SPORADIC FUNDIC GLAND POLYP‐RELATED ADENOMAS OCCURRED IN NON‐ATROPHIC GASTRIC MUCOSA WITHOUT HELICOBACTER PYLORI INFECTION

We report three cases of adenoma associated with sporadic fundic gland polyp (FGP) in the non‐atrophic fundic gland mucosa without Helicobacter pylori (HP) infection, which was verified with both serological and histopathological examinations. Gastric tubular adenoma (flat adenoma) is common and focal cancers occurring in the hyperplastic polyp of foveolar cell type are also sometimes experienced. However, adenomas occurring in sporadic FGP are valuable, as they are very rare, in upper gastrointestinal endoscopy. Whether or not these adenoma lesions of three sporadic FGP cases may become the background of protruded gastric cancers without HP infection remains unclear. Therefore, we emphasize the importance of histological examination on fundic gland polyps that are >5 mm in size to accumulate new similar cases. Follow‐up studies of these lesions are also needed to evaluate their outcomes.     

Benign gastric polyps: morphological and functional origin

The most common types of benign gastric polyps are fundic gland polyps, hyperplastic polyps, and adenomas. The aim of this study was to determine on which morphological and functional background benign gastric polyps develop. The study includes 85 consecutive patients with gastric polyps and sex- and age-matched controls without polyps selected at random from a general population sample. The type of polyp was hyperplastic in 52 (61%), fundic gland in 18 (21%), adenoma in 10 (12%), carcinoid in 2 (2%), hamartoma in 2 (2%), and inflammatory fibroid in 1 (1%) of the cases. Routine biopsies from the gastric corpus and antrum were examined for presence of gastritis and H. pylori. Blood samples were analyzed for H. pylori antibodies, H⁺,K⁺-ATPase antibodies, gastrin, and pepsinogen I. Patients with hyperplastic polyps had increased P-gastrin concentrations and S-H⁺,K⁺-ATPase antibody titers and decreased S-pepsinogen I concentrations with a high prevalence of atrophic corpus gastritis or pangastritis. A similar pattern was observed among patients with adenomas, whereas patients with fundic gland polyps had normal serology and a lower prevalence of gastritis and H. pylori infection than controls. In conclusion, hyperplastic polyps and adenomas are generally associated with atrophic gastritis. Patients with fundic gland polyps seem to have a sounder mucosa than controls. Whereas the risk of malignant gastric neoplasia is increased in patients with hyperplastic polyps or adenomas, this does not seem to be the case in patients with fundic gland polyps.     

Gastric mucosa in female patients with fundic glandular polyps.

To evaluate the characteristics of the gastric mucosa in women with fundic glandular polyps, we examined gastric acid secretion, fasting serum levels of pepsinogen I and gastrin, and gastric histology in 11 female patients with fundic polyps, and compared the results with 30 female controls without endoscopic abnormalities and 50 female patients with gastric foveolar hyperplastic polyps. No significant difference was found in gastric and secretion and fasting serum levels of pepsinogen I and gastrin between the patients with fundic glandular polyps and the control subjects. Histological examination showed that atrophic gastritis was generally not found in the patients with fundic glandular polyps. In contrast, gastric acid secretion and fasting serum levels of pepsinogen I were significantly lower and serum gastrin levels were significantly higher in the patients with foveolar hyperplastic polyps than in the other two groups. Also, patients with foveolar hyperplastic polyps had a higher prevalence and further advanced atrophic gastritis in the fundus than did the other two groups. Our investigations demonstrated that fundic glandular polyps arise from gastric mucosa without atrophic gastritis, whereas foveolar hyperplastic polyps develop from mucosa affected by atrophic gastritis, especially type A gastritis.     

