Stomach polyps (gastric polyps) are abnormal growths that develop on the inner lining of the stomach. They are a common finding, often discovered incidentally during medical examinations. While most polyps are benign, certain types have the potential to develop into stomach cancer over time. Understanding the specific type of polyp is the most important factor in determining the seriousness and necessary management.
What Exactly Are Gastric Polyps
A gastric polyp is a small protrusion or mass of cells extending from the mucosal lining of the stomach wall. These growths form when cells in the stomach lining multiply excessively, creating a visible bump. Most stomach polyps do not cause noticeable symptoms and are frequently found during an upper endoscopy performed for issues like chronic heartburn or indigestion.
The formation of polyps is often linked to underlying conditions causing long-term irritation or changes in the stomach environment. Chronic inflammation of the stomach lining (gastritis) is a major contributing factor. Long-term use of proton pump inhibitors (PPIs), used to reduce stomach acid, can also lead to specific polyp types. Additionally, infection with Helicobacter pylori (H. pylori), which causes chronic gastritis, is a known cause for another category of gastric polyps.
Understanding the Different Types and Their Risk Profiles
The seriousness of a gastric polyp depends entirely on its cellular composition and potential for malignancy. The three most common types are Fundic Gland Polyps, Hyperplastic Polyps, and Adenomas, each carrying a distinct risk profile. Fundic Gland Polyps (FGPs) are the most frequently encountered type, often appearing in the upper region of the stomach.
FGPs occurring sporadically or linked to long-term PPI use have a very low risk of becoming cancerous. However, FGPs appearing in the context of rare genetic conditions like Familial Adenomatous Polyposis (FAP) carry a higher risk and require aggressive monitoring or removal. Hyperplastic polyps are the second most common type and are strongly associated with chronic inflammation, typically due to H. pylori infection.
These hyperplastic growths are generally low-risk, but their potential for malignancy increases significantly when they grow larger than one centimeter. The most concerning category is adenomas, which are considered precancerous lesions and carry the highest risk of progression to stomach cancer. Adenomas mandate removal due to the inherent risk of dysplasia, which is the abnormal change in cell structure.
How Gastric Polyps Are Detected and Evaluated
Gastric polyps are most commonly detected during an upper endoscopy. This procedure involves passing a flexible tube with a camera through the mouth to examine the esophagus, stomach, and small intestine. The endoscopy allows the physician to visually inspect the gastric lining and identify abnormal growths. Most polyps are discovered incidentally while investigating symptoms unrelated to the polyp itself.
Once visualized, a definitive diagnosis requires obtaining a tissue sample through a biopsy during the endoscopy. The collected tissue is sent to a pathologist for microscopic evaluation to determine the specific cell type and composition. This analysis confirms the polyp type and checks for the presence of dysplasia, the key indicator of cancer risk. These findings directly inform the subsequent management strategy and surveillance schedule.
Treatment Options and Long-Term Management
Management of gastric polyps is tailored to the specific type, size, and risk profile identified by the biopsy. Small Fundic Gland Polyps (FGPs) not associated with a genetic syndrome and showing no dysplasia often do not require removal. These low-risk polyps are typically managed with surveillance, involving periodic repeat endoscopies to monitor for growth or change.
All adenomatous polyps, due to their precancerous nature, and hyperplastic polyps larger than one centimeter are typically removed during endoscopy via a polypectomy. For hyperplastic polyps linked to H. pylori, the primary treatment involves antibiotics to eradicate the bacterial infection. Successful H. pylori treatment can often lead to the regression and disappearance of these polyps, eliminating the need for physical removal.
Long-term management focuses on preventing recurrence and monitoring for new growths, especially for patients with higher-risk polyps. This involves a schedule of repeat endoscopies, with the interval determined by pathology results and the physician’s assessment of cancer risk. For patients whose FGPs are linked to PPI use, the physician may recommend alternative acid-reducing medications or adjusting the dosage.