Symptoms of a polyp of the stomach. Inflammatory fibrous polyps. Fibrous inflammatory appearance

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Polyp twelve duodenal ulcer- This is one of the types of benign neoplasm. In addition to polyps, doctors can find lipoma, myoma, fibroma, and so on in the duodenum. In this part of the intestine, they appear quite rarely and are considered safe for humans. However, in 30% of cases, it can also degenerate into cancer, so treatment is still necessary.

What is a polyp

Polyps are called tumors, they grow on the mucous membrane of organs, including the body of the duodenum or its bulb. They appear on the intestinal wall and grow into its lumen, are benign.

Polyps can be of two types: on the "leg", that is, they have a thin membrane that connects it and the surface of the organ, as well as on the base. The second kind of appearance resembles a bump. Outwardly, they can be different: oval or spherical, sometimes they look like a mushroom. Their surface is also different: sometimes smooth, sometimes velvety, sometimes granular, in color - a little darker than the mucosa itself. The body of the polyp itself is formed from parts of the epithelium, and there are many vessels in the connective tissue.

Most often they are small, barely growing to 1 cm, but sometimes they grow or form groups. Polyps can be small, that is, up to 2 cm in size, large if they grow from 2 to 5 cm, and giant if their size exceeds 5 cm.

Many have a tendency to degenerate into a cancerous tumor. Therefore, often their appearance is a precancerous condition. Especially dangerous are those polyps that are inherited, then the risk of rebirth is high.

Kinds

There are several types of polyps:

Single.
Multiple.
Polyposis, when there are a lot of them.

Also, these neoplasms can be divided into the following groups:

Inflammatory polyp. They appear where the tissue has become inflamed.
Hyperplastic polyp that grows from normal tissue. It rarely turns into cancer.
A neoplastic polyp, meaning it has begun to grow from tissues or cells that are atypical. They can be divided into benign and malignant, that is, adenomatous. Such polyps grow from the glandular epithelium (this is a special layer of cells that first forms and then releases various substances). It is adenomatous polyps that can later degenerate into cancer. Doctors have noticed that the risk of rebirth increases if it reaches a significant size.
There is another type, inflammatory-fibromatous. But they can be called polyps with a stretch, since they only resemble these neoplasms in their shape, but are not polyps.

Causes of polyps in the duodenum

It cannot be said that polyps in the 12th duodenum appear for one reason or another. Physicians do not have such a list, but there are several hypotheses that explain their appearance. Someone is sure that polyps are a transition from inflammatory disease to cancer. Others believe that the wrong embryonic development of the mucous membrane is to blame. But a single theory that would explain the appearance of these neoplasms does not yet exist.

A number of factors have been observed that are predisposing, they contribute to the appearance of polyps:

heredity. There is a high risk of detecting neoplasms if they were found in relatives;
improper nutrition. If a person ate too much smoked or salted food, did not refuse fatty foods, and at the same time ate little vegetables and fruits, he may have polyps;
bad habits. They also play a role in the onset of the disease, so it is not recommended to abuse alcohol and smoke. Also included here are sedentary image life, low physical activity person;
ecological situation. If the patient lives in an ecologically unfavorable region, then this cannot but affect his health;
can affect and frequent constipation, as well as intestinal dysbacteriosis;
some chronic diseases 12 duodenal ulcer or digestive system, allergies, general decrease in immunity.

Symptoms

If polyps appear in the lumen of the duodenum, there may be no symptoms. It is in this organ that the disease in the first stages can be asymptomatic, since polyps develop and grow slowly when compared with the same neoplasms in other organs. Often this benign tumor is found by chance when the doctor examines the gastrointestinal tract. But sometimes the symptoms of the disease still make themselves felt. They can be different, since much depends on the size of the benign tumor, and on its location, on the degree of damage to the mucous membrane.

Symptoms and treatment are similar to the signs and treatment of other gastrointestinal diseases:

a person is disturbed drawing pains: it hurts either the whole abdomen, or the epigastric region. The pain appears after eating, after 1-3 hours;
the patient has heartburn, belching;
he loses his appetite, begins to lose weight rapidly, he may have anemia;
often the patient feels sick, vomiting appears;
diarrhea is gradually replaced by constipation;
if there is hidden bleeding, the patient has weakness, dizziness, he feels unwell;
depression may occur.