Gastric polyps: a retrospective analysis of 26,000 digestive endoscopies

BACKGROUND: Gastric polyps are small gastric lesions, asymptomatic in most cases and are generally discovered inadvertently during upper digestive endoscopy. AIM: To retrospectively review the characteristics and frequency of gastric polyps, derived from the gastric mucosal epithelium in a large series of endoscopies. METHODS: One hundred and fifty three patients in a series of 26,000 consecutive upper digestive endoscopies done over a 5-year period, being that each patient had only one examination were analyzed and their histological and Yamada classification, as well as their location, size, histopathological findings and treatment studied. All patients had at least one gastric polyp, as confirmed by histological examination. RESULTS: The polyps were classified as hyperplastic, adenomatous and fundic gland polyps. The most of them measure less than 1 cm (hyperplastic polyps - 60,5%; adenomatous polyps - 73,6%; fundic gland polyps - 72%). Hyperplastic polyps were the most frequent and accounted for 71.3% of the cases, whereas fundic gland polyps accounted for 16.3% and adenomatous polyps for 12.4%. Hyperplastic and adenomatous polyps were primarily single, whereas fundic gland polyps tended to be multiple. A carcinoma was detected in one hyperplastic polyp (0.9%) and in two adenomatous polyps (10.5%). High grade dysplastic foci were found in four adenomatous polyps (21%). CONCLUSIONS: The digestive endoscopy is the safest and efficient method for the diagnosis of the gastric polyps, that in most of the patients does not show characteristic symptoms. The histopathological definition is not possible to the endoscopic glance being needed the pathologist's aid, once the conduct to be adopted will depend on the result of the biopsy.     

CHANGES IN MUCOSAL PHOSPHOLIPID‐RELATED PROTECTION IN SOME GASTRIC DISEASES

Background: Phospholipids play an important role in gastric mucosal protection. The purpose of the present study was to investigate changes in various phospholipids in the fundic and pyloric gland mucosae of patients with gastric mucosal disease. Methods: One hundred and five patients with superficial gastritis, duodenal ulcer, gastric ulcer or gastric cancer were studied. Patients underwent endoscopy to obtain biopsy specimens from both the fundic and pyloric gland mucosae. The phospholipid contents were measured by high performance liquid chromatography. Results: Total phospholipid level was significantly greater in the fundic gland mucosa than in the pyloric gland mucosa (P = 0.037), and the level in the fundic gland mucosa was high in all four gastric diseases studied. The difference was significant in patients with gastric ulcers (P = 0.0156). Total phospholipid levels were the highest in superficial gastritis, followed by duodenal ulcer, gastric ulcer and gastric cancer. In all four gastric diseases, phosphatidylserine (PS), phosphatidylethanolamine (PE), and phosphatidylcholine (PC) levels were high, while phosphatidylinositol, lysophosphatidylcholine, and sphingomyelin levels were low. The PE and PC levels were higher in the fundic gland mucosa than in the pyloric glandular mucosa, whereas the PS level was higher in the pyloric gland mucosa than in the fundic gland mucosa. Conclusions: The fundic gland mucosa has stronger phospholipid‐related protection than the pyloric gland mucosa, based on the levels of mucosal phospholipids. The main phospholipids for gastric mucosal protection are PC and PE (in the fundic gland mucosa) and PS (in the pyloric gland mucosa). Phospholipid‐related protection is strong in superficial gastritis and duodenal ulcer, but is reduced in the pyloric gland mucosa in patients with gastric ulcers, and in both gastric gland mucosae in patients with gastric cancer.     

Gastric polyps: Association with Helicobacter pylori status and the pathology of the surrounding mucosa,a cross sectional study

aim:To assess the endoscopic characteristics of gastric polyps and their association with Helicobacter pylori(H.pylori)status in a predominantly Hispanic population.m ETHODS:We conducted a retrospective study of all esophagogastroduodenoscopies performed at our institution.Demographic,endoscopic and histopathological data were reviewed.Categorization of patients into Hispanic and Non-Hispanic was based on selfidentification.Patients without resection/biopsy were not included in the analysis.Identification of polyps type was based on histological examination.One way analysis of variance was used to compare continuousvariables among different polyp types and Fisher’s exact test was used compare categorical variables among polyp types.Unadjusted and adjusted comparisons of demographic and clinical characteristics were performed according to the H.pylori status and polyp type using logistic regressions.RESULTS:Of 7090 patients who had upper endoscopy,335 patients had gastric polyps(4.7%).Resection or biopsy of gastric polyps was performed in 296 patients(88.4%)with a total of 442 polyps removed or biopsied.Of 296 patients,87(29%)had hyperplastic polyps,82(28%)had fundic gland polyps and 5(1.7%)had adenomatous polyps.Hyperplastic polyps were significantly associated with positive H.pylori status compared with fundic gland polyps(OR=4.621;95%CI:1.92-11.13,P=0.001).Hyperplastic polyps were also found to be significantly associated with portal hypertensive gastropathy compared with fundic gland polyps(OR=6.903;95%CI:1.41-33.93,P=0.0174).Out of 296 patients,30(10.1%)had a followup endoscopy with a mean duration of 26±16.3 mo.Interval development of cancer was not noted in any of the patients during follow up period.CONCLUSi ON:Gastric hyperplastic polyps were significantly associated with positive H.pylori status and portal hypertensive gastropathy as compared with fundic gland polyps.     

