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Gastric polyps are all abnormal protrusions of the stomach wall towards its interior. They are usually found by chance as they rarely cause symptoms. They are an important find, as some of them may be cancerous.
Polyps in the stomach are most often found accidentally during gastroscopy, i.e. gastric colonoscopy, performed due to suspected other diseases of the gastrointestinal tract. They concern men and women equally, in 2/3 of cases after the age of sixty. In 1/4 of the cases, gastric polyps occur in multiple forms. If they cause symptoms, which is rarely the case, they are signs of gastrointestinal bleeding (latent or overt) or gastrointestinal obstruction, manifested, among others, by vomiting and stomach pain.
Due to the fact that the polyp in the stomach may turn out to be cancerous, all gastric polyps should be histopathologically examined (microscopic examination). For this purpose, the detected polyps are either completely removed (if the diameter of the polyp exceeds 1 cm) or biopsied, i.e. a small fragment of tissue is removed. If there are many polyps in the stomach, the largest ones are removed and the smaller ones are biopsied. Histopathological examination is used, among others evaluation of the nature and type of the polyp. At the same time, a test is carried out to assess the presence of H. pylori bacteria in the stomach, which in some cases is responsible for the presence of polyps. The prognosis and further management depend on the results of these tests.
The most common types of gastric polyps include:
- hyperplastic polyps,
- focal foveal growth,
- adenomas,
- carcinoid tumors.
Polyp hyperplastic
The most common type of gastric polyp (75% of gastric polyps) may be single but is often multiple. Its size may vary from 1 mm to 12 cm (approximately 1 cm on average). A hyperplastic polyp arises as a result of uncontrolled, excessive regeneration of the epithelium, to which it is stimulated by chronic inflammation of the gastric mucosa. Conditions that predispose to the occurrence of this type of polyps are therefore: chronic atrophic or erosive gastritis, pernicious anemia and gastric ulcer disease. Over time, polyps may disappear by themselves, remain unchanged, or increase in size. Hyperplastic polyps undergo neoplastic transformation with an estimated frequency of 0,5-7,1%. The risk of malignancy is greatest in polyps larger than 2 cm in diameter or with a pedunculated form, and these polyps are completely removed. If the test for H. pylori is positive, antibiotic treatment is recommended to remove bacteria from the stomach (eradication treatment). Such therapy, in most cases, leads to the regression of hyperplastic polypoid lesions. A follow-up gastroscopy is performed after treatment to assess its effectiveness.
How is the stomach examined?
Focal foveal hyperplasia
Polyps with a focal foveal character are usually small, 1 to 8 mm in diameter, although they are also larger. These changes probably result from divisions and transformations of improperly placed cells in the gastric mucosa. Among them, there are sporadic polyps associated with the chronic use of anti-ulcer drugs and with familial adenomatous polyposis.
Sporadic polyps more often affect women than men. They usually appear in middle age. In 40% of cases, they are multiple.
Treatment-dependent polyps are associated with long-term therapy (over 5 years) with drugs inhibiting the secretion of hydrochloric acid from the group of proton pump inhibitors. Discontinuation of drugs from this group often causes regression of such polyps. Therefore, in the case of multiple polyps and taking drugs from this group, discontinuation of these drugs should be considered. Interestingly, in the case of focal foveal hyperplasia, H. pylori infection has a protective effect and reduces the incidence of this type of polyp. Sporadic and treatment-related polyps very rarely transform into neoplastic lesions of a malignant nature, therefore they do not require endoscopic surveillance.
In some cases, gastric polyps with focal foveal hyperplasia are associated with the presence of a genetically determined syndrome of familial adenomatous polyposis. Then they appear earlier, are usually multiple and affect men and women equally. In familial polyposis syndrome, they sometimes become malignant and at a very high risk of developing colorectal cancer, they require regular gastroscopic and colonoscopic examinations.
Adenomas
Adenomatous polyps account for 6-10% of gastric polyps. They can be up to 15 cm in size. They are often associated with chronic gastritis. They are benign neoplastic lesions, but carry a high risk of turning into a malignant form, therefore all of them should be removed, regardless of their size. Some of them already contain malignant neoplasms or coexist with lesions of this type located in the rest of the stomach. As in the case of hyperplastic polyps, all patients with such polyps should be tested for H. pylori infection and, if positive, should undergo eradication treatment. Due to the risk of developing gastric cancer, a gastroscopic check-up is recommended in people with adenomatous polyps one year after the removal of the polyps.
Gastric adenomas are more common in people with familial adenomatous polyposis, in which they occur with a 90% frequency. In this syndrome, the risk of gastrointestinal cancer is high and requires regular annual gastroscopic and colonoscopic examinations.
Carcinoid
It is a tumor that originates in endocrine cells. Most often it occurs as multiple lesions and is usually mild. Single carcinoids, especially those with a larger diameter (> 2 cm), are more aggressive and metastasize. A feature of carcinoid tumors is the secretion of active substances such as serotonin or histamine, therefore, in addition to symptoms of bleeding or gastrointestinal obstruction, it may cause symptoms of the so-called carcinoid syndrome. These include redness of the face and neck for several minutes with palpitations and dizziness, watery diarrhea with abdominal pain, and attacks of breathlessness. Carcinoid polyps may be associated with atrophic gastritis, endocrine neoplasia, or may be sporadic. In the first two cases, if the polyp is smaller than 1 cm, a polypectomy (removal of the polyp) performed during gastroscopy is sufficient for treatment. Occasional carcinoids require a partial or complete removal of the stomach along with the surrounding lymph nodes.
Although gastric polyps usually do not cause symptoms and are detected accidentally, they should always be verified by histopathological examination and, if necessary, removed. In some types of polyps, discontinuation of chronic ulcer therapy or treatment of H. pylori infection may result in regression of the polyps.
Text: lek. Marek Kaszuba