How would I know if stomach polyps were present? According to the Mayo Clinic, stomach polyps won’t cause any symptoms at all in most people. Symptoms usually appear only when the polyps are large or great in number. Stomach polyps form when the stomach lining becomes inflamed and forms small protrusions. When a polyp is small, which is the case for the majority of people, it won’t cause a disruption within the functioning of the stomach or form into a lesion or sore. These protrusions can eventually become ulcerous.
In general, once a polyp is observed, it is removed or biopsied and classified. Prognosis and management are specific to the underlying pathology. However, pathology is generally not known at the time of the initial endoscopy and some general management issues are commonly applied to all patients with gastric polyps.
Overall, stomach polyps are rare compared to other gastric conditions. Most stomach polyps are less than 1 centimeter in diameter and due to inflammation or hyperplasia. Larger stomach polyps (greater than 1.5cm in diameter) are associated with a greater risk of malignancy and if the polyp is larger than 2cm in diameter, it is usually removed immediately.
Types of Stomach Polyps
1. Hypertrophic Polyps
Most stomach polyps occur due to inflammation or hyperplasia of the epithelium or deeper layers. Overgrowth of tissue (hyperplasia) in the stomach lining occur as a result of repeated inflammation. There are usually multiple hypertrophic polyps present simultaneously which appear oval in shape with a smooth surface. Sometimes the polyp is ulcerated, similar to a peptic ulcer, although this is usually superficial. Microscopic examination of the polyp reveals significant edema (swelling) in the lamnia propria layer and it is not uncommon for the mucosa around the polyp to also be inflamed.
The most common cause of stomach polyps is chronic gastritis. Persistent irritation of the stomach lining triggers excessive growth of normal cells (hyperplasia). If the gastritis is a result of long term H.pylori infection, successful eradication and appropriate treatment of H.pylori gastritis may lead to the polyp resolving spontaneously. Most cases of gastritis that lead to a polyp formation will result in a hypertrophic polyp.
2. Fundic Gland Polyps
Also known as fundic cystic gland polyps, these stomach polyps arise as a result of a cyst-like dilation of the glandular tissue of the stomach lining. The growth is typically lined by flattened parietal and chief cells. The tissue of the polyp as well as the surrounding tissue are usually not edematous and inflamed.
This is often linked to an inherited condition known as familial adenomatous polyposis (FAP). However the rise in fundic gland polyps in recent years may be linked to long term use of proton pump inhibitors which may result in increased gastrin secretion and hyperplasia of the glandular tissue.
3. Gastric Adenomas
Adenomas are a less common type of gastric polyp (10% of cases) and is most commonly found in the antrum of the stomach. These types of polyps are composed of abnormal intestinal-type columnar epithelium. The level of dysplasia of these cells may be low or high grade. Adenomas are the most likely type of stomach polyp to become cancerous. The risk of malignancy is linked to its size. Polyps larger than 2cm in diameter are of a higher risk.
An adenoma is more likely to occur in cases of chronic H.pylori gastritis or autoimmune gastritis that progress to atrophic gastritis (destruction of the stomach lining as a result of chronic inflammation). A family history of familial adenomatous polyposis (FAP) also increases the incidence of an adenoma.
Signs, symptoms & indicators of Stomach Polyps
Epigastric pain
When the stomach polyps grow larger or increase in number, the patient may begin to suffer from some pain or discomfort in the abdominal region. As the condition persists, the abdomen may become more tender than normal and develop a heightened sensitivity to touch.
Conditions that suggest Stomach Polyps
Benign stomach polyps
Risk factors for Stomach Polyps
Helicobacter Pylori Infection
The most common cause of stomach polyps is chronic gastritis. Persistent irritation of the stomach lining triggers excessive growth of normal cells (hyperplasia). If the gastritis is a result of long term H.pylori infection, successful eradication and appropriate treatment of H.pylori gastritis may lead to the polyp resolving spontaneously.
(Past) PPI antacid use
Fundic gland polyps have generally been considered benign. However, they are known to be increased in patients receiving proton pump inhibitors. [John Gever, Staff Writer, MedPage Today Published: October 08, 2008]
History of stomach polyps
Stomach Polyps suggests the following may be present
Colon Cancer
Records of more than 78,000 patients showed no association between the presence of fundic gland polyps and high-grade dysplasia or cancer in the colon, reported Cristian Robiou, M.D., of Caris Diagnostics in Irving, Tex., in an oral presentation at the American College of Gastroenterology meeting.
