Hyperplastic polyp: causes, symptoms, treatment

As a result of an abnormally increased division of the cells of the mucosal epithelium in the cavity organs, a hyperplastic polyp can form. Since the overgrown cells have a normal structure (they do not exude from ordinary epithelial cells), hyperplastic polyps are related to benign forms.

[1], [2], [3]

Epidemiology

Hyperplastic polyps of the large intestine account for up to 90% of all polyposis formations of this localization (according to another version, 30-40%); as a rule, they are formed in the large intestine (in the straight and sigmoid colon).

Polyps of the stomach are most often found in men after 50-60 years, although, according to the practice of gastroenterologists, this pathology is practically the same frequency detected in patients of both sexes, including in young people.

It is generally believed that in the stomach and intestine, hyperplastic polyps are found in a half dozen times more often than adenomatous polyps. However, some clinical studies (based on histology data) have shown that hyperplastic polyps are detected in patients only 10-12% more adenomatous. In most cases, the hyperplastic polyps of the stomach are single (according to other sources - multiple).

Statistics on hyperplastic polyps of the uterus (hyperplastic processes of the endometrium) are also ambiguous: according to one data, these formations on the mucous membrane of the uterus, cervical canal and cervix are detected in 5% of patients, in others - in almost a quarter.

[4], [5], [6]

Causes of the hyperplastic polyp

Oncologists consider adenomatous polyps formed with epithelial meta- and dysplasia to be true, and hyperplastic polyps are defined as pseudopolips or polypoid formations, the appearance of which is associated with focal hyperplasia (increased proliferation) of the cells of the growth layer of the mucosal epithelium.

Although the exact mechanism of inheritance has not yet been determined, but as clinical practice shows, at least 5% of the causes of hyperplastic polyps lie in a genetically determined predisposition.

But, basically, the etiology of the appearance of such polyps is associated with inflammatory diseases of the cavity organs and GIT structures. Hyperplastic poly esophagus, which accounts for 8-12% of cases of gastrointestinal polyps, most often occurs with chronic inflammation of its mucosa (esophagitis) and gastroesophageal reflux disease (GERD). Primary localization is the upper part of the esophagus and the area of the cardiac sphincter.

Epithelial hyperplastic polyps of the stomach can be formed due to any form of gastritis, primarily atrophic, hypertrophic or hyperplastic, autoimmune inflammation of the stomach mucosa, stomach ulcer, and also in the presence of food allergies. Polyps are soft, have a leg, protrude into the lumen of the stomach, the most common place of their location is the cardial, pyloric and antral sections.

Among the reasons for this rather rare pathology, like the hyperplastic polyp of the duodenum, which is most often localized in its bulb, gastroenterologists note duodenitis or reflux gastritis. With cholecystitis, pathologies of bile ducts and cholelithiasis, as well as liver diseases (with a violation of the synthesis of bile acids), bind the hyperplastic polyp of the gallbladder.

The most common localization of focal hyperplasia in elderly patients is the large intestine and, accordingly: hyperplastic polyps of the large intestine (proctologists call it metaplastic), the colon, which is the department of the thick, as well as the caecum. Most often they accompany enterocolitis, ulcerative colitis and Crohn's disease. Polyps are of various sizes (on average 2-5 mm) and forms, can be on a thin stalk or protrude into the intestine due to elevation on a fairly wide base. Also read -  Polyps of the large intestine

In the bladder, the formation of a hyperplastic polyp can be triggered by stagnation of urine, chronic cystitis, urolithiasis, prostatitis. Urologists even distinguish chronic form of polyposis cystitis, which after repeated catheterization of the bladder can develop in men.

The reasons why women often develop hyperplastic polyps of the uterus, gynecologists explain the physiological specificity of its internal mucous membrane (endometrium), which at the childbearing age monthly exfoliates and leaves with menstrual secretions, and then - by proliferation of cells - is restored. Conditions for endometrial polyps arise when the level of estrogen is increased, there are inflammatory gynecological diseases, as well as due to damage to all layers of the endometrium because of its curettage in abortions.

