Hyperplastic polyp: causes, symptoms, treatment

As a result of abnormally increased division of mucous epithelial cells in cavity organs, a hyperplastic polyp may form. Since the overgrown cells have a normal structure (do not differ from normal epithelial cells), hyperplastic polyps are benign formations.

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Epidemiology

Hyperplastic polyps of the colon make up to 90% of all polypous formations in this localization (according to another version - 30-40%); as a rule, they form in the large intestine (in the rectum and sigmoid colon).

Gastric polyps are most often found in men after 50-60 years of age, although, according to practicing gastroenterologists, this pathology is detected with almost equal frequency in patients of both sexes, including young people.

It is generally accepted that hyperplastic polyps are found in the stomach and intestines fifteen times more often than adenomatous ones. However, some clinical studies (based on histology data) have shown that hyperplastic polyps are found in patients only 10-12% more often than adenomatous ones. In most cases, 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 some data, these formations on the mucous membrane of the uterus, cervical canal and cervix are detected in 5% of patients, according to others - in almost a quarter.

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Causes of a hyperplastic polyp

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

Although the exact mechanism of inheritance has not yet been determined, clinical practice shows that in at least 5% of cases the causes of hyperplastic polyps are rooted in a genetic predisposition.

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

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

Among the causes of such a rare pathology as hyperplastic polyp of the duodenum, which is most often localized in its bulb, gastroenterologists note duodenitis or reflux gastritis. Hyperplastic polyp of the gallbladder is associated with cholecystitis, pathologies of the bile ducts and cholelithiasis, as well as liver diseases (with impaired synthesis of bile acids).

The most common localization of focal hyperplasia in elderly patients is the large intestine and, accordingly: hyperplastic polyp of the colon (proctologists call it metaplastic), colon, which is a section of the colon, and the cecum. Most often, they accompany enterocolitis, nonspecific ulcerative colitis and Crohn's disease. Polyps come in different sizes (on average 2-5 mm) and shapes, can be on a thin stalk or protrude into the intestine due to elevation on a fairly wide base. Also read - Colon Polyps

In the urinary bladder, the formation of a hyperplastic polyp can be provoked by urinary stasis, chronic cystitis, urolithiasis, prostatitis. Urologists even distinguish a chronic form of polypous cystitis, which can develop in men after repeated catheterization of the urinary bladder.

Gynecologists explain the reasons why women often develop hyperplastic uterine polyps by the physiological specifics of its internal mucous membrane (endometrium), which peels off every month during childbearing age and comes out with menstrual discharge, and then is restored by cell proliferation. Conditions for endometrial polyps arise when the level of estrogen is elevated, there are inflammatory gynecological diseases, and also as a result of damage to all layers of the endometrium due to its curettage during abortions.

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

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Risk factors

In addition to the diseases and conditions listed above, the following risk factors for the development of hyperplastic polyps of the esophagus, stomach and various parts of the intestine should be taken into account:

• age over 45-50 years;
• colonization of the submucosal layer of the stomach by the bacterium H. pylori;
• an unhealthy diet with an excess of spicy and fatty foods, preservatives and trans fats with an insufficient amount of foods containing fiber;
• long-term treatment of gastritis with high acidity and GERD with antisecretory drugs (PPI group) to reduce the production of hydrochloric acid in the stomach;
• smoking and alcohol;
• metabolic disorders;
• autoimmune diseases.

The risk of developing a hyperplastic polyp of the uterus increases with hormonal disorders, as well as in women who, with the onset of menopause, take drugs that are analogous to female sex hormones.

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Pathogenesis

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

The tissue of all mucous membranes – due to their initially high proliferative activity – is capable of completely recovering from damage caused by inflammation, replacing dying cells with new ones. And in the area of inflammation or non-inflammatory damage, proliferation is much more intense than in the process of normal physiological renewal of mucous epithelial cells.

This complex biochemical process occurring at the molecular and cellular level may have certain deviations from the norm. They may be due to deficiency/excess or disruption of the interaction of many endogenous components 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 cell mitosis and differentiation; cyclic nucleotides that regulate the sequence of phases of intracellular transformations.

It is believed that a developing hyperplastic polyp in the form of a growth on a stalk or a thickened plaque is a focus of hyperplasia of the mucous membrane of the corresponding organ: multilayer squamous epithelium of the esophagus, cylindrical and glandular epithelium of the stomach and intestines, single-layer villous epithelium of the duodenum, prismatic epithelium of the gallbladder, endometrium or endocervix.