A case of gastric adenocarcinoma arising from a fundic gland polyp

A rare case of gastric adenocarcinoma arising on the surface of a fundic gland polyp is reported. A 36-year-old Japanese woman was referred to our hospital for examination and treatment of a polyp that had been detected in another hospital. She did not have a history of familial adenomatous polyposis (FAP). Endoscopic examination revealed a 10-mm-diameter fundic gland polyp in the body of the stomach. The polyp had an irregular depression on its top, suggesting the presence of malignancy. Endoscopic mucosal resection was done to make a histological diagnosis. This revealed a fundic gland polyp with a tiny superficial adenocarcinoma. Atrophic changes of the gastric mucosa were mild, although Helicobacter pylori infection was positive. It is suggested that fundic gland polyps have the potential for malignant transformation.     

Autoimmune metaplastic atrophic gastritis in chinese: a study of 320 patients at a large tertiary medical center

Objectives: Autoimmune metaplastic atrophic gastritis (AMAG) is an uncommon disease worldwide and may predispose to gastric carcinoid tumors or adenocarcinomas. The aims of this study were to outline the clinical characteristics of Chinese AMAG patients, including demographic pattern, hematologic features, and gastroscopic and histopathologic findings.

Patients and methods: A total of 320 Chinese patients with AMAG, from January 2007 to December 2014, were reviewed in a regional hospital of China.

Results: Of the 320 AMAG patients, the mean age was 60.6?±?12.3 years [range 26–86; 206 (64.4%) women]. The coarse annual detection rate was 0.9%. Anemia was present in only 19.3% patients (53/275) and 3.5% (11/315) AMAG patients also had primary biliary cirrhosis. One hundred and thirty-six had endoscopically identifiable lesions. These lesions consisted of 130 polypoid lesions (63 hyperplastic polyps, 2 oxyntic mucosa pseudopolyps, 2 intestinal-type gastric adenomas, 2 fundic gland polyps, 5 concurrent polyps, 14 well-differentiated neuroendocrine neoplasms, 7 submucosal tumors and 35 chronic gastritis), 6 adenocarcinomas. The detection rate of atrophy and intestinal metaplasia in antral mucosa were 47.2 and 37.5%, respectively.

Conclusions: AMAG is more frequent than expected in China and display a female predominance, accompanied with other autoimmune disorders. AMAG should be paid more attention by clinicians through a multidisciplinary team approach.     

Análisis de casos y controles de pólipos de glándulas fúndicas e inhibidores de bomba de protones. La perspectiva de un patólogo

Introduction and aimAdequately preserved slides and tissue blocks in pathology archives, when re-reviewed and associated with patient charts, are important tools to further assess prevalence changes and associations of certain pathologies. Our aim was to identify whether proton-pump inhibitor (PPI) use, dose, and duration of use were associated with gastric polyps and their phenotypes in a case-control study.MethodsThe slides from patients with a morphologic diagnosis of either hyperplastic polyps or fundic gland polyps were retrieved from the 1980, 1990, 2000, 2010, and 2016 surgical pathology files at a tertiary care hospital in Mexico City and re-evaluated. Cases were paired by age and sex with patients that underwent endoscopy and gastric mucosa biopsy in the same year, with no evidence of polyps.ResultsA total of 133 (3.8%) patients with gastric polyps were identified from 3,499 gastric biopsies taken in the abovementioned years and compared with 133 paired controls. Dyspepsia was more prevalent in the controls (p = 0.002) and abdominal pain was more prevalent in the patients with gastric polyps (p = 0.001). PPI use (OR 7.7, 95% confidence interval, 4.4-13.3) and taking more than one PPI medication (OR 4.9, 95% confidence interval, 1.09-22.3) were significantly associated with the presence of gastric polyps. The fundic gland phenotype in the oxyntic mucosa was more frequently associated with PPI use (p < 0.042), with a continuous increase in its prevalence starting in the year 2000 (p = 0.017 for trend).ConclusionPPI administration for at least one year was associated with gastric fundic gland polyps.     