More details about polyps of other localization in gynecology -  Cervical canal polyps  and  Cervical polyp

[7], [8], [9], [10]

Risk factors

In addition to the diseases and conditions listed above, it is necessary to take into account such risk factors for the occurrence of hyperplastic polyps of the esophagus, stomach and various parts of the intestine:

• age over 45-50 years;
• colonization of the submucosal layer of the stomach by H. Pylori;
• inadequate nutrition with an abundance of spicy and fatty foods, preservatives and trans fats with insufficient quantity of products containing fibers;
• prolonged treatment of gastritis with high acidity and GERD antisecretory drugs (IPP group) to reduce the production of hydrochloric acid in the stomach;
• smoking and alcohol;
• metabolic disorders;
• autoimmune diseases.

The risk of the formation of hyperplastic polyps of the uterus with hormonal disorders increases, as well as in women who, with the onset of menopause, take analogues of female sex hormones.

[11], [12], [13], [14], [15], [16], [17], [18]

Pathogenesis

Experts see the pathogenesis of the formation of this type of polyps in violation of natural processes - physiological regeneration of the mucous membranes of the cavity organs, therefore hyperplastic polyps can be called regenerative polyps.

The tissue of all mucous membranes - thanks to their initially high proliferative activity - is able to fully recover after damage caused by inflammation, replacing the dying cells with new ones. And in the zone of inflammation or non-inflammatory damage, the proliferation goes much more intensively than during the normal physiological renewal of the cells of the mucosal epithelium.

This complex biochemical process, occurring at the molecular and cellular level, may have certain deviations from the norm. They may be due to a lack / excess or disruption of the interaction of many endogenous constituents of the cell cycle: transforming growth factors (TGF) and tumor necrosis factor (TNF); inhibitors of proteolytic enzymes (proteinases) and polyamines; prostaglandins, interleukins and lymphocyte stimulators of cellular mitosis and differentiation; cyclic nucleotides ordering the sequence of intracellular transformation phases.

It is believed that the emerging hyperplastic polyp in the form of an outgrowth on the peduncle or thickened plaque is the focus of hyperplasia of the mucosa of the corresponding organ: multilayered squamous epithelium of the esophagus, cylindrical and glandular epithelium of the stomach and intestine, single-layer villous epithelium of the duodenum, prismatic epithelium of the gallbladder, endometrium or endocervix.

[19], [20], [21], [22], [23], [24], [25]

Symptoms of the hyperplastic polyp

Since hyperplastic polyps in a third of cases do not cause symptoms, their detection is a matter of chance. Symptoms of the hyperplastic polyp appear when its size and / or localization disturb certain structures of the cavity organs or affect their functions.

The first signs of the formation of a fairly large polyp in the esophagus are a feeling of discomfort in the sternum, which can later be joined by complaints of soreness and difficulty in swallowing (dysphagia), nausea and vomiting after eating, and with pressure of the polyp on the trachea - on breathing problems. Frequent erosion of the esophageal polyps is noted, which causes their bleeding, leading to anemia and general weakness.

Latent development of the hyperplastic polyp in the stomach cavity is a long process, but as the formation grows, it can lead to heartburn, nausea, stomach pain after eating (when the walls of the stomach are stretched), diarrhea.

In more than half the cases, there are no symptoms even when the hyperplastic polyp is located in the duodenum. However, its increase at first can be manifested by heartburn and eructation, and then with nausea and aching pains in the epigastric region, especially after an hour and a half after eating. In addition, ulceration of such polyps is often observed, and as a result, latent bleeding can occur, leading to dizziness and weakness.

Hyperplastic polyp of the large intestine and all parts of the large intestine in many also have subclinical form, and its presence is not even suspected. But if you began to pester the flatulence, constipation or diarrhea appeared, there was no explainable loss of body weight (sometimes up to 10% of weight), the appearance of feces changed (with the appearance of blood in them), or more and more frequent intestinal colic, this could mean the presence of colorectal hyperplastic polyp.

The hyperplastic polyp of the gallbladder can manifest itself with dry mouth, deterioration of appetite, nausea, periodic dull pain in the hypochondrium region on the right (if the polyp is in the neck of the bladder, the pain is more frequent and occurs after consuming fats).

With the growth of polyps in the bladder, there may be symptoms similar to manifestations of cystitis, and the hyperplastic polyp of the uterus usually presents itself as a violation of the menstrual cycle, secretions of the smearing character, pains in the lower abdomen.

[26], [27], [28]

Forms

In the absence of a strict classification of hyperplastic polyps, specialists distinguish their separate species.