Diagnostics

If the patient is not worried about the signs of the disease, that is, it is asymptomatic, it is almost impossible to make a correct diagnosis. But it happens that it is discovered by chance when the patient was examined due to the appearance of other pathologies of the gastrointestinal tract. If the symptoms listed above appear, or at least some of them, the doctor may prescribe an examination to make the correct diagnosis.

Basic surveys

The doctor will ask the patient to donate blood for analysis, by which it will be possible to determine the presence of anemia, as well as to make a coprogram, that is, to see if there is blood in the patient's stool. But this is not enough, a number of examinations will have to be carried out, the main of which is FEGDS or fibroesophagogastroduodenoscopy. Thanks to this method, the physician can examine the mucous membrane of not only the duodenum, but of the entire gastrointestinal tract. For this, an endoscope with a camera is used.

Also, with the help of this equipment, you can take the material for analysis. A biopsy will show whether the tumor was benign and will help to see the structure of the tissues. Moreover, if single polyps of small size, with a long stem and an oval head can be found in the duodenum, they can be removed immediately. This procedure is painless and is performed using a small tube.

Additional examinations

There are other methods of examination that are used less often:

Radiography when barium contrast is applied. Thanks to this method, you can see the polyp, it will look like a darkened defect of a round or oval shape with clearly defined edges. If it is a polyposis, then these blackouts merge into one. You can use this diagnostic method, but it has its drawbacks: polyps that are small (up to 10 mm) are not visible, and it is not clear whether they can degenerate into a tumor.
ultrasound. It helps to determine the presence of a tumor, since the picture shows clear boundaries of the growth that grows into the intestinal lumen. Also on the ultrasound you can see if the polyp has a leg.
CT. It is prescribed if it is not possible to make the patient FGDS, as well as if a malignant tumor is suspected. Expensive examination to be carried out frequently. But it also helps to find small polyps, determine their structure, consider all anomalies of the gastrointestinal tract, and using this procedure, you can find out the causes of the appearance of polyps.
MRI. With it, you can get a detailed image of the duodenum. But it is rarely used for the diagnosis of polyps, since the intestines are multilayered, it can be difficult to enlighten all its bends. In addition, MRI expensive procedure, and it does not show inflammatory processes. But the degree of damage to the mucosa and all, even the smallest, neoplasms are visible.

Treatment

If a tumor was found, even if benign, it must be removed. Therefore, this disease is treated surgically. Sometimes the patient may be prescribed medications to help the body recover before surgery. Most often, drug treatment is carried out if the patient has reduced immunity, he has anemia, or there are disorders in blood clotting, as well as in the treatment of elderly patients.

As mentioned above, small polyps of a certain shape can be removed already during the diagnosis. For this, a gastroduodenoscope with fiber-optic equipment is used, with a metal loop that captures the polyp. After removal of the tumor, the wound is cauterized, laser therapy and medical sanitation are carried out.

If it is a large polyp that has grown to 5 cm, or they are found in the duodenal bulb, a resection of the affected area is performed. During surgical intervention do an analysis of intestinal tissue for histology. If the biopsy shows that the tumor is malignant, then after the operation the patient will have to undergo chemotherapy. When it is confirmed that the neoplasm is benign, the patient has every chance to fully recover.

Prevention

Even if you managed to get rid of polyps, there is a risk that they will reappear. Usually, after 2 years, a relapse begins, polyps can grow again in the duodenum. To avoid this, it is important to carry out prevention:

Refrain from alcoholic beverages.
Try to eat right.
Register with a gastroenterologist and undergo at least once a year endoscopic examination.

It is also important to constantly be examined for those whose relatives suffer from this disease and those who have chronic diseases Gastrointestinal tract and everyone over 45 years old.

If you have polyps, you should not refuse treatment. Otherwise, complications may appear: polyps may degenerate into cancer, perforation of the tumor may form with the development of peritonitis, or the intestinal lumen will narrow due to an increase in the size of the polyp. There may also be bleeding from the polyp. Therefore, the disease must be treated, and the sooner you see a doctor, the easier it will be to do so.

A polyp is usually called any formation protruding into the lumen of an organ. Polyp is a macroscopic term, and its nature can be established only after histological examination. Polyps make up about 3% of all stomach tumors, while cancer accounts for 88%. In structure precancerous diseases stomach, the proportion of polyps is minimal - only 1%.

According to the international histological classification, all polyps are divided into true (adenomas) and tumor-like formations. Among all gastric polyps, adenomas occur in 14-15% of cases. Hyperplastic and fibrous polyps, which are not tumors according to the histological structure, make up the majority of gastric polyps (more than 85%) and are built from glands lined with pitted epithelium.