胃息肉的临床病理特征和内镜治疗随访观察

背景：胃息肉是一种常见病,病因不明且有癌变的可能。目的：分析胃息肉的临床、内镜、病理特征和内镜治疗效果。方法：对2006年7月1日～2009年7月1日于空军总医院接受胃镜检查,诊断为增生性息肉、腺瘤性息肉和胃底腺息肉的患者进行回顾性分析。结果：共检出三种常见类型的胃息肉392例,检出率为3.4％,单发283例,多发109例。61．5％的患者位于30～59岁年龄段．53．1％的患者息肉形态为山田Ⅱ型,64．0％的患者息肉最大径≤0．5cm。365例行病理检查者中,增生性、腺瘤性和胃底腺息肉分别占63．6％、5．5％和31．0％,前两者好发于胃窦部,后者好发于胃体、胃底部。383例患者成功接受内镜治疗。75例有随访资料者中20例复发,其中13例为多发息肉。结论：胃息肉内镜下多为山田Ⅱ型,直径较小,多为单发．病理类型上以增生性息肉和胃底腺息肉多见。多发息肉治疗后易复发。     

The changing histological pattern of gastric polyps in an ethnically heterogeneous population

Abstract

Background and aim: Variation in the prevalence of various types of gastric polyps worldwide may reflect different etiologies. Here, the authors report the dynamic changes in histological distribution of gastric polyps over time and by ethnicity for individuals who underwent gastroscopies between 1994 and 2009 at two hospitals in Jerusalem, Israel. During this time period, the proportion of patients receiving proton pump inhibitors (PPIs) increased while the proportion of patients infected with Helicobacter pylori (H. pylori) decreased. Patients and methods: Pathological reports of biopsies from 50,071 consecutive gastroscopies were reviewed. Results. Gastric polyps were detected in 727 individuals. The yearly prevalence of gastric polyps was ≤1% between 1994 and 2001 and ≥2% from 2004 to 2009, of which overall 66% were hyperplastic polyps and 23% fundic gland polyps (FGPs). FGPs were diagnosed exclusively in the Jewish population. From 2001 to 2004, an increase in the absolute number of newly discovered hyperplastic and FGPs per year was observed. However from 2005, a divergent trend of changes was observed: While the proportion of patients with hyperplastic polyps dropped from 0.72 during the 2001–2004 period to 0.62 during the 2005–2009 period (p = 0.02), the proportion of patients with FGPs at these time periods increased from 0.16 to 0.33 (p = 0.0001). Conclusions. The yearly prevalence of gastric polyps in Jerusalem has recently doubled. This occurred mainly due to the increasing prevalence of FGPs. The changing epidemiology of gastric polyps is probably related to the interaction between genetic factors and fluctuating environmental factors like H. pylori infection rates and exposure to PPIs.     

Gastric ulcers in the fundic gland area.

Gastric ulcers have been thought to occur only in the pyloric gland area. However, endoscopic examinations using the Congo red test showed that 18 of the ulcers examined (7.8%) were surrounded by an acid-secreting area, and so were in the fundic gland area. Histological examination of specimens obtained by gastrectomy also showed that five of the lesions examined (4.5%) were located in the fundic gland area. Ulcers in the fundic gland area were found most frequently in the angle and lower gastric body, adjacent to acid-secreting boundary. These ulcers were associated with little or no fundal gastritis, whereas ulcers in the pyloric gland area were usually associated with moderate or severe fundal gastritis. Unlike ulcers of similar depth in the pyloric gland area, ulcers surrounded by normal fundic mucosa healed rapidly and completely. No recurrence of these ulcers was seen in a 1-year endoscopic follow-up period.     

Re-evaluation of Histogenesis of Gastric Carcinomas: A Comparative Histopathological Study Between Helicobacter pylori-Negative and H. pylori-Positive Cases

We histopathologically re-evaluated the histogenesis of gastric carcinomas from comparative studies between Helicobacter pylori-positive and H. pylori-negative cases using the gastritis score from the Updated Sydney System. The incidence of H. pylori-negative gastric carcinomas was 3.11% (12/386); they are likely to develop in the fundic gland mucosa, and show a gastric phenotype by mucin immunohistochemistry. Even in cases of completely gastric and predominantly gastric phenotypes, CDX2 protein was expressed in most cases (90.9% of pT1 and 100% of pT2-3), indicating a possibility that intestinalization of carcinoma cells occurs independently of the background mucosa. Regarding the degree of gastritis of background mucosa surrounding 143 H. pylori-positive differentiated-type adenocarcinomas, the mean score ranged from 1.497 to 1.713. Our data support the hypothesis that intestinal metaplasia is not a precancerous but a paracancerous lesion, and most gastric adenocarcinomas develop in mildly to moderately atrophic mucosa with H. pylori-infection, i.e., ongoing atrophy.     

