What is a stomach polyp?
A stomach, or gastric, polyp is an unusual growth of tissue within the inner lining of the stomach. Depending on the type, polyps may appear in bunches within specific areas of the stomach. The location of the polyps helps to identify the type.
Most stomach polyps are not cancerous, but there are some types that have a higher risk to turn into cancer.
What are the types of stomach polyps?
Stomach polyps usually fall into two categories: non-neoplastic (benign or non-cancerous) and neoplastic (greater risk of cancer). Within those categories, epithelial polyps are the most common stomach polyps. Epithelial polyps include fundic gland polyps, hyperplastic polyps and adenomatous polyps.
- Fundic gland polyps
Fundic gland polyps are the most common stomach polyp. They occur in the fundus, or the upper portion of the stomach. When they are found during an endoscopy, there are usually several of them, and they appear as small, smooth flat bumps. These polyps rarely develop into cancer. Fundic gland polyps are often associated with proton pump inhibitor use. In those cases, the doctor may recommend that the patient stop taking the medication.
- Hyperplastic polyps
Hyperplastic polyps appear in bunches, and are found scattered throughout the stomach. In addition, these polyps are also found near a stomach ulcer. Hyperplastic polyps are strongly linked with disorders that inflame or irritate the stomach, such as chronic gastritis, H. pylori gastritis, and pernicious anemia (the body does not absorb enough of the vitamin B-12, which causes a drop in the number of red blood cells). If the H. pylori bacteria is present and successfully treated, the hyperplastic polyps in most patients will heal. The cancer risk associated with hyperplastic polyps is minor, but they may be linked to an increased risk of cancer in the stomach lining, especially if the patient suffers from chronic gastritis. There is a risk of cancer within the stomach lining rather than the polyp itself, so the doctor may also take multiple biopsies of the area surrounding the polyp.
- Adenomatous polyps
Adenomatous polyps are the most common neoplastic polyp and are found in the antrum portion of the stomach (near the bottom). They are usually the beginning of stomach cancer. They may also suggest an increased risk of cancer within the intestines or elsewhere in the body. The doctor will need to perform additional tests to correctly diagnose and treat the condition. Because of the increased risk of cancer, all adenomatous polyps should be removed. Removal is usually done with an endoscope. The doctor may recommend surgery if there are many of these polyps and if the cancer has begun to spread.
Who is affected by stomach polyps?
Stomach polyps occur in adult men and women of all ages. They become more common as the person ages, and especially affect those older than 65. Certain types of polyps, such as fundic gland polyps, are commonly found in middle-aged women.
Symptoms and Causes
What causes stomach polyps?
A link between the Helicobacter pylori (H. pylori), bacteria and stomach polyps has been identified. H. pylori bacteria can lead to an infection that over years may cause stomach ulcers.
In addition, people who use proton pump inhibitors to treat gastritis (irritation in the stomach lining) and acid reflux (heartburn) are at greater risk for stomach polyps. Proton pump inhibitors are drugs that reduce the production of acid in the stomach.
What are the symptoms of stomach polyps?
Stomach polyps usually do not cause symptoms. They are usually found when a patient is being examined for another stomach issue.
Larger polyps may cause internal bleeding or abdominal pain. If internal bleeding continues, the patient may become anemic (low iron). Occasionally, the polyps may cause a blockage from the stomach to the intestine.
Diagnosis and Tests
How are stomach polyps diagnosed?
Stomach polyps are usually found during an endoscopy for another stomach issue. An endoscopy is a procedure in which an endoscope, a flexible tube with a camera on the end, is inserted into the mouth and down into the stomach to examine it.
Although the vast majority of stomach polyps (more than 90%) do not lead to cancer, certain types of polyps need further examination to make sure there are no cancer cells present. If an abnormal area is found, biopsies (tissue samples) can be taken while the endoscope is still in the stomach. These tissues are then examined in the laboratory to look for cancer cells.
Management and Treatment
How are stomach polyps treated?
If necessary, stomach polyps can be removed with the endoscope. During an endoscopy, a biopsy of one or more of the polyps will be taken for examination to make sure that the tissue is not cancerous. If the polyps are large, or look different from the other polyps, they may be removed entirely while the endoscope is in the stomach. If several polyps are found, the doctor may recommend surgery.
In addition, polyps may be a sign of gastritis that may require further diagnosis and treatment.
Who is at risk of developing stomach polyps?
Patients who take proton pump inhibitors for gastritis, acid reflux, or other stomach problems may be at greater risk for developing stomach polyps.
Also, the presence of the H. pylori bacteria within the patient’s stomach may also increase the risk of stomach polyps. All patients should be tested for active H. pylori infection; if present, the infection should be treated.
What type of follow-up is required with stomach polyps?
Depending on the type of stomach polyp, the doctor may recommend another endoscopy within one year to look for any new polyps. For patients who have had cancerous polyps, the follow-up endoscopy should take place every six months for the first three years.
If the patient has a family history of stomach cancer, the doctor may recommend that the patient undergo regular endoscopies (every one to two years).
For patients younger than 40 who have several polyps, the doctor may also recommend more tests within the colon (large intestine), in addition to the stomach.
If the proton pump inhibitors seem to be causing the polyps, the doctor may recommend discontinuing this medication.