Epithelial gastric polyps

Gastric polyps are lesions projected above the mucosal surface, which are detected in approximately 1–6% of upper gastrointestinal endoscopies. Based to their shape, polyps are classified as pedunculate, semi-pedunculate, sessile and flat. Depending on the histopathological type, some of them have the potential to transform into adenocarcinoma. Polyps can be of epithelial and non-epithelial origin. The first group, which is discussed in greater detail in this paper, includes fundic gland polyps, hyperplastic, adenomatous and hamartomatous polyps. Non-epithelial polyps include stromal tumours, leiomyomas, fibrous inflammatory polyps, fibroids, fibromyomas, lipomas, ectopic pancreas, neuroendocrine tumours, neuromas, and some vascular lesions. Multiple polyps in patients under the age of 40 years require more extensive diagnosis for hereditary polyposis syndromes, which are associated with an increased risk of gastric cancer, as well as other gastrointestinal and extra-gastrointestinal malignancies. In recent years, there has been a clear decrease in the proportion of hyperplastic polyps and an increase in the proportion of fundic gland polyps among all gastric polyps, which is probably related to the increased use of proton pump inhibitors and a reduced incidence of Helicobacter pylori infections. About 90% of gastric polyps are detected accidentally and usually do not cause clinical symptoms, but large polyps may be responsible for anaemia, bloody stools, abdominal pain, and even pyloric obstruction, which may be manifested by vomiting, severe flatulence, lack of appetite or progressive weight loss.

Changes of Gastric Juice Microenvironment in Patients with Fundic Gland Polyp and Hyperplastic Polyp

<b><i>Introduction:</i></b> The aim of this study was to study the relationship between the formation of gastric fundic gland polyp and gastric hyperplastic polyp (HP) and the changes of gastric juice microenvironment. <b><i>Methods:</i></b> The proton-pump inhibitor (PPI) applications to patients were recorded. Gastric juices and biopsy polyps were collected for pathological examination, <i>H. pylori</i> tests, biomarkers, and <i>MUC1</i>, <i>MUC2</i>, <i>MUC5AC expression</i> measurement. <b><i>Results:</i></b> Among 34,892 patients, the detection rate of gastric fundic gland polyps was significantly higher than that of gastric HPs (<i>p</i> &#x3c; 0.01). The incidence rate of gastric fundic gland polyp and gastric HP in PPI users (<i>n</i> = 3,886) was higher than that of non-PPI users (<i>p</i> &#x3c; 0.01). The occurrence of polyp was positively related to the duration of PPI application and the <i>H. pylori</i>-positive rate. The bile reflux rate between fundic gland polys group (17.61%) and HPs (28.67%) was significantly different (<i>p</i> &#x3c; 0.01). The levels of gastric juice Gastrin-17, epidermal growth factor (EGF) and MUC₂ from patients with gastric fundic gland polyps and gastric HPs were higher than those in the control group (<i>p</i> &#x3c; 0.01). However, patients with gastric fundic gland polyps and HPs had significantly lower gastric juice PGE₂ and MUC5AC (<i>p</i> &#x3c; 0.01). <b><i>Conclusion:</i></b> PPI application, <i>H. pylori</i> infection, and bile reflux are the potential risk factors for formation of fundic gland polyps and HPs. The potential mechanism of polyps’ formation can be related to the levels of Gastrin-17, EGF, MUC₂, PGE₂, and MUC5AC in gastric juice.

Gastric Polyps: A 10-Year Analysis Of 18496 Upper Endoscopies

Background/Aims: Gastric polyps (GPs) are usually asymptomatic lesions of the upper gastrointestinal tract observed in 1-3% of esophagogastroduodenoscopies (EGD). The majority of polyps are benign. The aim of this study was to precise the frequency of different types of gastric polyps in our population, and to analyze their possible association with other factors.Materials and Methods: A total of 18496 consecutive patients undergoing EGD over a ten-year period (between 2007 and 2018) in a tertiary hospital were retrospectively reviewed. Eighty-six patients diagnosed with gastric polyps were analysed. Demographics, medical history of the patients, and indication for gastroscopy were collected. Morphological, histological characteristics of polyps, and therapeutic management data were also collected.Results: GPs were found in 86 out of 18496 (0.46%) reviewed EGD, corresponding to a total of 141 polyps. There were 64 female (74.4%) and 22 male patients (25.6%) with a sex ratio (M/F) of 0.34. The average age was 58.1 years. One hundred and forty one polyps were included, and histopathology was obtained on 127 GPs. The most common location was the fundus (59.6%) and 48.9% were smaller than 5 mm. The polyp was unique in 75.6% of cases. According to Paris classification, 80% of the polyps were sessile (Is). Hyperplastic polyps were the most common (55.9%) were hyperplastic polyps, followed by sporadic fundic gland polyps in 23 patients (18.1%), 7 (5.5%) were adenomas, and 4 (3.1%) were neuroendocrine tumors type 1. The following factors were associated with hyperplastic polyps: anemia (p= 0.022), single polyp (p= 0.025) and size ≥ 5mm (p= 0.048). Comparing hyperplastic polyps biopsies to resected polyps, no difference was found in the evolutionary profile of the 2 groups. A size less than 10 mm (p=0.013) was associated with fundic gland polyps. Sixty polyps (47.2%) were treated by cold forceps, 19 (15%) treated by a mucosal resection and 15 (11.8%) with diathermic snare. Five procedural bleeding incidents were observed (3.9%). Only the use of anticoagulant treatment was associated with a high bleeding risk (p= 0.005). The comparative histological study between specimens of biopsied GPs and endoscopic polypectomy led to an overall agreement of 95.3%.Conclusion: In our study, the GPs frequency was 0.36%. Hyperplastic polyps and fundic gland are the most common gastric polyps in our country. The high frequency of Helicobacter pylori infection in our patients and in our area may explain the high frequency of HP.