Macroscopically, adenomas are single and multiple, having a wide base and stalk. Adenomas are localized more often in the antrum and cardia of the stomach. The diameter of adenomas ranges from a few millimeters to 4-5 cm.

According to the classification of S. Yamada, based on endoscopic signs, polyps are divided into 4 types:

Flat
speaker
On a short leg
education various sizes on legs of various lengths.

In the stomach, single, multiple polyps and polyposis can occur. When they appear stomach polyp symptoms colonoscopy is required.

The favorite localization of gastric polyps is the body and antrum. With polyposis, they gradually spread to the cardiac section.

Type 1 polyps are from 3 to 6 mm in diameter, they are plaque-like formations that do not differ in color from the surrounding gastric mucosa. Such polyps are often multiple, localized on the body of the stomach and in the antrum. On instrumental palpation, the polyps are soft, easily displaced with a portion of the mucous membrane, and bleed moderately during the biopsy. According to their histological structure, these are, as a rule, hyperplastic polyps.

Type 2 polyps are hemispherical in shape, 1.5 to 2 cm in diameter, with a smooth surface, their color is brighter compared to the surrounding gastric mucosa. The consistency of the polyp depends on its histological structure. Polyps of the adenomatous type with instrumental palpation are denser than hyperplastic polyps, and they are usually single.

Type 3 polyps - round or oval, on a short stalk, with a diameter of several millimeters to several centimeters. Small polyps have a finely bumpy surface and a grayish-red color.

Type 4 polyps are formations of various sizes (from a few millimeters to 3 cm), sometimes they have such a long stem around which the polyp can twist. The polyp has a smooth or bumpy surface, resembling a cauliflower in appearance.

Common to all types of polyps is that the gastric mucosa around the polyps is not changed, the polyps are easily displaced when grasped with biopsy forceps, they bleed moderately during instrumental palpation.

All stomach polyps are currently removed during endoscopy. To remove polyps from the upper gastrointestinal tract, radio wave surgery is widely used, on the basis of which the Surgitron device was created.

Polyposis of the stomach is a benign epithelial formation that poses a danger to human life, since it tends to degenerate into malignant cancerous tumors. The symptoms and causes of the disease are not very pronounced while the cell hyperplasia is benign, and therefore extremely dangerous - on early stages the person does not even think about the diagnosis. Fortunately, medicine does not stand still, new types of research and treatment appear. What to do if you suspect you have symptoms of the disease? Of course, consult a doctor and undergo a routine examination! The consequences of delay or ignoring are dangerous to health.

Causes and classification

According to International classification diseases (ICD), this disease has the code K31.7 (diseases of the esophagus, stomach and duodenum) - polyps of the stomach and duodenum, D13.1 (benign and formation of an indefinite or unknown nature) -.

Why do tumors appear? The reasons that favorably affect the appearance of polyps inside the body are not fully understood and therefore especially dangerous. However, there are a number of diagnosed prerequisites for development:

Inflammatory processes often act as a breeding ground for the appearance of polyps. The body of the stomach is covered with ulcers and gastritis (for example, hypertrophic polyposis gastritis), breaking the integrity, increasing irritation and creating favorable environment for pathological neoplasms. For example, large tumors in the pylorus or fundic cell hyperplasia.
Age over 40 years. The pathogenesis of the disease is not fully understood, but doctors attribute this to the aging of the body, the coating of the stomach is more vulnerable to cancerous tumors.
Bacteria - infects the stomach and duodenum. Etiologically, it affects the appearance of ulcers and cancer of the stomach, duodenitis, and some lymphomas. Statistics show that infection Helicobacter pylori does not always lead to the formation of polyps.
Hereditary predisposition:
- Familial adenomatous polyposis (ICD code C18, D12) leads to the formation of multiple polyps in the colon, sometimes spreading to the stomach. The disease is asymptomatic, occasionally accompanied by hemopositive stools.
- Peutz-Gigers syndrome (ICD code Q85.8) - is manifested by polyposis of the gastrointestinal tract. Reliable symptoms: appear on the skin, gums and cheeks big spots. Localized in the antrum of the stomach, on a wide base, bright severe hyperplasia. The tumors formed in this syndrome tend to form cysts, accompanied by cystic enlarged glands with mucus.
- Juvenile polyposis syndrome (absent in the ICD) is a familial polyposis that occurs in children with an autosomal dominant type of inheritance. The polyp is large, rounded, with an ulcerated surface, the coating is usually edematous and contains an inflammatory infiltrate, hyperplasia is observed.
Some medicines. (ICD code K21) and long-term use inhibitors proton pump associated with the appearance of polyps of the fundic gland and tumors of the pylorus.
Wrong nutrition. People whose diet consists mainly of spicy, fatty foods are more prone to the formation of polyps in the stomach.
High levels of stress and a weakened immune system contribute to the aggressive appearance of polyps in large quantities Oh.

