From the Guidelines
Stomach polyps can be caused by factors other than H. pylori infection, including genetic conditions like Peutz-Jeghers syndrome, juvenile polyposis, and Cronkhite-Canada syndrome, as well as chronic stomach inflammation, certain medications, and lifestyle factors.
Causes of Gastric Polyps
The causes of gastric polyps can be diverse, ranging from spontaneous development to conditions associated with chronic inflammation or genetic predispositions. Some key factors include:
- Fundic gland polyps, which are the most common type and often develop spontaneously or in people taking proton pump inhibitors (PPIs) like omeprazole or pantoprazole for extended periods 1.
- Hyperplastic polyps, which may result from chronic stomach inflammation due to autoimmune gastritis or pernicious anemia.
- Adenomatous polyps, though rare, can develop from genetic factors or familial adenomatous polyposis syndrome.
- Inflammatory fibroid polyps, which arise from submucosa inflammation.
- Chronic gastritis from bile reflux, certain medications like NSAIDs, excessive alcohol consumption, and smoking.
- Rare genetic conditions like Peutz-Jeghers syndrome, characterized by hamartomatous gastrointestinal polyps and mucocutaneous freckling 1, and juvenile polyposis, which presents with multiple colorectal polyps but also with polyps in the stomach and small intestine 1.
Management and Recommendations
Given the potential for malignancy, especially in adenomatous polyps, regular monitoring through endoscopy is recommended for polyps larger than 0.5 cm, with removal typically advised for those larger than 1 cm or showing concerning features. This approach aims to decrease the cancer risk and prevent symptoms such as bleeding, anemia, and diarrhea. For patients with a high number of polyps, colectomy with ileorectal anastomosis may be appropriate, as seen in the management of juvenile polyposis 1.
Quality of Life and Morbidity Considerations
The management of gastric polyps should prioritize minimizing morbidity and improving quality of life. This includes prompt diagnosis and treatment of symptoms, regular surveillance to prevent cancer, and consideration of the psychological impact of living with a condition that may require frequent medical interventions. By focusing on these aspects, healthcare providers can offer comprehensive care that addresses the physical and emotional well-being of patients with gastric polyps.
From the Research
Causes of Gastric Polyps
Besides Helicobacter pylori (H. pylori) infection, there are several other causes of gastric polyps, including:
- Familial adenomatous polyposis (FAP) 2, 3, 4, 5, 6
- Peutz-Jeghers syndrome 3, 4, 5, 6
- Juvenile polyposis syndrome 3, 4, 5
- Cowden syndrome 3, 4
- Cronkhite-Canada syndrome 4
- Gastric Adenocarcinoma and Proximal Polyposis of the Stomach (GAPPS) 5
- Lynch syndrome 5
- Autoimmune gastritis due to pernicious anemia 6
- Chronic atrophic gastritis consequent to H. pylori infection 6
- Ménétrier disease 6
Syndromic Gastric Polyps
Some gastric polyps are part of an underlying hereditary syndrome, including:
- FAP, which is characterized by the development of many tens to thousands of adenomas in the rectum and colon 2
- Peutz-Jeghers syndrome, which is associated with an increased risk of gastric cancer 3, 5
- Juvenile polyposis syndrome, which is characterized by the development of juvenile polyps in the gastrointestinal tract 3, 5
- GAPPS, which is a recently described heritable syndrome characterized by isolated gastric polyposis and risk of gastric cancer 5
Non-Syndromic Gastric Polyps
Non-syndromic gastric polyps can also occur, including: