Gastric polyps are abnormal growths that form on the inner lining of the stomach. These growths are typically small and often do not cause any noticeable symptoms. While many gastric polyps are benign, some types do carry a potential risk of developing into stomach cancer over time. Understanding the different forms of these polyps and how they are managed is therefore important.
Types of Gastric Polyps
Fundic gland polyps are the most frequently encountered type of gastric polyp, often found in the upper part of the stomach. These polyps are benign. Their development is commonly associated with the long-term use of proton pump inhibitors (PPIs), medications used to reduce stomach acid. While most are sporadic, a smaller number of fundic gland polyps can be linked to genetic conditions like Familial Adenomatous Polyposis (FAP), where they may show dysplasia, an abnormal cell growth, and carry a higher risk of gastric cancer.
Hyperplastic polyps represent the second most common type of gastric polyp, and they can appear anywhere in the stomach lining. Although typically benign, these polyps have a small potential to develop into dysplasia or even cancer, particularly if they are larger than 1 centimeter or are associated with Helicobacter pylori infection or chronic stomach inflammation. Eradicating an H. pylori infection can sometimes lead to the regression of these polyps.
Adenomas are considered the most concerning type of gastric polyp due to their higher likelihood of becoming cancerous. These precancerous growths are often found in the lower part of the stomach. The risk of an adenoma developing into stomach cancer increases with its size and the presence of dysplasia.
How Gastric Polyps Are Discovered
Gastric polyps frequently do not cause any symptoms. When symptoms do occur, they might include abdominal pain, nausea, or bleeding, which could lead to anemia. Larger polyps can sometimes cause ulcers on their surface or, rarely, block the passage between the stomach and the small intestine, leading to symptoms like vomiting or weight loss.
The primary method for discovering gastric polyps is through an upper endoscopy, also known as esophagogastroduodenoscopy (EGD). During this procedure, a thin, flexible tube with a camera is inserted through the mouth to visualize the lining of the esophagus, stomach, and duodenum. If a polyp is observed, a small tissue sample, called a biopsy, is typically taken. This biopsy is then examined under a microscope by a pathologist to determine the specific type of polyp and to check for any abnormal or cancerous cell changes.
Causes and Risk Factors
Chronic inflammation of the stomach lining, known as gastritis, is a common factor contributing to the formation of gastric polyps. This ongoing inflammation, often caused by Helicobacter pylori (H. pylori) bacterial infection or autoimmune conditions, can lead to the development of hyperplastic polyps. Persistent mucosal irritation stimulates the proliferation of gastric epithelial cells, increasing the likelihood of polyp formation.
Long-term use of proton pump inhibitors (PPIs), medications that reduce stomach acid, is associated with the development of fundic gland polyps. PPIs decrease stomach acidity, which in turn increases the production of gastrin, a hormone that promotes the growth of certain stomach cells, leading to polyp formation. While some studies suggest a direct causal link, others indicate that fundic gland polyps can occur independently of PPI use.
Genetic syndromes also play a role in gastric polyp formation. Familial Adenomatous Polyposis (FAP) is a rare inherited condition that significantly increases the risk of developing numerous polyps throughout the digestive tract, including adenomas and some fundic gland polyps in the stomach. The presence of gastric adenomas in younger individuals can sometimes indicate an underlying genetic condition like FAP, warranting further investigation.
The incidence of gastric polyps increases with age.
Treatment and Management
The approach to managing gastric polyps varies depending on their type, size, location, and whether they show any concerning features like dysplasia. Many small, benign polyps, such as most fundic gland polyps or small hyperplastic polyps without dysplasia, may not require immediate removal. Instead, these polyps are often managed with periodic endoscopic surveillance to monitor for any changes in size or appearance.
For larger polyps, adenomas, or any polyp exhibiting dysplastic changes, endoscopic removal, known as polypectomy, is the most common treatment. This minimally invasive procedure is performed during an endoscopy, where specialized instruments are used to resect the polyp from the stomach lining. Smaller polyps might be removed with forceps, while larger ones often require a wire loop and electrocautery.
Addressing underlying conditions can also be part of the management strategy. For instance, if H. pylori infection is present, eradicating the bacteria with antibiotics can lead to the regression of associated hyperplastic polyps. In cases where fundic gland polyps are linked to PPI use, a doctor might recommend adjusting or discontinuing the medication, which can sometimes result in polyp regression.
Surgical removal of gastric polyps is less common and is typically reserved for very large polyps, those with a high suspicion of malignancy that cannot be removed endoscopically, or in rare instances where cancer has spread into surrounding tissue. This approach emphasizes individualized care, with treatment decisions made based on a comprehensive assessment by a healthcare professional.