Stomach Polyps

What are stomach polyps?

Stomach polyps are growths on the inside lining of your stomach. They’re also called gastric polyps. Polyps are a type of tumor that grows out of the mucous lining inside your hollow organs, like the ones in your gastrointestinal tract. Stomach polyps are usually benign, but some can become cancerous.

Are stomach polyps serious?

Many of the most common types of stomach polyps have little to no cancerous potential. Some types are precancerous, so they usually aren’t yet cancerous when a healthcare provider finds them. Polyps take a long time to turn into cancer. Healthcare providers remove them to prevent this from happening.

What are the different types of stomach polyps?

The most common types of stomach polyps are epithelial polyps, which means they grow out of the topmost layer of your stomach lining (epithelium.) Other, less common types can start in the deeper layers of your stomach lining and protrude through the upper layers. These are called mesenchymal polyps.

Epithelial stomach polyps include:

Fundic gland polyps. These are the most common stomach polyps, usually appearing sporadically through the upper part of your stomach (the fundus). They have little to no cancerous potential when they appear this way. However, they can sometimes occur in greater numbers with rare hereditary cancer syndromes, including familial adenomatous polyposis (FAP) and gastric adenocarcinoma and proximal polyposis of the stomach (GAPPS). In these cases, they’re more likely to be precancerous.

Hyperplastic polyps. These are the second most common stomach polyps, and they also have little to no cancerous potential. They’re usually associated with inflammation in your stomach (gastritis). However, they can sometimes occur simultaneously with another cancer and can be considered a warning sign. When healthcare providers find them, they sample the surrounding mucosa to check for cancer.

Adenomatous polyps (adenomas). Around 10% of stomach polyps are adenomas, making them the most common precancerous type. They’re typically sporadic and solitary. But they can sometimes occur in greater numbers in association with familial adenomatous polyposis (FAP). Healthcare providers remove these polyps when they find them and examine them to determine their cancerous potential.

Gastric neuroendocrine tumors (carcinoid tumors). Carcinoid tumors grow out of neuroendocrine cells in your stomach lining. They represent 1% of all stomach tumors and can be cancerous or benign. There are four distinct types, and each has a slightly different prognosis (outlook). Healthcare providers identify the type in order to judge its cancerous potential.

Hamartomatous polyps (hamartomas). Hamartomas make up 1% of stomach polyps. They can appear sporadically or with certain rare hereditary syndromes, including Peutz-Jeghers syndrome, juvenile polyposis syndrome and PTEN hamartoma tumor syndrome. When they appear sporadically, they’re often solitary and benign. In syndromes, they appear in numbers and have cancerous potential.

Mesenchymal stomach polyps include:

Inflammatory fibroid polyps. Inflammatory fibroid polyps are rare, benign tumors whose origins are still in debate. They’ve sometimes been called granulomas, which are clusters of immune cells triggered by an inflammatory reaction. They’re usually solitary and small, but they can cause problems when they get big. In your stomach, a big one could potentially obstruct the outlet at the bottom (pylorus).

Gastrointestinal stromal tumors (GIST). GISTs are rare precancerous tumors that start in the deepest layer of your stomach lining (muscularis propria). Healthcare providers remove them when they find them. Removing these tumors usually requires a separate procedure, like endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD).

Leiomyomas. These rare smooth muscle tumors can develop in the muscularis propria and appear as lumps on the surface of your stomach lining. They can sometimes be cancerous (leiomyosarcomas). They may require a separate procedure to remove them.

How common are stomach polyps?

Stomach polyps overall are uncommon. They appear in approximately 4% of upper endoscopy exams (which go inside your stomach with a lighted camera). Around half of these are fundic gland polyps, 30% are hyperplastic polyps and 10% are adenomatous polyps, with rarer types making up the last 10%.

Do stomach polyps have symptoms?

Most stomach polyps don’t cause any symptoms. They’re usually discovered by accident during an exam you’re having for some other reason. However, some types of polyps can bleed. And rarely, some types can grow large enough to cause an obstruction. These events might cause different sets of symptoms, like:

• Bleeding: You won’t feel bleeding in your GI tract, but if you bleed a lot, you might see signs of blood in your poop. (Upper GI bleeding is more likely to cause black, tarry stools than red ones.) Over time, you might even lose enough blood to cause anemia, with symptoms like paleness, weakness and fatigue.
• Obstruction: A polyp large enough to interfere with your digestive system may cause symptoms like nausea, indigestion and stomach pain. It might feel tender when you press on your stomach. If a polyp actually blocks the outlet to your stomach, you might vomit, lose your appetite and lose weight.

What do stomach polyps look like?

