How would I know if stomach polyps were present? According to the Mayo Clinic, stomach polyps won't cause any symptoms at all in most people. Symptoms usually appear only when the polyps are large or great in number. Stomach polyps form when the stomach lining becomes inflamed and forms small protrusions. When a polyp is small, which is the case for the majority of people, it won't cause a disruption within the functioning of the stomach or form into a lesion or sore. These protrusions can eventually become ulcerous.
In general, once a polyp is observed, it is removed or biopsied and classified. Prognosis and management are specific to the underlying pathology. However, pathology is generally not known at the time of the initial endoscopy and some general management issues are commonly applied to all patients with gastric polyps.
Overall, stomach polyps are rare compared to other gastric conditions. Most stomach polyps are less than 1 centimeter in diameter and due to inflammation or hyperplasia. Larger stomach polyps (greater than 1.5cm in diameter) are associated with a greater risk of malignancy and if the polyp is larger than 2cm in diameter, it is usually removed immediately.
Types of Stomach Polyps
1. Hypertrophic Polyps
Most stomach polyps occur due to inflammation or hyperplasia of the epithelium or deeper layers. Overgrowth of tissue (hyperplasia) in the stomach lining occur as a result of repeated inflammation. There are usually multiple hypertrophic polyps present simultaneously which appear oval in shape with a smooth surface. Sometimes the polyp is ulcerated, similar to a peptic ulcer, although this is usually superficial. Microscopic examination of the polyp reveals significant edema (swelling) in the lamnia propria layer and it is not uncommon for the mucosa around the polyp to also be inflamed.
The most common cause of stomach polyps is chronic gastritis. Persistent irritation of the stomach lining triggers excessive growth of normal cells (hyperplasia). If the gastritis is a result of long term H.pylori infection, successful eradication and appropriate treatment of H.pylori gastritis may lead to the polyp resolving spontaneously. Most cases of gastritis that lead to a polyp formation will result in a hypertrophic polyp.
2. Fundic Gland Polyps
Also known as fundic cystic gland polyps, these stomach polyps arise as a result of a cyst-like dilation of the glandular tissue of the stomach lining. The growth is typically lined by flattened parietal and chief cells. The tissue of the polyp as well as the surrounding tissue are usually not edematous and inflamed.
This is often linked to an inherited condition known as familial adenomatous polyposis (FAP). However the rise in fundic gland polyps in recent years may be linked to long term use of proton pump inhibitors which may result in increased gastrin secretion and hyperplasia of the glandular tissue.
3. Gastric Adenomas
Adenomas are a less common type of gastric polyp (10% of cases) and is most commonly found in the antrum of the stomach. These types of polyps are composed of abnormal intestinal-type columnar epithelium. The level of dysplasia of these cells may be low or high grade. Adenomas are the most likely type of stomach polyp to become cancerous. The risk of malignancy is linked to its size. Polyps larger than 2cm in diameter are of a higher risk.
An adenoma is more likely to occur in cases of chronic H.pylori gastritis or autoimmune gastritis that progress to atrophic gastritis (destruction of the stomach lining as a result of chronic inflammation). A family history of familial adenomatous polyposis (FAP) also increases the incidence of an adenoma.