History

Fact Explanation
Asymptomatic Patients with hyperplastic gastric polyps and duodenal polyps are usually asymptomatic. [1,6]
Symptoms of gastric outlet obstruction (GOO) GOO is a common complication of hyperplastic gastric polyps. Patients present with projectile non-bilious vomiting soon after meals. [1]
Symptoms of iron deficiency anemia Hyperplastic gastric polyps cause occult bleeding leading to iron deficiency anemia. Fatigue, increased sleepiness, pica are features suggestive of iron deficiency anemia. [1,3]
Upper gastrointestinal bleeding Although rare, patients can present with upper gastrointestinal bleeding, hematemesis and hematochezia. The latter is an extremely rare presentation. [1,3]
History of long term use of proton pump inhibitors (PPI) Long term use of PPIs leads to the development of fundic gland polyps. [1,2]
History of Helicobacter pylori infection H. pylori infection is a recognized etiological factor for the development of hyperplastic gastric polyps. [1]
Symptoms of intestinal obstruction Inflammatory fibroid polyps (Vanek's tumor) can present with symptoms of intestinal obstruction. Recurrent vomiting, colicky abdominal pain, constipation and abdominal distension can be the presenting complains. [3,4]
Fever [3] Gastric inflammatory fibroid polyps can present with fever.
Family history of familial adenomatous polyposis (FAP) Patients with FAP can have gastric and duodenal polyps. Unlike colonic polyps gastric and duodenal polyps and other extracolonic polyps have low risk (5% to 10%) of malignant transformation. [5,6]
References
  1. NAYUDU SURESH KUMAR, NIAZI MASOOMA, BALAR BHAVNA, KUMBUM KAVITHA. A Rare Complication of Hyperplastic Gastric Polyp. Case Reports in Gastrointestinal Medicine [online] 2013 December, 2013:1-3 [viewed 15 August 2014] Available from: doi:10.1155/2013/631975
  2. SAMARASAM INIAN, ROBERTS-THOMSON JAMES, BROCKWELL DEREK. Gastric fundic gland polyps: a clinico-pathological study from North West Tasmania. [online] 2009 June, 79(6):467-470 [viewed 15 August 2014] Available from: doi:10.1111/j.1445-2197.2009.04948.x
  3. ZHANG CHENGHAI, CUI MING, XING JIADI, SHI YUNFEI, SU XIANGQIAN. Massive gastrointestinal bleeding caused by a giant gastric inflammatory fibroid polyp: A case report. International Journal of Surgery Case Reports [online] 2014 December, 5(9):571-573 [viewed 15 August 2014] Available from: doi:10.1016/j.ijscr.2014.05.004
  4. NEISHABOORI H, MALEKI I, EMADIAN O. Jejunal intussusception caused by a huge Vanek's tumor: a case report Gastroenterol Hepatol Bed Bench [online] 2013, 6(4):210-213 [viewed 15 August 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4017524
  5. SRINIVASA D, WRAY CJ. Total gastrectomy with isoperistaltic jejunal interposition flap for symptomatic management of gastric polyposis from familial adenomatous polyposis J Gastrointest Oncol [online] 2014 Feb, 5(1):E18-E21 [viewed 15 August 2014] Available from: doi:10.3978/j.issn.2078-6891.2013.053
  6. BASFORD PJ, BHANDARI P. Endoscopic management of nonampullary duodenal polyps Therap Adv Gastroenterol [online] 2012 Mar, 5(2):127-138 [viewed 15 August 2014] Available from: doi:10.1177/1756283X11429590

Examination

Fact Explanation
Signs of iron deficiency anemia Mucosal and conjunctival pallor, koilonychia are peripheral signs of iron deficiency anemia. Aortic flow murmur can be auscultated due to hyperdynamic circulation. [1]
References
  1. NAYUDU SURESH KUMAR, NIAZI MASOOMA, BALAR BHAVNA, KUMBUM KAVITHA. A Rare Complication of Hyperplastic Gastric Polyp. Case Reports in Gastrointestinal Medicine [online] 2013 December, 2013:1-3 [viewed 15 August 2014] Available from: doi:10.1155/2013/631975

