Gastric Polyps Protons Spirochetes and hyperplasia Damian PatonGay

Gastric Polyps: Protons, Spirochetes and hyperplasia Damian Paton-Gay Jan 2007

The Plan…. I. A quick look at the epidemiology and major types of polyps II. Do PPI’s cause polyps? III. Does H. pylori infection cause polyps? IV. What do gastric polyps have to do with colonic adenomas and carcinomas?

Epidemiology § A few large epidemiological studies § Incidence 1 -3% of gastroscopies

Frequency and Types of Polyps Fundic Gland Polyps ~50% Hyperplastic Polyps 28% (some texts report up to 78%) Adenomas 10% Heterotopic tissue Polyps associated with Add up to ~1%

Fundic Gland Polyps § Often multiple 2 -3 mm sessile lesions in body and fundus § “Focal increase in glandular elements” § Sporadic in general population § 53% incidence in FAP § Almost invariably benign § 3 case reports of gastric ca in a fundic gland polyp in a pt with FAP

Hyperplastic Polyps § Usually solitary <1. 5 cm sessile lesions in body § Described as “shinier” and softer than other polyps § May have an umbilicated center § Higher risk of harbouring dysplasia than fundic gland polyps § These have been associated with H. pylori (more later)

Hyperplastic Polyps § Risk of developing adenocarcinoma in a hyperplastic polyp is considered ~2% § Based on a study of 477 hyperplastic polyps in 1990 § Daibo M et al. Malignant Transformation of Gastric Hyperplastic Polyps. Am J Gastroenterol. 1990 Mar; 85(3): 327 -8�

Adenomas § § Usually solitary and sessile polyps Most often antral Often quite large (10+ cm in diameter) Very similar to colonic polyps…. § Can be tubular, tubulovillous or villous § Premalignant lesions § Incidence of carinoma is between 3 and 11%

Adenomas continued § As with colonic polyps § Risk of Ca ^’s with polyp size and histologic type § Also - the presence of a gastric adenoma increases the risk of carcinoma elsewhere in the stomach