Fundic glands

When 1.5 volumes acetone is added to the trichloroacetic acid filtrate of the gastric juice, an abundant flocculent precipitate forms, which contains all the components of dissolved mucin with the exception of soluble mucus. If this precipitate is taken up in dilute alkali and then acidified with dilute HCl down to pH 3.5, a fine flocculent precipitate forms, which we named dissolved mucoprotein (G27, G36). It was later renamed glandular mucoprotein (G9, G38) because of its close relationship to the fundic glands of the stomach. This material contained much protein its nitrogen content was 12.61 0.44% and its tyrosine content 7.50 0.65% by the Folin-Giocalteu reaction. The reducing substance content was 6.38 1.48% before and 12.5% after hydrolysis (G9, G27, G36) (see Table 4). Werner (W9) determined the composition of this mucoprotein fraction and found that it contained 11.2% N by Kjeldahl, 8.8% hexosamine, 4.8% uronic acid, and 2.0% sialic acid. 

An uncontrolled retrospective study of patients who had taken proton pump inhibitors for an average of 33 months found gastric polyps in 17 of 231 patients who underwent two or more endoscopies for complicated gastro-esophageal reflux disease (33). The polyps were generally small (under 1 cm), sessile, and multiple, and were present in the proximal or mid gastric body. Of the 15 polyps removed endoscopically, nine were fundic gland type, four were hyperplastic, and two were inflammatory. None had any dysplasia or carcinoma. 

Declich P, Ferrara A, Galati F, Caruso S, Baldacci MP, Ambrosiani L. Do fundic gland polyps develop under long-term omeprazole therapy Am J Gastroenterol 1998 93(8) 1393. 

Naegels S, Urbain D. Omeprazole and fundic gland polyps. Am J Gastroenterol 1998 93(5) 855. 

Fig. 10.1 Immunocytolocalization of HGL in chief cells of fundic glands. Chief cells containing HGL were stained by rabbit polyclonal anti-HGL antibodies coupled to rhodamin,...

Burt RW. Gastric fundic gland polyps. Gastroenterology. 2003 125 1462-1469. 

Declich P, Isimbaldi G, Sironi M, et al. Sporadic fundic gland polyps an immunohistochemical study of their antigenic profile. Pathol Res Pract. 1996 192 808-815. 

Sekine S, Shibata T, Yamauchi Y, et al. Beta-catenin mutations in sporadic fundic gland polyps. Virchows Arch. 2002 440 381-386. 

Hassan A, Yerian LM, Kuan SF, et al. Immunohistochemical evaluation of adenomatous polyposis coli, beta-catenin, c-Myc, cyclin Dl, p53, and retinoblastoma protein expression in syndromic and sporadic fundic gland polyps. Hum Pathol. 2004 35 328-334. 

FIGURE 12.2 Normal gastric mucosa (hematoxylin and eosin staining). Note the surface epithelium and fundic glands in the deep portion. 

A prospective study of 1780 consecutive upper gastrointestinal endoscopies showed a prevalence of gastric polyps of 7.2% ( = 129) within this subgroup, 77 patients (4.3%) had fundic gland polyps [77. Proton pump inhibitors had been used by 64% of patients with fundic polyps and 16% of those without polyps. Multiple regression analysis showed that three... 

Hongo M, Fujimoto K, Gastric Polyps Study Group. Incidence and risk factor of fundic gland polyp and hyperplastic polyp in long-term proton pump inhibitor therapy a prospective study in Japan. J Gastroenterol 2010 45 618-24. 

Zelter A, Fernandez JL, Bilder C, Rodriguez P, Wonaga A, Dorado F, Galich M, Viola LA. Fundic gland polyps and association with proton pump inhibitor intake a prospective study in 1,780 endoscopies. Dig Dis Sci 2011 56 1743-8. 

The pyloric glands contain only one type of cell. The function of these cells is not clear, but they are believed to be mucous cells of the type found in the neck of the fundic glands. The cardial glands also are made primarily of mucous cells, although a few pepsinogen cells may be found. 

Acetylcholine is released in the mucosa by postganglionic nerve endings found either in the fundus in the area of the fundic gland, which secretes hydrochloric acid, or in the pylorus in the area of the endocrine gland, which secretes gastrin. 

Acetylcholine is known to stimulate directly the fundic gland to secrete hydrochloric acid to sensitize parietal cells to the action of gastrin and to stimulate directly gastrin secretion in the pyloric region. 

Grossman MI. Secretion of acid and pepsin in response to distention of vagally innervated fundic gland area in dogs. Gastroenterology 42 1 S-12, 1962. 

D cells are present both in the fundus and antrum and contain somatostatin. The D cells of the antrum exhibit elongated processes that extend to the basal portions of G cells and are more frequent here than in the fundus. These cells also extend processes to the lumen of the antral gland. The fundic D cells are relatively sparse and have no contact with the lumen of the fundic gland. 

Levine RA, Kohen KR, Schwartzel EH Jr. Prostaglandin E2-histamine in interactions on cAMP, cGMP, and add production in isolated fundic glands. Am J Physiol 1982 242 G21-G26. 

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