Differential Diagnoses

Fact Explanation
Gastrointestinal stromal tumors (GISTs) [1] GISTs are the most common mesenchymal tumors involving the gastrointestinal tract. There is a 3% risk of malignancy associated with GISTs.
Infantile Hypertrophic Pyloric Stenosis (IHPS) IHPS is another possible cause for gastric outlet obstruction in infants. Projectile non-bilious vomiting soon after feeds is the usual presentation. [2]
Carcinoma of the stomach Carcinoma of the stomach can also be seen as a gastric mass. Characteristically patients present with significant loss of appetite and weight. [3]
References
  1. ZHANG CHENGHAI, CUI MING, XING JIADI, SHI YUNFEI, SU XIANGQIAN. Massive gastrointestinal bleeding caused by a giant gastric inflammatory fibroid polyp: A case report. International Journal of Surgery Case Reports [online] 2014 December, 5(9):571-573 [viewed 15 August 2014] Available from: doi:10.1016/j.ijscr.2014.05.004
  2. SITHASANAN N, SRI HARI S, RAMANUJAM TM. Hyperplastic Gastric Polyps in an Infant, Mimicking Infantile Hypertrophic Pyloric Stenosis - A Case Report and Review of the Literature. Med J Malaysia [online] 2014 Feb, 69(1):31-32 [viewed 15 August 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/24814626
  3. YADA TOMOYUKI, YOKOI CHIZU, UEMURA NAOMI. The Current State of Diagnosis and Treatment for Early Gastric Cancer. Diagnostic and Therapeutic Endoscopy [online] 2013 December, 2013:1-9 [viewed 15 August 2014] Available from: doi:10.1155/2013/241320

Investigations - for Diagnosis

Fact Explanation
Upper gastrointestinal endoscopy (UGIE) UGIE is helpful in detecting the presence of gastric polyp and also aids in obtaining biopsy samples for further histological evaluation. Inflammatory fibroid polyps are seen as semi-pedunculated protrusions of the gastric mucosa commonly over the gastric antrum. Exudates and white spots can also be seen over the sessile polyps. [1,2] Most of the duodenal polyps are sessile and commonly seen in the second part of the duodenum. [4]
Endoscopic ultrasound scan Endoscopic ultrasound is helpful in more accurate assessment of the size of the polyp especially before planning surgical resection. [4]
Histology [2] Histological examination of the IFPs reveals submucosal vascular and fibroblast proliferation. Multiple eosinophils are also seen due to inflammation. Dysplastic and malignant changes can also be detected. [3]
Fecal occult blood Occult bleeding from the polyp can be detected from positive fecal occult blood test. [1]
References
  1. NAYUDU SURESH KUMAR, NIAZI MASOOMA, BALAR BHAVNA, KUMBUM KAVITHA. A Rare Complication of Hyperplastic Gastric Polyp. Case Reports in Gastrointestinal Medicine [online] 2013 December, 2013:1-3 [viewed 15 August 2014] Available from: doi:10.1155/2013/631975
  2. ZHANG CHENGHAI, CUI MING, XING JIADI, SHI YUNFEI, SU XIANGQIAN. Massive gastrointestinal bleeding caused by a giant gastric inflammatory fibroid polyp: A case report. International Journal of Surgery Case Reports [online] 2014 December, 5(9):571-573 [viewed 15 August 2014] Available from: doi:10.1016/j.ijscr.2014.05.004
  3. NEISHABOORI H, MALEKI I, EMADIAN O. Jejunal intussusception caused by a huge Vanek's tumor: a case report Gastroenterol Hepatol Bed Bench [online] 2013, 6(4):210-213 [viewed 15 August 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4017524
  4. BASFORD PJ, BHANDARI P. Endoscopic management of nonampullary duodenal polyps Therap Adv Gastroenterol [online] 2012 Mar, 5(2):127-138 [viewed 15 August 2014] Available from: doi:10.1177/1756283X11429590

Investigations - Fitness for Management

Fact Explanation
Full blood count Reduced hemoglobin, mean corpuscular hemoglobin concentration, and mean cell volume can be detected in iron deficiency anemia. [1]
References
  1. NAYUDU SURESH KUMAR, NIAZI MASOOMA, BALAR BHAVNA, KUMBUM KAVITHA. A Rare Complication of Hyperplastic Gastric Polyp. Case Reports in Gastrointestinal Medicine [online] 2013 December, 2013:1-3 [viewed 15 August 2014] Available from: doi:10.1155/2013/631975

