Gastric polyps
Gastric polyps, also referred to as stomach polyps, are small growths that develop on the lining of the stomach. These polyps can arise due to chronic inflammation, the long-term use of proton pump inhibitors, and infections such as those caused by Helicobacter pylori. While many individuals with gastric polyps remain asymptomatic, some may experience symptoms like bleeding, obstruction, nausea, or changes in appetite. Incidence rates of gastric polyps vary, with some studies reporting occurrences in 0.5 to 23 percent of patients undergoing upper gastrointestinal endoscopies. Most gastric polyps are benign, particularly hyperplastic polyps, while adenomatous polyps, which can arise in certain genetic syndromes, carry a higher risk of cancer transformation. Diagnosis typically occurs incidentally during endoscopy for unrelated issues, and treatment options may include removal of the polyps or antibiotics if an infection is present. Regular monitoring is advised, especially for individuals with genetic predispositions to polyps. Understanding gastric polyps is essential for managing potential health risks associated with these growths.
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Gastric polyps
ALSO KNOWN AS: Stomach polyps
RELATED CONDITIONS: Gastritis, familial adenomatous polyposis, Peutz-Jeghers syndrome, gastric carcinoid tumors
DEFINITION: Gastric polyps are small tissue growths on the lining of the stomach.
Risk factors: Risk factors for gastric polyps are chronic inflammation and the long-term use of proton pump inhibitors. Age, genetic factors, and infection from Helicobacter pylori are also risk factors.
Etiology and the disease process: The cause of gastric polyps is not completely understood. Hyperplastic polyps are thought to arise from irritation or chronic inflammation of the stomach lining. The nature of the causative agent has not been clearly established; suggested irritants include coffee, tea, and gastric acid. Long-term use of proton pump inhibitors is associated with the development of hyperplastic and carcinoid polyps; this may be related to the decrease in stomach acid, which, in turn, causes an increase in gastrin, a hormone that supports cell growth. Familial cancer syndromes such as familial adenomatous polyposis and Peutz-Jeghers syndrome have been linked with gastric polyps, suggesting that genetic mutations have a role in polyp formation.
Incidence: In 1996 the Italian Journal of Gastroenterology published the results of an endoscopic study of almost 13,000 patients during a four-year period (Archimandritis 1996). The study showed that gastric polyps were found in 157 patients (1.2 percent). About 66 percent of the gastric polyps were in patients over age sixty. The gastric polyps were hyperplastic (75.6 percent), inflammatory (17.8 percent), and adenomatous (6.6 percent). No correlation with stomach cancer and no gender preponderance were found with gastric polyps. In literature pertaining to studies published through the mid-2020s, it is apparent the incidence of gastric polyps varies widely. They were found in 0.5 through 23 percent of all upper gastrointestinal endoscopies. In the United States, gastric polyps were found in 6 percent of patients having this procedure.
Symptoms: Patients usually have no symptoms. However, if they are symptomatic, they may develop bleeding from the stomach or obstruction (blockage of the digestive tract). Pain, blood in vomit and stool, heartburn, acid reflux, nausea, and changes in appetite are other possible symptoms.
Screening and diagnosis: Most gastric polyps are discovered and diagnosed incidentally when endoscopy of the stomach is performed for an unrelated reason. Upper endoscopy is a procedure using an endoscope, a flexible tube with a small camera and an instrument for that is introduced through the upper digestive tract; it allows visual examination of the esophagus, stomach, and upper duodenum, the first part of the small intestine.
No staging is applicable for gastric polyps.
Treatment and therapy: Gastric polyps can be removed during endoscopy and examined in the laboratory. If the polyps are too large, surgery may be necessary. If gastric polyps are related to infection, antibiotics may be prescribed. Lifestyle changes can also be beneficial. Multiple polyps may require removal of the largest polyp and sampling from the remaining polyps; there is no need to remove all polyps. Treatment will be based on the nature of these polyps.
Prognosis, prevention, and outcomes: The majority of gastric polyps are benign. Hyperplastic polyps are also generally benign. The polyps associated with familial adenomatous polyposis and Peutz-Jeghers syndrome can become adenomatous in nature. Adenomatous polyps have an increased risk for cancer transformation; therefore, regular surveillance with upper endoscopy is warranted for these familial conditions.
Bibliography
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Huang, C. Z., et al. "Relative Risk Factors Associated with the Development of Fundic Gland Polyps." European Journal of Gastroenterology & Hepatology, vol. 26.11, 2014, pp. 1217–1221.
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Wang, Wei, et al. "The Prevalence and Risk Factors of Gastric Polyp in Asymptomatic Patients Receiving Health Examination." Gastroenterology Research and Practice, vol. 2018, 2018, doi.org/10.1155/2018/9451905. Accessed 18 June 2024.
“What Are the Risk Factors for Stomach Cancer?” American Cancer Society, 22 Jan. 2021, www.cancer.org/cancer/types/stomach-cancer/causes-risks-prevention/risk-factors.html. Accessed 18 June 2024.
Yamada, Tadataka, ed., et al. Textbook of Gastroenterology. 5th ed. Chichester: Blackwell, 2009.