From the Guidelines
The treatment for foveolar hyperplasia in the gastric mucosa should focus on addressing the underlying cause, which may involve the management of gastric polyps, particularly hyperplastic polyps, as recommended by the British Society of Gastroenterology guidelines 1. When considering the management of foveolar hyperplasia, it's essential to understand that this condition can be associated with hyperplastic polyps, which are a type of epithelial gastric polyp. According to the guidelines, if hyperplastic polyps are present, especially those larger than 1 cm, pedunculated, or causing symptoms, resection is suggested, along with the eradication of H. pylori if present 1.
Key Considerations
- The background mucosa should be endoscopically assessed for gastritis, gastric intestinal metaplasia (GIM), H. pylori, and synchronous neoplasia if adenomas or hyperplastic polyps are found 1.
- The use of enhanced endoscopic imaging can aid in the characterization of gastric polyps when there is diagnostic uncertainty following white light examination 1.
- Regular follow-up gastroscopy is crucial, with recommendations for follow-up at 12 months after complete endoscopic excision of adenomas, then annually thereafter, as appropriate 1.
Treatment Approach
Given the association of foveolar hyperplasia with chronic inflammation and potential presence of hyperplastic polyps, the treatment approach should include:
- Addressing H. pylori infection with eradication therapy if present.
- Considering the resection of hyperplastic polyps based on size, morphology, and symptoms.
- Utilizing proton pump inhibitors (PPIs) for the management of chronic inflammation, although specific guidance on PPI use in this context is not provided in the referenced guidelines.
- Lifestyle modifications to reduce gastric inflammation, such as avoiding NSAIDs, alcohol, and spicy foods.
Monitoring and Follow-Up
Regular endoscopic follow-up is essential to monitor the resolution of foveolar hyperplasia and to assess for any development of synchronous neoplasia or progression of gastric mucosal changes. The exact timing of follow-up may vary based on the initial findings and the presence of other risk factors for gastric adenocarcinoma, as outlined in the guidelines 1.
From the Research
Treatment for Foveolar Hyperplasia in the Gastric Mucosa
The treatment for foveolar hyperplasia in the gastric mucosa can vary depending on the underlying cause. Some key points to consider include:
- In cases of Helicobacter pylori gastritis, treatment typically involves eradication of the infection 2.
- For non-Helicobacter pylori-associated gastropathy, treatment may involve addressing the underlying cause, such as discontinuing NSAIDs or ASS 3.
- In patients with infantile hypertrophic pyloric stenosis (IHPS) and foveolar cell hyperplasia, an extended pyloromyotomy may be necessary to resolve persistent obstruction 4.
- Idiopathic focal foveolar hyperplasia in infants may require surgical excision of the involved mucosa with pyloroplasty or pyloromyotomy 5.
- Long-term treatment with omeprazole may lead to hyperplastic changes in endocrine cells, but the incidence and severity of these lesions are unaffected by treatment 6.
Key Considerations
Some important considerations when treating foveolar hyperplasia include:
- Accurate diagnosis of the underlying cause is crucial in determining the appropriate treatment.
- Treatment should be tailored to the individual patient's needs and may involve a combination of medical and surgical interventions.
- Regular follow-up and monitoring are necessary to ensure that the treatment is effective and to address any potential complications.
Treatment Options
Treatment options for foveolar hyperplasia may include:
- Antibiotics to eradicate Helicobacter pylori infection 2.
- Discontinuation of NSAIDs or ASS 3.
- Extended pyloromyotomy for patients with IHPS and foveolar cell hyperplasia 4.
- Surgical excision of the involved mucosa with pyloroplasty or pyloromyotomy for idiopathic focal foveolar hyperplasia in infants 5.
- Omeprazole treatment for patients with reflux oesophagitis or peptic ulcer resistant to H2-receptor antagonist therapy 6.