What are Fundic Gland Polyps?
Fundic gland polyps
refers to the occurrence of small (2-5mm), multiple polyps in the fundus of the stomach. Polyps are abnormal growths of tissue from the mucous lining of the stomach. Fundus refer to the top left most portion of the stomach. It is the rounded ceiling of the stomach and the curved cavity is well equipped to store undigested food and intestinal gases.
This condition is very commonly seen in individuals with the inherited condition of polyposis or numerous polyps as in Familial adenomatous polyposis (FAP). However, it could also occur sporadically in any individual without any preexisting polyposis condition. Individuals with the condition familial adenomatous polyposis are predisposed to the risks of developing malignancy.
This disease is common among middle aged women and is found in 0.8 to 1.9% of patients undergoing investigative procedures like esophagogastroduodenoscopy. It is the most common type of gastric polyps detected in an upper endoscopy. Numerous of these tiny polyps occur on the gastric mucous lining in the stomach wall where the parietal cells are concentrated.The parietal cells are responsible for secretion of the gastric acid. The polyps are sessile which would mean that they are without any stalks. The presence of the polyps causes both superficial and deep lesions on the surface of the fundic glands. Parietal cell hyperplasia ( abnormal proliferation or multiplication) of the cells may result in superficial and deep dilations in the fundic gland.
Symptoms of Fundic Gland Polyps
The condition could exist without any symptom and can be an incidental finding during an investigation like gastroscopy done for any other reason. Other symptoms include the following:
- Epigastric pain
- Unexplained weight loss
What are the causes behind this condition?
- Preexisting FAP, which increases the risk of the discussed disease, is brought about by the abnormal mutation in the APC gene.
- In sporadic cases, it could be caused by the prolonged use of proton pump inhibitors (gastric acid suppressing medications like omeprazole). The persistent gastric acid suppression brought about by the proton pump inhibitors causes excess secretion of the hormone gastrin. This hormone signals the brain to increase the secretion of the gastric acids. This particular event could be associated with the development of polyps in sporadic cases.
- Mutations in the beta catenin gene is also responsible for it in sporadic cases.
Congenital conditions associated with the disease
- Familial Adenomatous Polyposis
- Peutz-Jeghers syndrome
- Cowden’s syndrome
- Juvenile polyposis
Treatment of Fundic gland Polyps
- The first step would be to discontinue the usage of proton pump inhibitors.
- Polypectomy is performed to remove polyps. Presence or development of high grade dysplasia (abnormal growth or development of cells) makes it imperative to remove the polyps. Larger polyps measuring more than 15mm needs to be removed with a procedure known as hot snare polypectomy. Smaller polyps are removed with procedures known as hot or cold biopsy forceps. However, they are treated as conservatively as possible. The above mentioned procedures come with the risks of perforation, thermal injury, necrosis of residual tissue and bleeding.
- A study showed that the administeration of Non Steroidal Anti Inflammatory Drugs (NSAIDs) can regress the polyps. However, the efficacy of this conclusion is not verified.
Associated cancer risk with the condition
- The condition comes with an associated cancer risk. When the condition is caused by congenital genetic mutations the cancer risk is more. The risk is substantially less in acquired or sporadic cases.
- Patients with multiple polyposis syndrome are required to go for regular screening for cancer. Periodic colonoscopy is advised to look for the presence of the said condition. If polyps as in FAP is discovered, other family members should also be advised cancer screening. Endoscopy is advised once in three years to look for abnormal cell proliferation and malignancy.