What is Gastric Polyp?
Gastric polyps are growths that project into the stomach and represent cell overgrowth. These growths originate from the lining or the layer beneath the lining of the stomach. It’s important to note these growths can sometimes potentially turn into cancerous growth.
There are different types of gastric polyps. These include gastric hyperplastic polyps, characterized by overgrowth of cells in the stomach lining; fundic gland polyps, which are primarily made up of parietal cells, a type of cell in the stomach wall, in dilated and irregular glands; and adenomatous polyps, which are marked by minor changes in gland cells.
There are other conditions as well that fall under the category of gastric polyps. For example, these can include carcinoids, which is a type of growth due to a group of hormone-producing cells; xanthomas and lymphoid proliferations, which are types of growths that infiltrate the stomach tissue; mesenchymal proliferations, a group of tumors that arise from the stromal (supportive) tissue of the stomach; and hamartomatous lesions, which are abnormal growths in the stomach wall.
Identifying the specific type of a gastric polyp just by looking at it through an endoscope (an instrument that helps visualize the inside of the stomach) can be challenging. In most cases, doctors will need to take a small piece of the polyp, known as a biopsy, and examine it under a microscope to accurately diagnose the type of polyp. This information is necessary to guide treatment.
What Causes Gastric Polyp?
Most of the time, gastric polyps – small growths in the stomach – are discovered unexpectedly during an endoscopic examination or an autopsy, which is why it’s difficult to understand what causes them. Many experts believe that gastric hyperplastic polyps (GHPs) develop due to long-term inflammation, often linked to an infection from a bacteria known as H. pylori or a condition known as atrophic gastritis where the stomach lining has worn away. This theory solidifies as most GHPs (about 70% of cases) will diminish within a year of getting rid of the H. pylori infection, provided there’s no another infection.
The causes of fundic gland polyps (FGPs) are less clear. However, some research suggests they might be related to long-term use of proton pump inhibitors (PPI), a type of medication that reduces stomach acid. This leads scientists to think that a process connected with suppressing stomach acid might play a role in these polyps forming.
With adenomas, another type of polyp, the risks of developing them rise with age and long-term inflammation or irritation of the tissue. This can result in a condition known as intestinal metaplasia, where the cells lining the digestive tract change form, which then increases the risk for the polyp to turn into cancer. This could happen because of acquired mutations that change the way the p53 and Ki-67 genes work. It is vital to note that finding a gastric adenoma in a younger patient could hint at a much more serious inherited condition called familial adenomatous polyposis (FAP), and this requires further testing.
Risk Factors and Frequency for Gastric Polyp
Gastric polyps are found in about 2% to 6% of people undergoing an endoscopic examination, according to several comprehensive studies. The different types of polyps vary in prevalence. Gastric hyperplastic polyps (GHPs) make up 17% to 42% of cases, fundic gland polyps (FGPs) comprise 37% to 77% of cases, adenomas make up 0.5% to 1%, and malignant tumors are found in about 1% to 2% of cases.
Gastric polyps are typically located in the fundus (upper part) of the stomach and are more common with increasing age. Differences in incidence between males and females are inconsistent across studies. However, it is generally found that females are more likely to have FGPs, while males are more likely to have adenomas. Lifestyle factors, like dietary habits, vary across populations and contribute to the different rates reported in different studies.
Signs and Symptoms of Gastric Polyp
Most gastric polyps do not cause any symptoms, with more than 90% of them only discovered during a routine endoscopy. When symptoms do arise, they can include indigestion, acid reflux, heartburn, stomach pain, feeling full quickly, blockage of the passage from the stomach, bleeding in the digestive tract, anemia, fatigue, and iron deficiency. However, gastric polyps are usually less than 2cm in size and are rarely detected during a physical exam.
- Indigestion
- Acid reflux
- Heartburn
- Stomach pain
- Feeling full quickly
- Blockage of the passage from the stomach
- Bleeding in the digestive tract
- Anemia
- Fatigue
- Iron deficiency
Testing for Gastric Polyp
Most stomach polyps don’t cause any symptoms, so they are often found by chance. Medical examinations usually begin because of symptoms of indigestion or if a routine blood test (also known as a CBC, or complete blood count) shows signs of anemia.
While it’s possible to see stomach polyps on non-invasive imaging tests like a CT (computed tomography) scan or an MRI (magnetic resonance imaging), this is rare and usually only happens when the polyp is very large.
The best way to check for stomach polyps is through a procedure called an esophagogastroduodenoscopy (EGD). This test is performed by a specialist and involves inserting a thin, flexible tube with a light and camera on one end into your eyes, stomach, and the beginning of your small intestine to check for any abnormalities.
Treatment Options for Gastric Polyp
When a person has a growth or “polyp” in their stomach, identifying what kind it is can be tough with just an endoscopy (a procedure where a doctor uses a thin tube with a camera to look inside the stomach). So, doctors generally take a sample of the polyp (biopsy) or remove it completely to figure out the best way to manage it. The risk of a polyp becoming cancerous goes up with its size – if it’s larger than 10 mm, it’s typically recommended to be taken out with a procedure called endoscopic mucosal resection (EMR). However, some doctors suggest removing polyps even if they’re more than 5 mm.
Before any procedure to touch or remove the polyp, a medicine called a proton pump inhibitor (PPI), which reduces stomach acid, is given via injection to aid in blood clot formation and limit bleeding. Often, patients continue taking PPI for 4 to 8 weeks after the procedure to help the biopsy or removal site heal. If test results show that the patient has a bacteria called H. Pylori, which can cause stomach ulcers and inflammation, they will start antibiotic treatment.
To determine the cause of inflammation in the stomach lining (also known as gastritis), the doctor often takes multiple biopsy samples from different parts of the stomach during the endoscopy.
The following steps after the biopsy depend on the test results of the polyps removed. If the test results show no signs of abnormal cell changes (dysplasia), the doctor generally recommends repeating the endoscopy after one year. However, if the test shows H. Pylori, a repeat endoscopy is often performed within 3 to 6 months to confirm that the bacteria is eradicated and to monitor the polyps.
If initial test results show lesions (damaged tissue) bigger than 5 to 10 mm and the patient has been using proton pump inhibitors long term, these medications should be stopped where possible, and the doctor will then carry out a follow-up endoscopy after a year to track the healing progress.
When the biopsy result of a stomach polyp reveals an adenoma (a non-cancerous tumor), it is recommended to schedule a repeat endoscopy after 1 year. In patients below 40 years old with multiple adenomas detected during the endoscopy, the doctor will typically ask about family medical history and recommend a colonoscopy (a test that allows the doctor to look at the inner lining of the large intestine) to rule out a hereditary condition known as Familial Adenomatous Polyposis (FAP), characterized by the development of numerous polyps in the colon and rectum.
In more serious cases, if the biopsy reveals dysplasia (pre-cancerous cells) or early cancer in the stomach polyp, repeat endoscopies are generally performed after one year and again after three years to closely monitor the person’s condition.
What else can Gastric Polyp be?
When a doctor is trying to diagnose gastric polyps, there are various other conditions that could also be causing the symptoms. These possibilities include:
- Gastric hyperplastic polyp
- Fundic gland polyp
- Adenoma
- Familial adenomatous polyposis
- Carcinoma
- Carcinoid
- Xanthoma
- Gastrointestinal stromal tumors
- Leiomyoma
- Fibroid polyps
- Peutz-Jegher syndrome
- Cowden syndrome
- Juvenile polyps
- Hemangioma
- Lymphangioma
- Lymphoma
- Neuroma
These are referred to as differentials and it’s important for the doctor to consider all of these to accurately diagnose the condition.
What to expect with Gastric Polyp
Generally, if gastric polyps, or abnormal tissue growths in the stomach, are found, the prognosis tends to be quite good. Some studies have found that less than 2% of investigated polyps have turned out to be cancerous.
However, certain characteristics can point to a normally benign polyp having a poorer prognosis. These include large-size polyps, old age of the patient, and the discovery of multiple adenomas, which are benign tumors that could potentially become cancerous. It’s been observed that the risk of these polyps turning into pre-cancerous or cancerous lesions increases significantly when they’re larger than 20mm, found in older patients, or if multiple adenomas are present.
Multiple adenomas might point toward a condition known as Familial Adenomatous Polyposis (FAP). FAP can greatly increase the risk of developing a type of cancer called adenocarcinoma.
Possible Complications When Diagnosed with Gastric Polyp
Gastric polyps, which are abnormal tissue growths in the stomach, can lead to a variety of complications. These complications include:
- Bleeding: When gastric polyps rupture, they can cause bleeding in the stomach.
- Perforation: This means that a hole forms in the stomach wall because of the polyp.
- Infection: Sometimes, gastric polyps can lead to infection in the stomach.
- Cancer: In rare cases, gastric polyps can turn into cancer.
- Ileus: This is a condition where the stomach can’t move food through the intestines, often as a result of polyps.
- Obstruction: Gastric polyps can block food passage through the stomach.
Preventing Gastric Polyp
Stomach cancer is the third leading cause of cancer-related deaths across the globe. Some stomach polyps, which are small growths that can develop in the stomach lining, have the potential to turn into cancer. Therefore, taking good care of these polyps could potentially help lower these numbers. Certain changes in eating habits and lifestyle can help reduce the risk of developing these polyps. This may include reducing the consumption of alcohol, quitting smoking, eating less fatty foods, and incorporating more fiber into the diet. Essentially, these changes can help in reducing the risk of stomach cancer to some extent.