Proton Pump Inhibitor-Related Gastric Mucosal Changes

Proton pump inhibitors (PPIs) are used worldwide to treat of acid-related disorders such as peptic ulcer and gastroesophageal reflux disease and to prevent gastroduodenal injuries due to nonsteroidal anti-inflammatory drugs. PPIs are the most potent inhibitors of gastric acid secretion currently available, and they are one of the most commonly prescribed classes of drugs because of their high efficacy and low toxicity. However, long-term PPI use causes histopathological changes such as parietal cell protrusion into the gland lumen, cystic dilation of gastric fundic glands, and foveolar epithelial hyperplasia. These changes can manifest on endoscopic examination as fundic gland polyps, hyperplastic polyps, multiple white and flat elevated lesions, cobblestone-like mucosa, or black spots. Clinicians must be aware of PPI-induced endoscopic features in patients with chronic long-term PPI use. Conversely, identifying patients with long-term PPI use based on their endoscopic findings is important. Recently, potassium-competitive acid blockers (P-CABs), a new class of acid suppressants that inhibit gastric acid secretion more strongly than PPIs, have recently been introduced clinically. Further long-term prospective studies on these gastric mucosal lesions in patients with either PPI or P-CAB use are required to investigate their association with histopathological changes and to establish the clinical significance of these findings. (Gut Liver 2021;15:-652)     

Gastric Pit Density and Depth of Foveolae of the Gastric Body Mucosa Assessed by Dye Endoscopy

Abstract: We examined the histological characteristics of the foveolar zone of the gastric body mucosa, using dye endoscopy and endoscopic biopsy. In 63 patients, the gastric area type of the gastric body was placed in one of the following categories; fundic gland type 0 (F₀), where small and fine areas are arranged closely to one another; F₁, where the areas are largest in size, round and high; F₂, where the areas are intemediate in size but not so high; F₃, where small and flat areas are loosely arranged; pseudo-pyloric gland type 1 (Pb₁), where the areas are regular in size and arrangement; and the completely atrophic gland type (Pb₂) with areas irregular in size and arrangement. The histological characteristics of the foveolar zone were emmined on printed microphotographs of the biopsy specimens of the gastric body. The density of the gastric pit was defined as the number of pits in a 1 mm width of the mucosal surface and depth of the foveolae was measured as the distance between the top and bottom (or the isthmus) of the foveolae as seen on vertical sections. The gastric pit density and depth of the foveolae were dense and shallow, respectively, in FO and sparse and deep, in Pbl and Pb₂ respectively. The degree of these factors showed independency in area types F₀, F₁ and Pb₂ and there were correlations of P<0.033 and P<0.001 between F₂ and Pb₁, F₃ and Pb₁, respectively. Our observations may be useful to define atrophic gastritis in the gastric body mucosa, in terms of the gastric area types.     

A study on the distribution of G-cells in human gastric mucosa

The distribution of G-cells in the gastric glands was studied quantitatively using the indirect immunoperoxidase method in 37 resected stomachs: 11 for esophageal cancer, 14 for gastric cancer, 4 for gastric ulcer, 7 for duodenal ulcer, and 1 for atypical epithelium. G-cells were seen in the pyloric glands and in the pseudopyloric glands in the atrophic fundic gland area. No G-cells were found in the fundic glands or in the cardiac glands. There was a significant correlation between the number of G-cells and the pyloric and/or pseudopyloric glandular tubes (p less than 0.01). The number of G-cells per glandular tube was 1.9 +/- 0.5 in the pyloric glands and 1.2 +/- 0.4 in the pseudopyloric glands on the pyloric part of the atrophic fundic gland area. G-cells were rarely seen in the pseudopyloric glands on the cardiac part of the atrophic fundic gland area. It is suggested that the pseudopyloric glands without G-cells in the cardiac region are akin to cardiac glands.     

