Characteristics of gastric adenocarcinoma of fundic gland type and fundic gland mucosal type based on H. pylori infection

Aims Gastric adenocarcinoma of the fundic gland type (GA-FG) and fundic gland mucosal type (GA-FGM) are uncommon variants of gastric neoplasia that demonstrate differentiation between fundic glands and the gastric foveolar epithelium. However, the characteristics of these subtypes of gastric neoplasia have not been thoroughly elucidated, particularly in relation to Helicobacter pylori (H. pylori) infection status. Therefore, this study aimed to evaluate the endoscopic and pathological features of GA-FG/GA-FGM in relation to H.□pylori infection. Methods This study retrospectively enrolled 48 patients (54 lesions) and categorized them into two groups: (i) the Hp-uninfected group (n=15) and (ii) the Hp-infected group (patients with current or past H. pylori infection [n=33]). The clinical, endoscopic, and pathological features of the two groups were compared. Results Statistically significant differences between Hp-uninfected and Hp-infected group were observed in the mean age (60.1 vs. 73.9 years, p<0.001), sex distribution (male/female=7/8 vs. 26/7, p=0.043), and the anatomical location of lesions (U/M/L=13/2/0 vs. 20/17/2, p=0.049). Moreover, synchronous and metachronous lesions were significantly more prevalent in the Hp-infected group (11 of 39 lesions), whereas multiple lesions were not observed in the Hp-uninfected group (p=0.024). Conclusions The proportion of elderly male patients with GA-FG and GA-FGM was significantly higher in those with H. pylori infection compared to those without H. pylori infection. Furthermore, endoscopists should understand that synchronous/metachronous lesions may occur in patients with a history of H. pylori infection. Publication History Article published online: 27 March 2025 © 2025. European Society of Gastrointestinal Endoscopy. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany