Gastric Polyps:Protons, Spirochetes and

hyperplasia

Damian Paton-GayJan 2007

Damian Paton-GayJan 2007

The Plan….

I. A quick look at the epidemiology and major types of polyps

II. Do PPI’s cause polyps?III. Does H. pylori infection cause

polyps?IV. What do gastric polyps have to do

with colonic adenomas and carcinomas?

Epidemiology

A few large epidemiological studies Incidence 1-3% of gastroscopies

Frequency and Types of PolypsFundic Gland Polyps ~50%

Hyperplastic Polyps 28% (some texts report up to 78%)

Adenomas 10%

Heterotopic tissue

Polyps associated with

Add up to ~1%

Fundic Gland Polyps

Often multiple 2-3 mm sessile lesions in body and fundus

“Focal increase in glandular elements”

Sporadic in general population 53% incidence in FAP

Almost invariably benign 3 case reports of gastric ca in a fundic

gland polyp in a pt with FAP

Hyperplastic Polyps

Usually solitary <1.5 cm sessile lesions in body

Described as “shinier” and softer than other polyps

May have an umbilicated center Higher risk of harbouring dysplasia

than fundic gland polyps These have been associated with H.

pylori (more later)

Hyperplastic Polyps

Risk of developing adenocarcinoma in a hyperplastic polyp is considered ~2% Based on a study of 477 hyperplastic

polyps in 1990 Daibo M et al. Malignant Transformation of

Gastric Hyperplastic Polyps. Am J Gastroenterol. 1990 Mar;85(3):327-8

Adenomas

Usually solitary and sessile polyps Most often antral Often quite large (10+ cm in

diameter) Very similar to colonic polyps….

Can be tubular, tubulovillous or villous Premalignant lesions

Incidence of carinoma is between 3 and 11%

Adenomas continued

As with colonic polyps Risk of Ca ^’s with polyp size and

histologic type

Also - the presence of a gastric adenoma increases the risk of carcinoma elsewhere in the stomach