For example, a polyp arising during the repair of an inflammation-damaged mucosa is defined as an inflammatory or inflammatory-hyperplastic polyp. Usually it does not have a leg, and among the cells forming it there are elements of the connective tissue of the basal layer of the mucous membranes. It can also be called an inflammatory fibrotic polyp.

If endoscopy reveals an inflammation of the mucous membrane that covers the polyp body, then this is a hyperplastic polyp with inflammation. And in cases of ulcers localized there - with erosions.

When parietal cells of tubular gastric glands (fundus) or exocrine cells secreting protective mucus are identified in the formation, then the hyperplastic glandular polyp is diagnosed.

Polyp with infiltration is a polyp, in the friable tissue of which there are inclusions of lymphoblasts and lymphocytes, plasmocytes and eosinophils, acidophilic granulocytes and macrophages.

[29], [30], [31]

Complications and consequences

Although the malignant degeneration of hyperplastic polyps recorded in clinical practice does not exceed 1-1.2%, the pathological proliferation of mucosal cells has consequences and complications, which manifest themselves as violations of the passage of the esophagus, duodenum and separate segments of the large intestine. In addition, the polyps on the leg can be restrained, and as a result of the formation of a hyperplastic polyp with erosions, chronic bleeding is possible.

[32], [33], [34], [35]

Diagnostics of the hyperplastic polyp

Instrumental diagnosis is the only method of detecting a hyperplastic polyp of any localization.

In the esophagus, stomach and duodenum, polyps of the hyperplastic type are detected with the help of endoscopic fibrogastroscopy, esophagogastroduodenoscopy or fibrogastroduodenoscopy with obligatory targeted biopsy.

The large intestine is examined by endoscopic colonoscopy, and feces are also needed (for the presence of blood in it). In the cavity of the gallbladder, hyperplastic polyp can be detected in contrast cholecystography and ultrasound.

Polyp in the bladder is diagnosed with contrast X-ray, ultrasound of the bladder and cystoscopy, and polyps in the uterine cavity are visualized during hysteroscopy (also with biopsy).

An obligatory biopsy is designed to establish the morphology of the polyp. Hyperplastic polyps are distinguished by great structural heterogeneity, and the morphological pattern of the polyp of the hyperplastic type has its own peculiarities in each specific case. For example, histological examination of the hyperplastic stomach polyp under the microscope reveals the presence of deep pits (crypts) on the surface of the stomach, in the lining of which there are elongated cells of mature cylindrical epithelium with a significant content of glycosaminoglycans that are not typical for this type of tissue, and also a number of cambial (undifferentiated) cells, impregnation of goblet cells, prismatic mucous exocrine cells and even cells of the intestinal epithelium. When the polyp surface is eroded, atypical stromal cells, neutrophils and granulocytes may enter into its structure.

[36], [37], [38], [39], [40], [41]

Differential diagnosis

Only on the basis of histology, differential diagnosis of the polyp of the hyperplastic type from polyp adenomatous or hamartomnogo, syndromes of hereditary polyposis (syndromes of Turko, Gardner or Kauden, juvenile polyposis), submucosal neoplasms, fibroma, gastrointestinal stromal tumor or polypoid cancer.

Treatment of the hyperplastic polyp

Since endoscopic visualization makes it impossible to distinguish between hyperplastic polyps and adenomatous prone to malignancy, to date, if the transverse size of the fluke is more than two centimeters, only surgical treatment is used - by endoscopic polypectomy (often performed concomitantly with diagnostic endoscopy of the organ). For larger lesions, laparotomy may be required.

Neither medication nor alternative treatment can remove the formed polyp. And all other methods, including herbal treatment, in this case are ineffective.

Some advise drinking decoctions and water infusions of St. John's wort (Hypericum perforatum) or wormwood (Artemisia absinthium). But the use of St. John's wort leads to an increase in the production of gastric juice and bile, as well as increased blood pressure and skin pigmentation. A glycosides of bitter wormwood also increase gastric secretion, but lowers blood pressure and heart rate.

Prevention

The mechanism of disorders occurring in the process of physiological and reparative tissue regeneration of the mucous membranes, medicine can not regulate for the time being, so there are no means that can prevent them. And the prevention of the onset of focal hyperplasia in the form of hyperplastic polyps has not been developed.

[42], [43], [44], [45]

Forecast

In the presence of hyperplastic polyps, the prognosis is favorable, and they can even disappear by themselves. But there is a possibility of a new polyp after the polypectomy, because the reasons for their appearance remain.

[46], [47]