopathological characteristics of the detected polyps were recorded.
Results: A total of 176 CAAG patients were included. Eighty-nine (50.5%) had 163 incidental polyps. Seventy-six patients (85%) had 130 non-endocrine lesions, among which 118 (90.7%) were inflammatory, 6 (4.6%) adenomatous, and 4 (3%) fundic; 33 patients (37%) had gastric neuroendocrine neoplasms (gNENs), and 21 (23.6%) both; one had MALToma and one gastric adenocarcinoma. Higher circulating levels of gastrin and chromogranin A were observed among patients with polyps (median 668 vs 893 pg/ml p = 0.0237, 146 vs 207 ng/ml p = 0.0027, respectively).
Conclusion: CAAG implies a high incidence of gNENs and exocrine lesions. Gastrin plays a possible trophic role on the mucosa. Further evidence is needed to validate its predictive role for increased polyp risk in CAAG.
Dig Liv Dis. 2023 Sep;55(9):1201-1207. doi: 10.1016/j.dld.2023.02.008.
* Gastric polyp은 전체 EGD에서 약 1~6%에서 발견됩니다. 85% 이상에서 양성 병변이며, inflammatory hyperplastic polyps, fundic glandular polyps, adenomatous polyps, gastric neuroendocrine neoplasms (gNENs), inflammatory fibroid polyps, hamartomatous polyps 등이 있습니다. 정상 점막에서는 거의 드물게 나타나고, atrophic mucosa나 Helicobacter pylori (H. Pylori)-related chronic atrophic gastritis 에서 주로 나타나며, 최근에는 PPI를 오랫동안 사용한 경우 hypergastrinemia로 인한 hyperplastic polyps이나 fundic gland polyps도 발견됩니다. 하지만, chronic autoimmune atrophic gastritis (CAAG)와 gastric polyps 와의 연관성은 덜 알려져 있으며, 이번 논문은 incidental gastric polyps 에 대한 frequency와 histopathologic predictors에 대한 연구 입니다.
* CAAG의 진단은 update Sydney system을 통한 조직검사를 시행하여 body-fundus-predominant atrophic gastritis를 기본으로 하였으며, 동반된 APCA나 anti-IF antibodies의 양성률, circulating gastrin levels을 함께 고려하여 진단하였습니다.
Table 1. Anthropometric, clinical, biochemical, and histological features of the overall population included.
Figure 1. Patients with chronic atrophic autoimmune gastritis and endoscopically detected lesions.
Figure 2. Histotypes of detected polyps in patients with chronic atrophic autoimmune gastritis.
Table 2. Anthropometric, clinical, biochemical, and histological differences between patients with diagnosed chronic atrophic autoimmune gastritis (CAAG) and detected gastric polyps and patients with CAAG without gastric polyps.
* Gastrin (668 pg/mL, IQR=340–1200 vs 893 pg/mL, IQR=481–1300, p = 0.0237)
Figure 3. Differences in circulating gastrin levels in patients with chronic atrophic autoimmune gastritis (CAAG) with or without endoscopic lesions.
* CgA (146 ng/mL, IQR=106–219 vs 207 ng/mL, IQR=126–360, p = 0.0027)
Figure 4. Differences in circulating Chromogranin A (CgA) levels in patients with chronic atrophic autoimmune gastritis (CAAG) with or without endoscopic lesions.
<Abstract>
Background: Gastric polyps represent an abnormal proliferation of the gastric mucosa. Chronic atrophic autoimmune gastritis (CAAG) targets parietal cells and results in hypo-achlorhydria and hypergastrinemia, which exerts a proliferative effect on the gastric mucosa.
Aims: We investigate the incidence of gastric polyps in CAAG patients.
Methods: This is a single-center retrospective study examining patients with confirmed CAAG from January 1990 until June 2022. Demographic, clinical, biochemical, and serological data were collected for each included patient. The histopathological characteristics of the detected polyps were recorded.
Results: A total of 176 CAAG patients were included. Eighty-nine (50.5%) had 163 incidental polyps. Seventy-six patients (85%) had 130 non-endocrine lesions, among which 118 (90.7%) were inflammatory, 6 (4.6%) adenomatous, and 4 (3%) fundic; 33 patients (37%) had gastric neuroendocrine neoplasms (gNENs), and 21 (23.6%) both; one had MALToma and one gastric adenocarcinoma. Higher circulating levels of gastrin and chromogranin A were observed among patients with polyps (median 668 vs 893 pg/ml p = 0.0237, 146 vs 207 ng/ml p = 0.0027, respectively).
Conclusion: CAAG implies a high incidence of gNENs and exocrine lesions. Gastrin plays a possible trophic role on the mucosa. Further evidence is needed to validate its predictive role for increased polyp risk in CAAG.