Gastric polyps are masses of cells that form on the inner lining of your stomach. These growths are common, found in approximately 2% to 6% of individuals undergoing an upper endoscopy, and their prevalence increases with age. Most gastric polyps are benign and their formation is often a response to damage or change within the stomach’s lining.
Types of Gastric Polyps and Their Causes
The specific type of gastric polyp determines its cause and potential for becoming cancerous. The most common varieties are fundic gland polyps, hyperplastic polyps, and adenomatous polyps. Each type arises from different circumstances within the stomach and carries a different level of risk.
Fundic gland polyps are the most frequently encountered type. These growths are typically small, smooth bumps found in the upper portion of the stomach, known as the fundus. A significant factor associated with their development is the long-term use of proton pump inhibitors (PPIs), medications commonly prescribed to reduce stomach acid. Sporadic fundic gland polyps not associated with a genetic syndrome have a very low chance of becoming cancerous.
Hyperplastic polyps often develop as a reaction to chronic inflammation in the stomach lining, a condition known as gastritis. This inflammation can be triggered by a bacterial infection from Helicobacter pylori (H. pylori). While these polyps are generally not cancerous, the risk increases in polyps larger than one centimeter. Their presence can also indicate an increased risk of cancer developing elsewhere in the stomach lining, particularly in the context of chronic gastritis.
Adenomatous polyps, or adenomas, are the least common type but are the most likely to become cancerous. These polyps are considered precancerous and arise in stomachs already affected by chronic gastritis and associated cellular changes. Certain inherited genetic syndromes, such as familial adenomatous polyposis (FAP), also increase the risk of developing adenomas. Due to their potential for malignant transformation, adenomas are typically recommended for removal.
Symptoms and Diagnosis
Most gastric polyps do not produce any noticeable signs or symptoms and are often discovered incidentally during an upper endoscopy for unrelated reasons. When symptoms do occur, they are usually associated with larger polyps. These can include abdominal pain, nausea, or a feeling of tenderness when pressing on the stomach.
On rare occasions, a large polyp can develop an open sore, or ulcer, on its surface, which may lead to bleeding. This bleeding can result in anemia, causing weakness and fatigue, or be visible as blood in the stool. In other rare instances, a polyp may grow large enough to block the opening between the stomach and the small intestine, leading to vomiting.
The definitive method for diagnosing gastric polyps is an upper endoscopy, a procedure where a thin, flexible tube with a camera is passed down the throat to examine the stomach lining. If a polyp is found, the physician can take a small tissue sample, called a biopsy. This tissue is then analyzed in a laboratory to determine the exact type of polyp and to check for any abnormal cells, a condition known as dysplasia, which can indicate a higher risk of cancer.
Treatment and Management
The course of action following a gastric polyp diagnosis depends on the polyp’s type, size, and whether abnormal cells are present. Not all polyps require immediate removal, and the management strategy is tailored to the individual.
For small fundic gland polyps or hyperplastic polyps that show no signs of dysplasia, a physician might recommend a surveillance-only approach. This “watch and wait” strategy involves periodic follow-up endoscopies to monitor the polyps for any changes in size or appearance.
Removal of the polyp, a procedure called a polypectomy, is the standard treatment for certain types of polyps. Adenomatous polyps are generally removed regardless of their size because of their potential to become cancerous. Larger polyps of any type, particularly those over one centimeter, or any polyp causing symptoms like bleeding, are also removed during the endoscopy.
An important part of management involves addressing the underlying condition that may have caused the polyps to form. If a H. pylori infection is detected, treatment with antibiotics can often lead to the regression of hyperplastic polyps. For individuals with fundic gland polyps who use PPIs, a doctor may evaluate whether the medication is still necessary. Following up with a healthcare provider is necessary to ensure any recurrence or new developments are caught early.