Polyps are defined as luminal lesions that project into the mucosal surface of the gastrointestinal tract and are characterized according to their morphological and histological features

BACKGROUND: The bacterium Helicobacter pylori is strongly associated with the development of gastric adenocarcinoma. Currently, the prevalence in developed countries is 40%, but this value increases considerably in developing countries, which can reach rates bigger than 90%. OBJECTIVE: The objective of this study was to determine the mean and annual prevalence of Helicobacter pylori infection in patients from Itajaí during the period from July 1992 to April 2016, as well as the gender and age groups most affected. METHODS: After consent of the clinical director of the Gastroclinica Itajaí and confidentiality commitment about the research, the database of the Endoscopy Service of the clinic was evaluated. All the patients who underwent their first upper digestive endoscopy with urease test and/or histological analysis were included. The data were submitted to statistical analysis of prevalence by gender, age group and years of study, with subsequent correction through the confidence interval. RESULTS: The mean prevalence of Helicobacter pylori infection thru all years of study was 50.07%. With the calculation of the annual prevalences, it was evident the gradual reduction of infection in the population of Itajaí, that was 81.3% in 1992, declining to 33% in the year of 2016. When classifying the prevalence of infection by gender, it was higher in males (53.59%), and gender distribution by age group showed no statistically significant difference among genders between the ages of 40 and 80 years. In relation to the age group, the highest prevalence was in the group between 40 and 49 years. CONCLUSION: Although this study is retrospective and based on endoscopic database analysis, without access to clinical data of patients such as prior use of proton pump inhibitor and antibiotics to endoscopy, its results are important because they may reflect the current panorama of Helicobacter pylori infection in the city under study, where it has been presenting a gradual reduction of prevalence over the years, with current rates similar to that of developed countries (33%). Future studies are needed to confirm our data.

Background/Objectives: Gastric cancer (GC) remains a leading cause of cancer mortality worldwide. While most cases are sporadic, approximately 10% show familial clustering with only a minority explained by known hereditary syndromes. The remaining, termed familial non-hereditary gastric cancer (FNHGC), lack a defined high-penetrance germline mutation. This review aims to summarize current knowledge regarding the diagnosis, risk factors, molecular characteristics and management of FNHGC. Methods: A comprehensive narrative review of the literature was conducted focusing on epidemiologic, molecular and clinical studies addressing families with multiple GC cases but no identified germline mutation. Results: The etiology of FNHGC is multifactorial, and H. pylori, with its related chronic gastritis, is probably the key driver. Familial clustering likely occurs when combined with other elements such as genetic polymorphisms, shared exposures to risk factors or even epigenetic phenomena. Molecular profiling reveals distinct patterns in familial tumors such as more frequent microsatellite instability; somatic CDH1 promoter hypermethylation; and recurrent somatic mutations in TP53, RHOA and DNA repair genes. Current management focuses on genetic testing to rule out hereditary syndromes, endoscopic surveillance and mitigation of risk factors, with eradication of H. pylori paramount. Conclusions: FNHGC represents a distinct subgroup of GC characterized by a multifactorial etiology related to exposure to risk factors and genetic susceptibility although significant gaps remain in fully explaining the condition. Ongoing research holds promise to provide tools for better detection and prevention in order to reduce the burden of GC in familial settings.

Background: Post‐endoscopy gastric cancer (PEGC) is a gastric cancer (GC) diagnosed within 3 years after an esophago‐gastro‐duodenoscopy (EGD) negative for cancer. Post‐endoscopy gastric cancer has a prevalence of 9%–11% in the western population and is potentially reducible through adequate surveillance and high‐quality endoscopy. However, Post‐Endoscopy Gastric Cancer features are not well defined. Objectives: Define Post‐Endoscopy Gastric Cancer prevalence in a gastric cancer low‐risk area as Spain, describe its characteristics and associated factors. Evaluate adherence to current recommendations for surveillance of preneoplastic gastric lesions and endoscopic quality indicators. Methods: A descriptive and analytical study included patients who met PEGC criteria and enrolled in the EpiGASTRIC registry—a national multicentric GC cohort—between April 2021 and May 2024. Results: Of 289 gastric cancer patients analyzed, 21 (7.3%) presented with PEGC. No differences were found between PEGCs and new‐onset gastric cancers (NOGC) regarding clinical‐demographic characteristics (males 52.4%, 65 years, caucasians 78.9%, previous Helicobacter pylori infection 56.3%) except for use of proton pump inhibitors (PPI) (81.0% vs. 44.9%, p ‐value = 0.002). Distal stomach (antrum and/or incisure) was more frequently affected in PEGC compared with NOGC (71.4% vs. 46.2%; p ‐value = 0.022), without differences in tumoral staging (I–II 52.4%) or histology (intestinal type 47.6%). Median time from last negative‐for‐cancer EGD to diagnosis was 13.6 months (interquartile range 4.1–26.8), with 38.1% of precursor lesions in previous endoscopy (19% chronic atrophic gastritis with metaplasia, 19% dysplasia). Considering last negative‐for‐cancer EGD, adherence to current recommendations was 66.6% for the surveillance of gastric lesions, and 14.3% for quality indicators (complete procedure 100%, high‐definition 38.1%, chromoendoscopy 10.0%). Conclusions: PEGC patients present a higher rate of distal stomach involvement and use of PPIs. Although precursor gastric lesions are commonly identified, adherence to current recommendations for their surveillance and to established quality indicators in EGDs is scarce. Despite its low prevalence, there is room for improvement to enhance the early detection and prevention strategies for PEGC.

The diagnostic value of an incisura biopsy during upper gastrointestinal endoscopies (UGEs) for detecting gastric cancer precursor lesions (GCPLs) remains debated. This study aimed to evaluate the impact of incisura biopsy on the detection of GCPL, staging according to Operative Link for Gastritis Assessment (OLGA) and Operative Link of Gastritis and Intestinal Metaplasia (OLGIM), and surveillance strategies. This observational, single-centre retrospective study included patients undergoing UGE between 2017 and 2022 with gastric biopsies from the corpus, antrum, and incisura in separate vials, and intestinal metaplasia (IM) identified in at least one site. OLGA/OLGIM stages were assessed with and without the incisura biopsy. Factors associated with stage or surveillance modifications were analysed. Among 27,166 patients undergoing UGEs, 819 patients met the inclusion criteria. Of the 819 patients, the median age was 67 years (interquartile range, 59–74 years), 59.5% were women, 89.3% originated from low gastric cancer (GC) risk regions, and 35.6% had current or prior Helicobacter pylori infection. The incisura presented isolated atrophy, IM, and dysplasia in 5.9%, 11.1%, and 1.6%, respectively. Its inclusion upstaged OLGA/OLGIM in 18.3% and 16.5%, respectively, which led to surveillance recommendations in 7.0% and 2.6% patients, respectively. Overall, this corresponded to a 9.0% absolute increase in patients recommended for surveillance compared with omitting the incisura biopsy. OLGIM upstage was associated with current H. pylori infection, alcohol intake, and origin from an intermediate GC-risk region, whereas surveillance changes were associated only with intermediate-risk origin. Adding an incisura biopsy to gastric mapping identified more advanced GCPL, upstaged OLGA/OLGIM in ∼20% of patients, and increased surveillance recommendations in an extra ∼10%. These results recommend the systematic inclusion of the incisura biopsy in GC risk stratification.