Idiopathic multitudinous fundic gland polyposis: A new disease and a management dilemma

Abstract

Two patients with idiopathic multitudinous fundic gland polyposis, a hitherto undescribed condition, were reported. They presented incidentally with a multitude of fundic gland polyps, 52 and 147, without a family history of polyposis, and these polyps were not attributable to the chronic use of proton pump inhibitors. All polyps were removed by hot‐biopsy polypectomy, and each was individually subjected to pathological examination, which showed no evidence of dysplasia. When confronted with gastric polyps of clinically undetermined origin, endoscopists would, to exclude dysplasia, usually resect all if they are few and sample some and survey the others periodically if they are numerous. The condition reported presents a management dilemma: Because the number of the polyps is such that they are manageable by total polypectomy, should this be carried out, despite the labor intensiveness involved, to exclude dysplasia, and are the polyps a variant of syndromic polyposis and therefore carry a malignant potential and inform the need for periodic surveillance and to investigate the patient's kindred? The frequency of this condition and whether it is truly not associated with dysplasia require further studies.

Multidinous fundic gland polyps: An yet‐underscribed association

“…We read with great interest the paper by Lam and Lau, 1 which recently appeared on your journal. In their paper, the authors report about two patients with a large number (52 and 147, respectively) of fundic gland polyps (FGPs) without any known association with previous therapies or genetic familial syndromes, which they aptly named “idiopathic” (literally “without known cause”) multidinous FGPs.…”

“…Lam and Lau 1 were clearly faced with a management dilemma—how to treat such unusual patients. They never received a long‐term treatment with proton pump inhibitors (if such a treatment promotes polyps at all), nor had a positive family history for genetic syndromes with a known risk for FGP development.…”