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Symptoms of a hyperplastic polyp

Since hyperplastic polyps do not cause symptoms in a third of cases, their detection is a matter of chance. Symptoms of a hyperplastic polyp appear when its size and/or location disrupt 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 area, which may later be joined by complaints of pain and difficulty swallowing (dysphagia), nausea and vomiting after eating, and breathing problems when the polyp presses on the trachea. Frequent erosion of esophageal polyps is noted, which causes their bleeding, leading to anemia and general weakness.

The latent development of a 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 stomach walls stretch), and diarrhea.

In more than half of the cases, there are no symptoms even when the hyperplastic polyp is localized in the duodenum. However, its enlargement may initially manifest itself as heartburn and belching, and then nausea and aching pain in the epigastric region, especially an hour or an hour and a half after eating. In addition, ulceration of such polyps is often observed and, as a result, hidden bleeding is possible, leading to dizziness and weakness.

Hyperplastic polyps of the colon and all parts of the colon also have a subclinical form in many people, and they are not even aware of their presence. But if flatulence has started to bother you, constipation or diarrhea has appeared, there is an inexplicable loss of body weight (sometimes up to 10% of weight), the appearance of feces has changed (with the appearance of blood in them) or intestinal colic occurs more and more often, then this may mean the presence of a colorectal hyperplastic polyp.

A hyperplastic polyp of the gallbladder may manifest itself as dry mouth, loss of appetite, nausea, and periodically occurring dull pain in the right hypochondrium (if the polyp is located in the neck of the gallbladder, the pain is more frequent and occurs after eating fats).

When polyps grow in the bladder, symptoms may be similar to those of cystitis, and a hyperplastic polyp of the uterus usually manifests itself through a disruption of the menstrual cycle, spotting, and pain in the lower abdomen.

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Forms

In the absence of a strict classification of hyperplastic polyps, specialists distinguish between their individual types.

For example, a polyp that occurs during the reparation of a mucosal area damaged by inflammation is defined as an inflammatory or inflammatory-hyperplastic polyp. It usually does not have a stalk, and among the cells that form it there are elements of connective tissue of the basal layer of the mucous membranes. It can also be called an inflammatory fibrous polyp.

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

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

A polyp with infiltration is a polyp in whose loose tissue there are inclusions of lymphoblasts and lymphocytes, plasma cells and eosinophils, acidophilic granulocytes and macrophages.

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Complications and consequences

Although the malignant transformation of hyperplastic polyps registered in clinical practice does not exceed 1-1.2%, the pathological proliferation of mucous membrane cells is characterized by consequences and complications that manifest themselves in the form of obstruction of the esophagus, duodenum and individual segments of the large intestine. In addition, pedunculated polyps can become strangulated, and as a result of the formation of a hyperplastic polyp with erosions, chronic bleeding is possible.

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Diagnostics of a hyperplastic polyp

Instrumental diagnostics is the only method for detecting a hyperplastic polyp of any location.

In the esophagus, stomach and duodenum, hyperplastic polyps are detected using endoscopic fibrogastroscopy, esophagogastroduodenoscopy or fibrogastroduodenoscopy - with mandatory targeted biopsy.

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

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

Mandatory biopsy is intended to establish the morphology of the polyp. Hyperplastic polyps are characterized by great structural heterogeneity, and the morphological picture of a hyperplastic polyp in each specific case has its own characteristics. For example, a histological examination of a hyperplastic gastric polyp under a microscope reveals the presence of deep pits (crypts) on its surface, 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, as well as a certain number of cambial (undifferentiated) cells, inclusions of goblet cells, prismatic mucous exocrine cells and even intestinal epithelial cells. With erosion of the polyp surface, its structure may include atypical stromal cells, neutrophils and granulocytes.

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Differential diagnosis

Only on the basis of histology is it possible to differentiate a hyperplastic polyp from an adenomatous or hamartomatous polyp, hereditary polyposis syndromes (Turcot, Gardner or Cowden syndromes, juvenile polyposis), submucosal neoplasms, fibromas, gastrointestinal stromal tumors or polypoid forms of cancer.

Treatment of a hyperplastic polyp

Since endoscopic visualization is unable to differentiate hyperplastic polyps from adenomatous polyps prone to malignancy, today, if the transverse size of the polyp is more than two centimeters, only surgical treatment is used - by endoscopic polypectomy (which is often performed simultaneously with diagnostic endoscopy of the organ). With larger sizes of formations, laparotomy may be required.

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

Some people recommend 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 increased production of gastric juice and bile, as well as increased blood pressure and skin pigmentation. And glycosides of wormwood also increase gastric secretion, but reduce blood pressure and heart rate.

Prevention

Medicine cannot regulate the mechanism of disorders occurring in the process of physiological and reparative regeneration of mucous membrane tissues yet, so there are no means to prevent them. And prevention of focal hyperplasia in the form of hyperplastic polyps has not been developed.

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Forecast

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

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