Different types of stomach polyps can look different ways. Some are more bulbous, and others are relatively flat. Healthcare providers describe broad, slightly raised polyps as “sessile,” and polyps with a head and a stalk as “pedunculated.” Some types can have ulcerations on the surface, which may bleed.

Polyps range in size from a millimeter to a few centimeters. Most are on the smaller side because they grow very slowly. Larger polyps are more likely to be cancerous because they’re older. But healthcare providers often can’t tell whether they’re cancerous without examining them under a microscope.

What causes stomach polyps?

Stomach polyps that are related to hereditary syndromes are genetic disorders. But sporadic stomach polyps are caused by a combination of genetics and other factors. That is, different genetic mutations create different types of polyps, but other factors seem to be involved in triggering these mutations.

Some of the triggers researchers have observed include:

• Chronic gastritis. Gastritis, inflammation in your stomach lining, can be erosive or nonerosive. Erosive gastritis is more common and is usually caused by chemical erosion or a chronic infection, like H. pylori. Nonerosive gastritis can lead to atrophy of your stomach lining (atrophic gastritis), which causes different cellular changes. Both kinds are related to different tumors, particularly hyperplastic polyps, adenomas, inflammatory fibroids and neuroendocrine tumors.
• Proton-pump inhibitors (PPIs). Proton pump inhibitors are commonly prescribed to reduce gastric acid for people with chronic indigestion and acid reflux. Using them often for a long time can interfere with the way your stomach lining works. When the medication stops certain cells from producing acid, other cells start to overproduce to try and make up for it. This is a common cause of benign fundic gland polyps and also, occasionally, gastric neuroendocrine tumors.

How are stomach polyps diagnosed?

Most stomach polyps are discovered during an upper endoscopy (EGD) exam. The gastroenterologist or surgeon conducting the exam will take tissue samples (biopsy) or remove the polyps (polypectomy) for further study. A pathologist will examine them to identify the type and whether they’re cancerous.

What do polyps in the stomach indicate?

Different types of polyps can mean different things. Depending on what they find, your healthcare provider might suggest following up with additional tests to check for different related conditions. For example, they might want to test for H. pylori infection or other chronic inflammatory conditions.

The size and number of your polyps also matter. If you have many, your provider might suggest genetic testing for hereditary syndromes. If you test positive for a syndrome, they’ll often need to look for other polyps in other places. If they find precancerous polyps, they may want to look in your stomach again.

What is the treatment for stomach polyps?

Treatment depends on what kind of polyps you have and the nature of those polyps. It might include:

• Stomach polyp removal.
• Additional polyp screenings.
• Treatment for related conditions.

Stomach polyp removal

Your healthcare provider may have removed your stomach polyps already during your upper endoscopy exam (polypectomy). But sometimes they need to look for or remove additional polyps. Some difficult or deeper polyps may require special techniques to remove them, like EMR, ESD, or rarely, surgery.

Additional screenings

If your provider found and removed precancerous or cancerous polyps, they’ll want to make sure to check again soon for any new ones arising. They’ll recommend a schedule of regular screenings based on the type and nature of the polyps they found. They may also want to track your response to therapy.

Treatment for related conditions

Sometimes, stomach polyps are your first sign that you have gastritis or another treatable condition. Your provider will address these conditions along with your polyps. In some cases, polyps that are directly related to H. pylori infection or the use of proton pump inhibitors go away with treatment.

Can you prevent stomach polyps?

Treating chronic gastritis and its causes may prevent certain types of stomach polyps. Reducing the use of proton pump inhibitors may prevent other types. Often, however, polyps related to proton pump inhibitors are benign, so it might not be necessary to change your medication or to prevent them.

What happens when you have polyps in your stomach?

If your provider finds polyps in your stomach, they’ll test them to determine what kind they are and what they mean. Most of the time, they don’t mean anything serious. The chance of finding stomach cancer in a polyp is less than 2%. You might discover that you have another treatable condition.

Should I change my diet after having stomach polyps removed?

A nutritious diet can help your stomach heal after endoscopic surgery as well as help prevent gastritis, a leading cause of stomach polyps. Healthcare providers advise an anti-inflammatory diet, emphasizing whole foods, lean protein and unsaturated fats over processed foods, excess sugar and saturated fats.

When should I see my healthcare provider?

It’s important to keep up with your screening appointments after having polyps removed. Your provider will tell you how often you should come back. You should also be sure to contact them about any unusual gastrointestinal symptoms. They can tell you if they’re normal or need to be checked out.

What questions should I ask my provider?

You might want to ask:

• What type of polyps do I have?
• Do my polyps have any cancerous potential?
• Am I at a higher risk or lower risk for stomach cancer?
• What was the probable cause of my stomach polyps?
• What changes should I make going forward to prevent stomach polyps?
• When should I have my next endoscopy screening?