How to reduce recurrence after endoscopic treatment of gastric hyperplastic polyps

10.1055/a-2631-5146

We read with great interest the study entitled “Malignant progression and recurrence rates following endoscopic treatment of gastric hyperplastic polyps” by Turkot et al. [1]. The authors demonstrated that the risk of malignant progression in gastric hyperplastic polyps (GHPs) is low (1.4%), and local recurrence after endoscopic resection is high (25.1%). Based on our experience, we agree with the low incidence of malignant progression in GHPs; however, there are several considerations regarding the high recurrence rate of GHPs after endoscopic resection.

Although not well defined, the main causes of GHPs are Helicobacter pylori infection and long-term use of potent acid-reducing agents such as proton pump inhibitors (PPIs) [2] [3]. The rate of disappearance of GHPs after H. pylori eradication is reported to be 68%–85% [3]; therefore, Japanese guidelines recommend H. pylori eradication as the first treatment for patients with GHPs [4]. In terms of long-term PPI use, GHPs were observed in 9% of long-term PPI users [2]. The exact pathophysiological mechanism of GHP formation is unclear, but gastrin receptors are expressed on the foveolar epithelium of GHPs [5]; thus, PPI-induced hypergastrinemia provokes hyperplasia of the gastric foveolar epithelium [2], leading to the recurrence of GHPs after endoscopic resection. Therefore, factors such as persistent H. pylori infection and long-term PPI use should be considered risk factors for the recurrence of GHPs after endoscopic resection. Accordingly, appropriate H. pylori eradication and proper use of PPIs should be considered after endoscopic resection to reduce the recurrence of GHPs.

Publication History

Article published online:
20 March 2026

• References

• 1 Turkot MH, Zaborowska M, Pilonis ND. et al. Malignant progression and recurrence rates following endoscopic treatment of gastric hyperplastic polyps. Endoscopy 2025; 57: 1348-1354
• 2 Kim GH. Proton pump inhibitor-related gastric mucosal changes. Gut Liver 2021; 15: 646-652
• 3 Chung WC. Helicobacter pylori eradication reduces risk for recurrence of gastric hyperplastic polyp after endoscopic resection. Korean J Intern Med 2023; 38: 141-143
• 4 Asaka M, Kato M, Takahashi S. et al. Guidelines for the management of Helicobacter pylori infection in Japan: 2009 revised edition. Helicobacter 2010; 15: 1-20
• 5 Takamura A, Ito M, Boda T. et al. High expression of gastrin receptor protein in injured mucosa of Helicobacter pylori-positive gastritis. Dig Dis Sci 2013; 58: 634-640