The classification of gastric polyps into species occurs according to morphological features and is divided into two types: neoplastic (adenomatous, glandular, cardiac, antral) and polyps not associated with neoplasia (hyperplastic, hyperplasiogenic). Also, the classification of the ICD includes a quantitative character - single, multiple. Neoplastic polyps include adenomatous and glandular polyps of the stomach:

The emerging adenomatous polyp (ICD code D13.1) consists of glandular cells of the stomach and is a precancerous condition, on a broad base to which it is attached on a leg. Adenomas are divided into tubular, papillotubular and papillary. Hyperplasia of this type is about 1 cm in diameter. Multiple adenomatous polyps with a diameter of more than 2 cm are a serious health hazard.
Glandular polyps of the stomach are similar to the surrounding gastric tissue, epithelial hyperplasia is negligible. These are soft, large polyps that tend to grow into cystic cavities that never extend beyond the muscle membrane. The structure is similar to hypertrophic polyposis gastritis. Predominantly occurs in the fundic part of the stomach. The risk of formation of glandular polyps in the pyloric region increases with the use of inhibitors.
Polyp of the antrum of the stomach (prepyloric) - has some signs of adenoma, but mostly single. Hyperplasia of the prepyloric section is the most vulnerable, compared to others, which is why it is more prone to malignant degeneration. According to statistics, the polyp of the prepyloric department is most common - in 70 cases out of 100.
Cardiac polyposis is the least common. They are localized in the zone of cardiac transition to the stomach. Normally, the sphincter prevents food from getting back into the esophagus from the stomach, but if the cardia is disrupted, acid seeps into the esophagus, which leads to inflammation. The consequences of disruption of the cardiac department: a polyp is formed, which transforms into a tumor on the leg.

Tumors not associated with neoplasia are divided into: non-associated and associated with polyposis types:

Hyperplasia that is not associated with polyposis often has a benign genesis. This group includes:
- A hyperplastic polyp is characterized by the proliferation of stomach epithelial cells and is a benign tumor on a wide process or stalk. Rarely, a hyperplastic polyp grows larger than 2 cm in diameter. They occur most often, develop due to chronic gastritis.
- Hyperplasiogenic polyp of the stomach. In structure, this is hyperplasia, similar to a cauliflower inflorescence. The development of such a polyp leads to a violation of the functions of the glands of the gastric mucosa. Hyperplasiogenic polypoid neoplasm is solitary, more common in the body of the stomach, the size does not exceed 2-3 cm. Malignancy is rare, only 20% of patients with gastric cancer found hyperplasiogenic polyps.
- Inflammatory fibrous polyp - fibrous pseudopolyp. Localized near the pylorus or prepyloric region, the size of the polyp often does not exceed 1.5-2 cm in diameter. The body is delimited, located on a wide bed or a distinct stalk in the submucosal layer. Accompanied by ulceration of the epithelium.
- Hypertrophic polyposis gastritis - characterized by single or numerous growths on the mucosa of the prepyloric stomach.
Neoplasms associated with polyposis are hereditary, and line the inner surface of the gastric mucosa. Types of such tumors: Gardner polyposis, Peutz-Gigers polyposis, juvenile polyposis syndrome.

Symptoms

Symptoms of the disease are not very pronounced, making it difficult to diagnose and reduce the likelihood of treatment in the early stages. The reasons why tumors appear are also poorly understood. This is very dangerous for health. You can list rare signs the fact that a person has polyposis:

uncomfortable It's a dull pain in the area of the pancreas;
acute pain in the stomach;
poor digestibility of food, nausea, vomiting;
bad breath;
large scatterings of tumors near the pylorus or prepyloric section disrupt the patency of the stomach, which leads to bloating, heaviness in the abdomen;
alternating constipation and diarrhea;
blood in stool blood clots in vomiting;
dull, aching pain in the stomach;
pigmentation of the gums and cheeks, purple color of the lips;
pigmentation on the palms.

It's dangerous to wait painful manifestations diseases, the consequences can be disappointing.

