Search

Simple Summary: Gastric polyps (GPs) are frequent gastric lesions, usually diagnosed incidentally. As upper gastrointestinal endoscopy becomes more frequent, the prevalence of GPs increases, with implications in clinical practice, as some of them can present different grades of malignant risk. The more common polyps are the epithelial ones, with a predominance of fundic gland polyps (FGPs) and gastric hyperplastic polyps (GHPs), in which prevalence varies according to local epidemiology. Up to now, the general recommendation is that all GPs should have histological evaluation by biopsy. However, novel advances in endoscopic techniques could allow for a more expectant management based on histopathological prediction by optical diagnosis. Further research and refinement of these techniques are necessary before their application in the clinical management of GPs. Gastric polyps (GPs) are common luminal lesions of the gastrointestinal tract, frequently detected incidentally in 1–6% of all upper gastrointestinal endoscopy. With the increasing use of endoscopy, the diagnosis of GPs has risen, highlighting the need for a thorough understanding of their pathophysiology and associated cancer risks. This review focuses on epithelial GPs, particularly fundic gland polyps (FGPs), hyperplastic polyps (GHPs) and gastric adenomas (GAs), discussing their classification, epidemiology, histopathology, endoscopic diagnosis, and current management. FGPs are predominantly associated with proton pump inhibitor (PPI) use and are common in regions with low Helicobacter pylori (Hp) prevalence, whereas GHPs are linked with Hp infection and chronic gastritis. GAs, although less common, have a significant risk of malignant transformation, especially in larger lesions. Management strategies vary according to polyp type, size, and dysplastic features, with resection recommended for high-risk lesions. Advances in endoscopic techniques, particularly narrow-band imaging (NBI), offer promising tools for differentiating between polyp types, potentially reducing the need for routine biopsies in the low-risk GPs. This review underscores the role of advanced imaging endoscopic techniques for the accurate classification and individualized management of GPs to mitigate the risk of gastric cancer. [ABSTRACT FROM AUTHOR]

Introduction: Gastric cancer (GC) is one of the most lethal malignancies worldwide. Helicobacter pylori is the primary cause of GC; therefore, its eradication reduces the risk of developing this neoplasia. There is extensive evidence regarding quadruple therapy with relevance to the European population. However, in Latin America, data are scarce. Furthermore, there is limited information about the eradication rates achieved by antibiotic schemes in European and Latin American populations., Objective: To compare the effectiveness of standard triple therapy (STT), quadruple concomitant therapy (QCT), and bismuth quadruple therapy (QBT) in six centers in Europe and Latin America., Methods: A retrospective study was carried out based on the LEGACy registry from 2017 to 2022. Data from adult patients recruited in Portugal, Spain, Chile, Mexico, and Paraguay with confirmed H. pylori infection who received eradication therapy and confirmatory tests at least 1 month apart were included. Treatment success by each scheme was compared using a mixed multilevel Poisson regression, adjusting for patient sex and age, together with country-specific variables, including prevalence of H. pylori antibiotic resistance (clarithromycin, metronidazole, and amoxicillin), and CYP2C19 polymorphisms., Results: 772 patients were incorporated (64.64% females; mean age of 52.93 years). The total H. pylori eradication rates were 75.20% (255/339) with STT, 88.70% (159/178) with QCT, and 91.30% (191/209) with QBT. Both quadruple therapies (QCT-QBT) showed significantly higher eradication rates compared with STT, with an adjusted incidence risk ratio (IRR) of 1.25 (p: <0.05); and 1.24 (p: <0.05), respectively. The antibiotic-resistance prevalence by country, but not the prevalence of CYP2C19 polymorphism, showed a statistically significant impact on eradication success., Conclusions: Both QCT and QBT are superior to STT for H. pylori eradication when adjusted for country-specific antibiotic resistance and CYP2C19 polymorphism in a sample of individuals residing in five countries within two continents., (© 2024 The Author(s). United European Gastroenterology Journal published by Wiley Periodicals LLC on behalf of United European Gastroenterology.)