Unusual gastric polyp showing submucosal proliferation of glands: Case report and literature review

We report an unusual pedunculated polyp in the stomach in a 41-year-old woman. She was hos-pitalized because of epigastric discomfort. Endoscopy revealed a polyp with a long stalk in the fundus of the stomach. The polypectomyzed polyp measured 23 × 18 × 9 mm and was characterized by submucosal proliferation of glands and cystic dilatation. The surface of the polyp was covered with gastric mucosa of fundic or pyloric gland type. The glandular structures consisted of various types of lining cells, including pyloric or mucous-neck cell type, surface mucous (foveolar) cell type, parietal-like cells, and somatostatin-positive cells. The submucosal glandular or cystic elements were connected with the overlying gastric mucosa through a defect of the muscularis mucosa, suggesting that this polyp may have been formed by the heterotopic inverted downgrowth of mucous glands into the submucosa. We discuss the histogenesis of this rare polyp and present a review of the literature. Received June 18, 1997; accepted Feb. 27, 1998     

The Correlation between Gastric Acid Secretion and Histology of Fundic and Antral Gland Area

Correlative studies were performed in 92 patients with gastric or duodenal ulcer, chronic gastritis, or diabetes mellitus. The basal acid secretion and that stimulated maximally by histamine or pentagastrin infusion decreased significantly with increasing severity of atrophic changes in the fundic gland area. Histological changes of antral mucosa were in 72 per cent of cases of similar degree as in fundic gland area. In the remainder of patients antral mucosa showed inflammatory or atrophic changes more advanced than the fundic gland area.     

Study of the gastric mucosal background in patients with gastric polyps

The characteristics of gastric mucosal patterns in the polyp-bearing stomach were investigated by the endoscopic Congo red test and systemic four-points biopsy in 46 patients with hyperplastic polyps and 21 patients with gastric adenomas. In addition, function of the stomach in these patients was assessed by determination of gastric acidity and fasting serum gastrin level and by gastrin response test to a beef extract. In the investigation of the gastric mucosal pattern in hyperplastic polyp patients, Type A gastritis (involving the corpus but sparing the antrum) was most frequently found. On the other hand, extensive intestinal metaplasia from the pyloric antrum to the corpus was most often noted in the adenoma-bearing stomach. Hypergastrinemia was more marked in hyperplastic polyp patients, and may be involved in the pathogenesis of hyperplastic polyps. Attention should be paid to the detection of cancer in areas without polyps during endoscopic observation and reexamination of patients. On these occasions, the characteristics of the background mucosa for each type of polyp should be kept in mind.     

Regular hemodialysis reverses gastric mucosal atrophy of patients with chronic renal failure

BACKGROUND/AIMS: Gastric mucosa of patients with chronic renal failure on regular hemodialysis is known to retain fundic glands relatively intact, but no evidence for regeneration of fundic glands by hemodialysis has been provided to date. This study was performed to investigate endoscopically and histopathologically if hemodialysis to treat renal failure would regenerate the background gastric mucosa and to elucidate factors associated with the mucosal regeneration. METHODOLOGY: First, the relationship between duration of hemodialysis and the degree of atrophy of the background gastric mucosa was investigated in patients with chronic renal failure treated and not treated by hemodialysis. Treated patients were further divided into long-term group treated for 4 years or longer and short-term group treated for shorter than 4 years. The degree of atrophy of gastric mucosa was evaluated by hematoxylin-eosin staining, PAS-alucian blue staining and immunohistochemical staining to detect Ki-67 expression using biopsy specimens obtained from gastric mucosa. The labeling index is the proportion of positively labeled cells with respect to the total number of cells. The proliferative index was calculated by multiplying the labeling index and the proliferative zone (length of the area between the uppermost and lowest labeled cells). Serum gastrin, glucagon and cholecystokinin were assayed as well as urine epidermal growth factor to elucidate factors associated with regeneration of gastric mucosa. Helicobacter pylori infection was examined by ELISA. RESULTS: In the long-term group, the degree of atrophy of gastric mucosa was endoscopically evaluated to be C1 type. In both of the two hemodialysis groups, endoscopically identified fundic gland region was histologically confirmed to be fundic glands by both hematoxylin-eosin staining and PAS-alucian blue staining. Epithelial cell proliferative index was significantly higher in long-term and short-term hemodialysis group than non-hemodialysis group (P=0.0001). No significant difference in serum gastrin, glucagon and cholecystokinin as well as urine epidermal growth factor was detectable among the three groups. Most patients of both hemodialysis groups were H. pylori-negative. CONCLUSIONS: A possibility of regeneration of the background gastric mucosa in proportion to the duration of hemodialysis was suggested on the basis of histopathological evidence. The observed regeneration of gastric mucosa was ascribable to elimination of factors associated with atrophy of gastric mucosa including H. pylori by hemodialysis.