Diagnostics

Types of diagnosis of polyposis include asking the patient about hereditary diseases, health complaints, endoscopic examination internal organs and laboratory research discovered samples. Based on the results of the study, the causes of the disease are established.

Endoscopy is a method of examining the organs of the gastrointestinal tract, in which an endoscope is inserted through the mouth opening. Endoscopy is a harmless and almost painless method of examination.

Fibrogastroscopy is performed endoscopy). Using an endoscope (a long, thin tube with a camera at the end), the doctor examines the upper gastrointestinal tract. If during the examination a polypoid neoplasm is found, as additional research ordered ultrasonography.

Endoscopic ultrasonography helps the doctor determine how deep the polyp has grown into the lining of the stomach. In addition to the camera, the endoscope is equipped with an ultrasonic sensor. The advantage of ultrasonography is the ability to visually distinguish between benign and tumor formations.

Fluoroscopy - allows you to examine the walls of the stomach after exposure contrast medium(usually it is a suspension of barium). This research method is used when large polyps or their scattering are found.

Endoscopic examination is accompanied by a biopsy of the polyp of the stomach - compulsory procedure performed during endoscopy. A small part is cut off from the polyp and mucosa in order to analyze for histology and cytology. In this way, the benignity/malignancy of the polyp is determined. If it is less than 1 cm in diameter, it is removed during a biopsy. Endoscopy of this kind eliminates the possibility cancerous degeneration, dysplasia and and helps in determining the type of polyp.

Treatment

First of all, the treatment of a polyp of the stomach is to follow the advice of a gastroenterologist. How to treat polyps in the stomach? Should it be removed? There are two directions - conservative and surgery(endoscopy), depending on the nature and severity of the disease.

conservative

Choice conservative treatment effective for small intestines, as they do not degenerate into cancer. Also, medication can affect the work of the cardia, reducing the likelihood of the appearance of new tumors, and stabilizing the work of the prepyloric section of the stomach.

Medications are prescribed mainly to stabilize the acidity of the stomach in order to reduce and avoid further epithelial damage to the cardia. If acidity is increased, drugs are prescribed that block the production of hydrochloric acid. In the presence of Helicobacter pylori, apply antibacterial agents. Following a certain diet affects the healing process.

Medically formed polyps are treated only if an operation is to be performed.

Should it be removed?

It is easy to cope with the disease surgically - just remove the formation. An endoscopic polypectomy, an operation to remove a tumor, or laser burning comes to the aid of a person and doctors. Types of surgical intervention:

Loop removal in polypectomy, which is suitable for all pedunculated polyps. If a polypoid neoplasm is detected, 3-5 ml of a solution of novocaine or aminocaproic acid is injected into the submucosal layer. Infiltration occurs and the formation rises above the surface of the mucosa, which facilitates the capture of the loop. A two-channel endoscope is used - a loop is wrapped around the area, and then, under the influence of current, the loop is welded to the mucosa. After the loop is tightened, the polyp is cut off by current.
Endoscopic biopsy during polypectomy is suitable for both small-diameter tumors (hyperplastic polyps) and large, overgrown ones (adenomas). Polypoid tumors more than 1.5 cm in diameter are removed by endoscopic method in parts.
Aspiration - suction of the tumor to the end of the device.
Laser cauterization is the most gentle method of polypectomy. Cauterization by a laser is carried out in layers, evaporating soft tissues. An indisputable plus of this method (laser) is the sealing of blood vessels, which contributes to rapid healing and prevents internal bleeding. Laser cauterization is a convenient way to get rid of tumors in the pylorus or intestines.
With multiple neoplasms in the distal part of the stomach, a segmental resection is prescribed. If tumors appear in the remaining stump, they also have to be removed, possibly cauterization with a laser.
Gastrectomy ( complete removal stomach).

With polyposis (the appearance of many polyps), polypectomy is performed repeatedly, affecting the intestines, in order to avoid bleeding, perforation, or worsening of the patient's condition. Often, cauterization and plastic surgery of the cardia are used for treatment. A hyperplastic polyp is most often not removed. The operation takes place once every 2-8 weeks, during which time the mucous membrane is restored.

Given the tendency of polyps to re-form, after surgical intervention must pass regular examinations at the doctor's. And only after making sure that the polyp has disappeared, you can return to normal life.

Version: Directory of Diseases MedElement

Polyp of stomach and duodenum (K31.7)

Gastroenterology

general information

Short description

Polyp of the stomach- accumulation of cells inner surface stomach.

