Gastric FGPs are the most common type of gastric polyps found in middle-aged adults undergoing upper endoscopy. FGPs have typical and characteristic endoscopic and histologic hallmarks. A positive association between FGPs and acid suppression has been noted. Why certain patients are more likely to develop FGPs in the setting of acid suppression remains unclear. FGPs can be sporadic, or they can be associated with an inherited polyposis syndrome such as FAP or AFAP. Patient age, history of acid suppression, family history, and prior colonoscopy results should be evaluated to determine the possible presence of an inherited syndrome. Ultimately, genetic testing may be necessary to establish the diagnosis and facilitate subsequent screening and surveillance of the patient and family members. The role of surveillance for sporadic FGPs is controversial, as these polyps have typically been regarded as benign lesions without malignant potential. There is a clear role for surveillance of FGPs in patients with an inherited polyposis syndrome due to the increased risk of dysplasia and cancer. Finally, FAP patients may benefit from chemoprevention with acid suppressive therapy to prevent FGP dysplasia and cancer.