Investigations - Screening/Staging

Fact Explanation
Upper gastrointestinal endoscopy (UGIE) Patients with FAP should be followed up with regular upper gastrointestinal endoscopies. Screening should begin around the age of 25 to 30 years. After polypectomy patients should also be followed up for early detection of recurrences. [1]
References
  1. BASFORD PJ, BHANDARI P. Endoscopic management of nonampullary duodenal polyps Therap Adv Gastroenterol [online] 2012 Mar, 5(2):127-138 [viewed 15 August 2014] Available from: doi:10.1177/1756283X11429590

Management - General Measures

Fact Explanation
Basic life support Rarely patients can present with severe upper gastrointestinal bleeding and collapse. Assessment of the airway, breathing and circulation should be followed by supplementation of oxygen and maintenance of airway patency. Intravenous administration of crystalloids should be followed by colloids and cross matched blood if necessary.
H. pylori eradication Eradication of H. pylori infection is indicated in all the patients with hyperplastic gastric polyps. Patients are prescribed triple therapy which consists of two antibiotics and one PPI. [1]
Discontinuation of PPIs If the possible etiology of fundal polyps is prolonged use of PPIs, discontinuation of PPIs will regress slowly. [2]
References
  1. NAYUDU SURESH KUMAR, NIAZI MASOOMA, BALAR BHAVNA, KUMBUM KAVITHA. A Rare Complication of Hyperplastic Gastric Polyp. Case Reports in Gastrointestinal Medicine [online] 2013 December, 2013:1-3 [viewed 15 August 2014] Available from: doi:10.1155/2013/631975
  2. GRAHAM DY, GENTA RM. Long-term proton pump inhibitor use and gastrointestinal cancer. Curr Gastroenterol Rep [online] 2008 Dec, 10(6):543-7 [viewed 15 August 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/19006608

Management - Specific Treatments

Fact Explanation
Endoscopic treatment Endoscopic polypectomy is the preferred non-invasive treatment option for hyperplastic gastric polyps which are larger than 1cm in size and for symptomatic polyps. Polypectomy reduces the risk (about 2.1%) of malignant transformation of the polyp. [1,3,6] Endoscopic mucosal resection or endoscopic submucosal dissection is preferred in treatment of sporadic nonampullary duodenal adenomas. [5] Argon plasma coagulation is another mode of endoscopic treatment for sessile polyps. This is also used as an adjunct to Endoscopic mucosal resection. [5]
Surgery Surgical wedge resection is indicated in the polyp cannot be removed endoscopically or when malignancy is a possibility. Gastrectomy is the treatment option in multiple gastric polyps, especially in FAP. [1,2,4]
References
  1. NAYUDU SURESH KUMAR, NIAZI MASOOMA, BALAR BHAVNA, KUMBUM KAVITHA. A Rare Complication of Hyperplastic Gastric Polyp. Case Reports in Gastrointestinal Medicine [online] 2013 December, 2013:1-3 [viewed 15 August 2014] Available from: doi:10.1155/2013/631975
  2. ZHANG CHENGHAI, CUI MING, XING JIADI, SHI YUNFEI, SU XIANGQIAN. Massive gastrointestinal bleeding caused by a giant gastric inflammatory fibroid polyp: A case report. International Journal of Surgery Case Reports [online] 2014 December, 5(9):571-573 [viewed 15 August 2014] Available from: doi:10.1016/j.ijscr.2014.05.004
  3. NEISHABOORI H, MALEKI I, EMADIAN O. Jejunal intussusception caused by a huge Vanek's tumor: a case report Gastroenterol Hepatol Bed Bench [online] 2013, 6(4):210-213 [viewed 15 August 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4017524
  4. SRINIVASA D, WRAY CJ. Total gastrectomy with isoperistaltic jejunal interposition flap for symptomatic management of gastric polyposis from familial adenomatous polyposis J Gastrointest Oncol [online] 2014 Feb, 5(1):E18-E21 [viewed 15 August 2014] Available from: doi:10.3978/j.issn.2078-6891.2013.053
  5. BASFORD PJ, BHANDARI P. Endoscopic management of nonampullary duodenal polyps Therap Adv Gastroenterol [online] 2012 Mar, 5(2):127-138 [viewed 15 August 2014] Available from: doi:10.1177/1756283X11429590
  6. SUN CK, YANG KC, LIAO CS. Endoscopic Management of Gastric Polyp with Outlet Obstruction without Polypectomy Case Rep Gastroenterol [online] , 5(2):267-271 [viewed 15 August 2014] Available from: doi:10.1159/000328443