Polyps of the duodenum(DPC) are rare and refer mainly to benign formations KDP (see " benign neoplasm duodenum" - D13.2). Sometimes polyps of the stomach, prolapsing into the lumen of the duodenum, are mistaken for polyps of the duodenum.

All polyps of the stomach and duodenum are divided into single, multiple and polyposis. Polyps range in size from a few millimeters to 5 cm or more (polyps larger than 2 cm are considered large).

The most common typology of stomach polyps includes:
- hyperplastic polyps;
- polyps of fundic glands;
- adenomatous polyps.

Hyperplastic polyp* - the most common polypoid formation of the stomach, consisting of glands lined with highly differentiated "overripe" pit epithelium and a small group of pyloric glands in depth.
Almost half of hyperplastic polyps (especially the colonic variant) have intestinal metaplasia. Metaplasia is a persistent replacement of differentiated cells of one type with differentiated cells of another type while maintaining the main type of tissue.
epithelium, erosion varying degrees maturity and cystic enlarged glands and cysts (in 70% of hyperplastic polyps).

Inflammatory fibrous polyp** (fibrous pseudopolyp, eosinophilic granulomatous polyp) is extremely rare and is usually localized in the pyloric region. The size of the polyp averages 1.5-2 cm in diameter, it is clearly delimited, has a wide base or a well-defined stalk. Such a polyp is located more often in the submucosal layer, the mucous membrane above it is thinned and often ulcerated.

Microscopically, an inflammatory fibrous polyp is represented by a loose or denser connective tissue, among which there are vessels of different diameters. The largest of the vessels are often surrounded by concentric layers of connective tissue fibers and fibroblasts, which is considered characteristic of these formations. In addition to fibroblasts, lymphoid and plasma cells, macrophages are detected.

Fundal glandular polyps(glandular polyps of the fundus of the stomach) - consist of hypertrophied glands of the fundus of the stomach. Among them are distinguished:
- sporadic polyps - have a wide base with a diameter of 1-5 mm, are not associated with chronic atrophic gastritis;
- glandular polyps of the fundus of the stomach against the background of familial adenomatous polyposis of the intestine;
- polyps caused by taking inhibitors (blockers) proton pump.
Some authors consider fundic glandular polyps to be a variant of the norm.

* When describing a hyperplastic polyp, the following terms are also used: regenerative polyp, inflammatory polyp, polyposis gastritis, hyperplasiogenic, organotypic, regenerative, hyperplastic adenomatous polyp.
The use of the term "hyperplastic adenomatous polyp" is not recommended as it may lead to confusion this concept with an adenoma (adenomatous polyp), which is a true neoplasm and fundamentally differs from a hyperplastic polyp by the presence of dysplasia Dysplasia - misdevelopment tissues and organs.
epithelium.

** Since in some cases in inflammatory fibrinous polyps the presence of a large number eosinophils, the term "eosinophilic granulomatous polyp" is also applied to these polyps. It should be borne in mind that this formation is not related to eosinophilic granuloma and eosinophilic gastritis.
Since this type of polyp has not been proven to be associated with inflammation, the most rational term for it is "fibrous pseudopolyp".

Note 1. The classification of polyps is based on the WHO histological classification of gastric tumors (1982), in which adenomas, tumors from the glandular epithelium, are classified as true gastric polyps, and all other types of polyps are considered as tumor-like processes.

2. congenital syndromes polyposis (how hereditary are assigned to the block of rubrics " congenital anomalies[malformations], deformities and chromosomal abnormalities"- Q00-Q99), which include:

Hamartoma polyp (Peutz-Jeghers syndrome);

Juvenile polyps;

Cowden disease;

Syndrome Gardner.
3. Ectopia of the pancreas into the wall of the stomach.
4. Xanthoma / xanthelasma.
5. Gastric carcinoid.

Note 2. The coding of the disease Cronkhite-Canada syndrome is controversial.

