Gastric Polyps:Protons, Spirochetes and hyperplasia Damian Paton-Gay Jan 2007
The Plan…. • A quick look at the epidemiology and major types of polyps • Do PPI’s cause polyps? • Does H. pylori infection cause polyps? • What do gastric polyps have to do with colonic adenomas and carcinomas?
Epidemiology • A few large epidemiological studies • Incidence 1-3% of gastroscopies
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