A stomach polyp, also known as a gastric polyp, is an unusual growth of cells that forms on the inner lining of the stomach. These growths are uncommon and often do not cause any noticeable symptoms. While many stomach polyps are benign, meaning they are non-cancerous, certain types carry a risk of developing into stomach cancer over time.
Different Kinds of Stomach Polyps
Stomach polyps are categorized into types, each with distinct characteristics and potential implications. Fundic gland polyps (FGPs) are among the most frequently observed, making up 37% to 77% of stomach polyps found during endoscopies. These polyps appear in the upper part of the stomach, known as the fundus, and are often linked to the long-term use of proton pump inhibitors (PPIs), medications that reduce stomach acid. Sporadic FGPs have a low risk of becoming cancerous. However, if they are larger than 1 centimeter or associated with genetic conditions like Familial Adenomatous Polyposis (FAP), their potential for malignancy increases.
Hyperplastic polyps are the second most common type, accounting for 17% to 42% of gastric polyps detected. These polyps are frequently associated with chronic inflammation of the stomach lining, often caused by Helicobacter pylori (H. pylori) bacterial infections. Hyperplastic polyps have a low risk of malignant transformation. This risk increases if they are large or if the underlying inflammation is not addressed. Treating the H. pylori infection can sometimes cause these polyps to shrink or even disappear.
Adenomas, also known as adenomatous polyps, are less common, making up 0.5% to 10% of stomach polyps, but they carry the highest risk of progressing to stomach cancer (gastric adenocarcinoma). These polyps are often found in individuals with chronic stomach inflammation that may lead to changes in the gastric lining. Given their higher malignant potential, adenomas usually require careful monitoring and removal. Less common types of stomach polyps include inflammatory fibroid polyps, hamartomatous polyps, and gastrointestinal stromal tumors (GISTs), each with varying risks.
Recognizing Symptoms and How They Are Diagnosed
Most stomach polyps do not cause any symptoms and are discovered incidentally during medical procedures. However, if polyps grow large, become ulcerated, or cause complications, they can lead to symptoms. These may include abdominal pain, a burning sensation in the chest (heartburn), nausea, or vomiting.
Larger polyps can also cause gastrointestinal bleeding, which might result in black stools (melena) or lead to anemia. In rare instances, a large polyp can obstruct the passage of food, leading to symptoms such as vomiting or weight loss. When symptoms do occur, they often prompt further investigation.
The primary method for diagnosing stomach polyps is an upper endoscopy. During this procedure, a thin, flexible tube equipped with a camera is guided through the mouth, down the esophagus, and into the stomach. If a polyp is identified, a tissue sample, or biopsy, is taken during the endoscopy. This tissue sample is then sent to a laboratory for microscopic examination, which helps determine the specific type of polyp and assess whether there are any cancerous or pre-cancerous cells.
Treatment Options and What to Expect
The approach to managing stomach polyps depends on their type, size, and the potential for cancer. For small polyps that are not adenomas and are benign, such as fundic gland polyps, a “watchful waiting” approach may be recommended. This involves periodic monitoring for changes in size or symptoms, as these polyps rarely become cancerous. If proton pump inhibitors are contributing to fundic gland polyps, discontinuing the medication, if medically appropriate, can sometimes lead to their regression.
Many stomach polyps, especially those that are larger, causing symptoms, or have a higher risk of malignancy (like adenomas), are removed through an endoscopic polypectomy. This procedure is performed during an upper endoscopy, where specialized instruments are used to remove the polyp. In cases where H. pylori infection is linked to hyperplastic polyps, treating the infection with antibiotics can often cause the polyps to disappear and may prevent their recurrence.
Surgical removal of a portion or all of the stomach, known as gastrectomy, is reserved for large polyps that cannot be safely removed endoscopically, or for polyps that are confirmed to be cancerous. After a polyp is removed, particularly for individuals with adenomas or multiple polyps, follow-up endoscopies are often recommended to monitor for new growths or recurrence. The frequency of these follow-up procedures depends on the polyp type and individual risk factors. While most stomach polyps are benign, proper diagnosis and management are important to prevent complications, including the development of stomach cancer.