Cronkhite-Canada Syndrome- sporadic (not congenital, not inherited) disease, which is manifested by polyposis of the gastrointestinal tract and can occur at any age. Belonging of the disease to hamartia Hamartia is a developmental anomaly: an incorrect ratio of tissues in the anatomical structures or the presence of abnormal remains of embryonic formations in a mature organism
not proven. The etiology is unknown, congenital character, heritability, family predisposition have not been proven.
About two-thirds of patients with this syndrome are of Japanese origin; the ratio of men and women is 2:1.
In Cronkhite-Canada syndrome, polyps are most often found in the stomach and large intestine, less often in small intestine, rarely - in the esophagus.
The syndrome includes diffuse polyposis of the gastrointestinal tract with chronic diarrhea, nail dystrophy, alopecia Alopecia - persistent or temporary, complete or partial loss (absence) of hair.
and diffuse hyperpigmentation of the skin. At the same time, hypoproteinemia is observed as a result of protein-losing enteropathy; the content of calcium, potassium and magnesium in the blood serum may also decrease due to malabsorption.
The prognosis of the disease is serious, malignancy is possible.
Treatment of enteropathy is substitution (diet, albumin infusion, partial parenteral nutrition, oral corticosteroids). GCS (glucocorticoids, glucocorticosteroids) - drugs one of the leading properties of which is to inhibit early stages synthesis of the main participants in the formation inflammatory processes(prostaglandins) in various tissues and organs.
) or surgical (resection).

Depending on the location of the polyps, Cronkhite-Canada syndrome may be coded alongside this subcategory of K31.7 in the following subcategories:
- Other specified diseases of intestine - K63.8;
- Polyp A polyp is a pathological formation protruding above the surface of an organ and associated with it by a leg or its base.
colon - K63.5.
However, since on biopsy polyps in Cronkhite-Canada syndrome resemble hamartoma polyps, some authors consider the syndrome to be a variant. congenital pathology by analogy with other hamartomas.

Until the end of the discussion short description syndrome is given in this subheading.

Classification

There is no single classification applicable to this subheading. For all polyps of the stomach, as one option, the classification of the British Gastroenterological Society is recommended.

Classification of polyps of the stomach(British Gastroenterological Society, 2010)

1. epithelial polyps:
- hyperplastic polyp;
- glandular polyp of the fundus of the stomach;
- adenomatous polyp (including familial adenomatous polyp);
- hamartoma polyp: juvenile polyp.

2. Non-mucosal intramural polyps:
- leiomyoma;
- inflammatory fibroid polyp;
- gastrointestinal stromal tumor;
- fibroma / fibromyoma;
- lipoma;
- ectopic pancreatic tissue;
- neurogenic and vascular tumors;
- neuroendocrine tumors (carcinoids).

Etiology and pathogenesis

Hyperplastic polyps arise as a result of a violation of cell renewal, an increase in the lifespan of cells, which leads to excessive regeneration of the surface and pit epithelium. There is no consensus on etiology.
As etiological reasons for hyperplastic polyps can act:
- later stages Helicobacter infection;
- some gastritis (for example, type A gastritis).

For inflammatory fibrous polyps it is assumed that the etiology is associated with hypochlorhydria or achlorhydria and Helicobacter pylori infection.

Epidemiology

Age: Mostly adults

Sign of prevalence: Rare

Polyps of the stomach are quite common: during gastroscopy, they are detected in 0.7-6.6% of the examined; according to autopsy data, polyps are found in 0.3-1.1% of cases of diseases upper division gastrointestinal tract.

Pseudotumor (non-true) polyps belonging to this subheading account for 90-95% of all polyposis formations of the stomach and duodenum.

Gastric polyps are more common in people aged 40-50 years, but can occur even in children.

In more than 70% of cases, gastric polyps are located in the outlet section of the stomach; the second most common site of injury is body of the stomach.
According to summary data, single polyps occur in 47-50% of cases, and multiple - in 52.6%. Diffuse polyposis of the stomach is observed in 2-10% of patients.

Factors and risk groups

- mature and advanced age;
- Helicobacter pylori infection;
- atrophic gastritis;
- long-term use of PPIs PPIs (PPIs) are proton pump inhibitors. medicinal substance, which reduces the secretion of gastric hydrochloric acid by blocking the proton pump in the lining (parietal) cells of the gastric glands.
.

Clinical picture

Clinical Criteria for Diagnosis

Nausea, belching, epigastric pain

Symptoms, course

specific clinical picture absent in gastric polyps. The exception is the bright clinic of Cronkhite-Canada syndrome (see section " general information"), which is conditionally assigned to this subheading.

In half of patients, gastric polyps may be asymptomatic and be a finding during examination. The course of the pathology can be characterized by a clinic of indefinite gastritis - nausea, belching, stable dull pains in the stomach after eating.
Polyps of the stomach are rarely manifested by bleeding, but when it occurs, it is not prolonged and massive. In this case, patients present with symptoms of chronic latent blood loss and anemia (pallor, weakness, hypotension, tachycardia).
Cases of obstruction of the antrum of the stomach by a giant polyp and even its prolapse into the lumen of the duodenum with a clinic of acute high obstruction are described.

