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Gastric Polyps: Protons, Spirochetes and hyperplasia

Gastric Polyps: Protons, Spirochetes and hyperplasia

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Gastric Polyps: Protons, Spirochetes and hyperplasia

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

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

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

  4. Frequency and Types of Polyps

  5. 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

  6. 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)

  7. 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

  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%

  9. 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