Stomach polyps are abnormal tissue growths that form on the inner lining of the stomach. They are often discovered incidentally during medical examinations for other conditions. While most stomach polyps are benign, meaning they are not cancerous, some types have the potential to develop into cancer over time.
Types of Stomach Polyps
Fundic gland polyps are the most frequently encountered type of stomach polyp, often found in the upper part of the stomach. They typically appear as numerous small, smooth bumps and generally carry a low risk of becoming cancerous. These polyps are sometimes associated with long-term use of proton pump inhibitors, medications used to reduce stomach acid.
Hyperplastic polyps are the second most common type of stomach polyp and can be scattered throughout the stomach. While usually benign, larger hyperplastic polyps or those linked to chronic H. pylori infection or atrophic gastritis carry a small risk of malignant transformation. These polyps form when the stomach produces an excess of mucus-secreting cells, often in response to inflammation.
Adenomatous polyps, also known as adenomas, have the highest potential for developing into stomach cancer. These polyps form when certain stomach cells develop in unusual, non-cancerous ways. They can occur anywhere in the stomach and often require removal and close monitoring.
Less common types include inflammatory fibroid polyps and hamartomatous polyps. Inflammatory fibroid polyps are rare, benign tumors that can obstruct the stomach’s outlet if they grow large. Gastrointestinal stromal tumors (GISTs) are another rare type that starts in deeper layers of the stomach lining and has precancerous potential.
Causes and Risk Factors
Chronic inflammation of the stomach lining, known as gastritis, is a common cause of stomach polyps. This inflammation can result from infections like Helicobacter pylori (H. pylori) or autoimmune conditions. In areas where H. pylori infections are prevalent, there is a higher risk for hyperplastic polyps.
Long-term use of proton pump inhibitors (PPIs) is linked to fundic gland polyps. These medications are often prescribed for conditions such as heartburn or gastroesophageal reflux disease (GERD). While PPIs can lead to these polyps, the polyps are benign.
Genetic syndromes, though rare, can significantly increase the risk for certain types of stomach polyps. Familial adenomatous polyposis (FAP) is an inherited condition that can lead to numerous precancerous adenomatous polyps throughout the digestive system. Peutz-Jeghers syndrome is another genetic disorder that can cause hamartomatous polyps.
Age is a risk factor, as their prevalence increases with age. While some risk factors like age and genetic predispositions cannot be changed, treating underlying causes such as H. pylori infection can reduce the risk of certain polyp types.
Symptoms and Detection
Most stomach polyps do not cause symptoms and are often discovered incidentally during an upper endoscopy for other health concerns. This incidental finding is common because the polyps are small, often less than 2 centimeters.
When symptoms do occur, they arise if polyps are larger or cause bleeding. Symptoms can include indigestion, acid reflux, and heartburn. Some individuals may experience stomach pain, nausea, or vomiting.
Larger polyps that bleed can lead to gastrointestinal blood loss, leading to anemia and iron deficiency, with symptoms like weakness and fatigue. In rare cases, a large polyp can cause an obstruction at the stomach’s outlet, leading to more severe symptoms.
Stomach polyps are primarily detected by an upper endoscopy, also known as gastroscopy. During this procedure, a thin, flexible tube with a camera is inserted through the mouth to visualize the stomach lining. If polyps are observed, a biopsy collects tissue samples for further examination.
Management and Follow-Up
The management approach for stomach polyps depends on their type, size, and cancer potential. Small, benign polyps, such as many fundic gland polyps, may only require regular monitoring. This involves periodic follow-up endoscopies to track growth or changes.
Removal, or polypectomy, is recommended for certain types of polyps, particularly adenomatous polyps, due to their higher cancer risk. Large hyperplastic polyps or any polyp causing symptoms like bleeding are also removed. Polypectomy can often be performed endoscopically, meaning it is done during an upper endoscopy, thus avoiding open surgery.
After removal, the tissue from the polyp is sent for pathological analysis. This biopsy determines the polyp type and presence of cancerous cells. The pathology results guide future management decisions and the frequency of surveillance endoscopies.
Ongoing surveillance with follow-up endoscopies is important for managing stomach polyps. The schedule for follow-up procedures is tailored based on the polyp’s characteristics, including type, size, and number, and any underlying conditions. If an H. pylori infection is a contributing factor, treating it with antibiotics may also be part of the management plan.