“The suggestion that the finding of a sporadic fundic gland polyp should trigger a colonoscopy cannot be supported,” Dr. Robiou asserted. [John Gever, Staff Writer, MedPage Today Published: October 08, 2008]
Key
| Weak or unproven link |
| Strong or generally accepted link |
| Proven definite or direct link |
| Weakly counter-indicative |
Glossary
Stomach
A hollow, muscular, J-shaped pouch located in the upper part of the abdomen to the left of the midline. The upper end (fundus) is large and dome-shaped; the area just below the fundus is called the body of the stomach. The fundus and the body are often referred to as the cardiac portion of the stomach. The lower (pyloric) portion curves downward and to the right and includes the antrum and the pylorus. The function of the stomach is to begin digestion by physically breaking down food received from the esophagus. The tissues of the stomach wall are composed of three types of muscle fibers: circular, longitudinal and oblique. These fibers create structural elasticity and contractibility, both of which are needed for digestion. The stomach mucosa contains cells which secrete hydrochloric acid and this in turn activates the other gastric enzymes pepsin and rennin. To protect itself from being destroyed by its own enzymes, the stomach’s mucous lining must constantly regenerate itself.
Polyp
A usually nonmalignant growth or tumor protruding from the mucous lining of an organ such as the nose, bladder or intestine, often causing obstruction.
Endoscopy
A procedure that uses an Endoscope.
Peptic Ulcer
A general term for gastric ulcers (stomach) and duodenal ulcers (duodenum), open sores in the stomach or duodenum caused by digestive juices and stomach acid. Most ulcers are no larger than a pencil eraser, but they can cause tremendous discomfort and pain. They occur most frequently in the 60 to 70 age group, and slightly more often in men than in women. Doctors now know that there are two major causes of ulcers: most often patients are infected with the bacteria Helicobacter pylori (H. pylori); others are regular users of non-steroidal anti-inflammatory drugs (NSAIDS), which include common products like aspirin and ibuprofen.
Edema
Abnormal accumulation of fluids within tissues resulting in swelling.
Mucosa
Mucous tissue layer lining tubular structures (nasal passages, ear canal, etc.).
Chronic
Usually Chronic illness: Illness extending over a long period of time.
Gastritis
Inflammation of the stomach lining. White blood cells move into the wall of the stomach as a response to some type of injury; this does not mean that there is an ulcer or cancer - it is simply inflammation, either acute or chronic. Symptoms depend on how acute it is and how long it has been present. In the acute phase, there may be pain in the upper abdomen, nausea and vomiting. In the chronic phase, the pain may be dull and there may be loss of appetite with a feeling of fullness after only a few bites of food. Very often, there are no symptoms at all. If the pain is severe, there may be an ulcer as well as gastritis.
Helicobacter Pylori
H. pylori is a bacterium that is found in the stomach which, along with acid secretion, damages stomach and duodenal tissue, causing inflammation and peptic ulcers. Although most people will never have symptoms or problems related to the infection, they may include: dull, 'gnawing' pain which may occur 2-3 hours after a meal, come and go for several days or weeks, occur in the middle of the night when the stomach is empty and be relieved by eating; loss of weight; loss of appetite; bloating; burping; nausea; vomiting.
Dysplasia
Abnormal development of tissue.
Adenoma
An ordinarily benign growth of epithelial tissue in which the tumor cells form glands or gland-like structures that tend to exhibit glandular function.
Autoimmune Disease
One of a large group of diseases in which the immune system turns against the body's own cells, tissues and organs, leading to chronic and often deadly conditions. Examples include multiple sclerosis, rheumatoid arthritis, systemic lupus, Bright's disease and diabetes.
Atrophic Gastritis
Chronic inflammation of the stomach that causes the breakdown of the mucous membranes and a reduction in the number of functioning stomach cells. Seen mainly in the elderly.
Benign
Literally: innocent; not malignant. Often used to refer to cells that are not cancerous.
Cancer
Refers to the various types of malignant neoplasms that contain cells growing out of control and invading adjacent tissues, which may metastasize to distant tissues.
Colon
The part of the large intestine that extends to the rectum. The colon takes the contents of the small intestine, moving them to the rectum by contracting.