In some cases, the clinical manifestations of a gastric polyp are very diverse, as a result of which patients for a long time treated for such concomitant diseases, how chronic cholecystitis, pancreatitis and others.

Malignization Malignancy is the acquisition by cells of a normal or pathologically altered tissue (for example, a benign tumor) of the properties of malignant tumor cells.
polyps occurs imperceptibly and is not accompanied by characteristic clinical signs. However, the suspicion of a malignant polyp should arise when the appearance or increase general weakness, a change in the nature of dyspeptic disorders, a decrease or loss of appetite, causeless weight loss.
For timely detection of malignancy, patients with a polyp or polyposis of the stomach should be under the constant dynamic supervision of an oncologist.

Diagnostics

1. FGDS is the gold standard for diagnosis. Allows you to take a biopsy, research for concomitant diseases (gastritis, Helicobacter pylori infection) and malignancy, as well as medical manipulations (from stopping bleeding to resection Resection - a surgical operation to remove part of an organ or anatomical formation, usually with the connection of its preserved parts.
polyps).
According to the literature, from 3 to 40% of polyps detected during gastroscopy are not visible radiographically.

2.X-ray contrast study. Gastric polyps appear as a filling defect of a round or oval shape with clear contours. If the polyps are located on the leg, the filling defect is displaced. With a close location of polyps, filling defects can merge with each other and acquire an irregular shape.
Prolapse of stomach polyps into the duodenum is more often noted when the patient is laid on the right side.
In the circumference of the polyps, the relief of the mucous membrane is not changed, the folds of the mucous membrane retain their transverse size and direction, or go around the polyps. Polyps do not cause damage motor function stomach.
Filling defects are better visualized with half-hard filling of the stomach with barium suspension and moderate dosed compression.
Polyps smaller than 5 mm are relatively difficult to detect.
Reliable radiological signs malignancy of polyps of the stomach are absent.

3.CT scan used in cases of suspected malignancy or impossibility of EGD FGDS - fibrogastroduodenoscopy ( instrumental research esophagus, stomach and duodenum using fiber optic endoscope)
.

4. Angiography Angiography - x-ray examination blood and lymphatic vessels after injection of a contrast agent.
conducted for differential diagnosis with intramural benign tumors of the stomach.

Laboratory diagnostics

There are no specific laboratory changes.
In some cases, hypo- or achlorhydria is detected, however, in patients young age they may be missing.
Pernicious anemia occurs in 10-15% of patients Pernicious anemia is a progressive form of anemia that occurs when there is a violation of the absorption of vitamin B12; one of the forms of etiology is hereditary, associated with a genetically determined deficiency of vitamin B12-binding blood factor
and/or posthemorrhagic anemia Posthemorrhagic anemia - Iron-deficiency anemia that develops after blood loss
(due to chronic bleeding).

Differential Diagnosis

Gastric polyps belonging to this subheading should be differentiated from the following diseases:
- adenomatous (true polyp) of the stomach;
- hamartoma polyp of the stomach (Peutz-Jeghers syndrome);

Juvenile polyps of the stomach;

Cowden disease;

Gardner's syndrome;
- ectopia of the pancreas in the wall of the stomach;
- xanthoma / xanthelasma;
- gastric carcinoid;
- peptic ulcer stomach and duodenum;
- gastrointestinal stromal tumors (GIST);

Dermoids;

Glomus tumor of the stomach;
- Menetrier's disease (giant hypertrophic folds of the stomach);
- malignant tumors stomach (polypoid cancer);
- endothelial tumors (hemangiomas, lymphangiomas, endotheliomas);
- benign tumors of mesenchymal origin (myomas, fibromas, fibromyomas, neurofibromas, neurinomas, neurilemmomas, lipomas);
- heteroplastic neoplasms of the stomach (choristomas, chondromas, osteomas and osteochondromas).

Polypoid cancer
In the early stages, polypoid cancer radiologically differs little from benign polyps. For cancer, the following signs are considered more characteristic:
- irregular shape of the filling defect with jagged and fuzzy contours;
- loss of peristalsis at the level of the tumor, which indicates infiltration of the submucosal, and sometimes the muscular layers of the stomach.
At benign polyps filling defects have an even contour, and the folds of the mucous membrane go around the polyp without interruption.

Gastroscopic picture, indicating the possibility of polypoid cancer:
- the polyp is larger than 2 cm;
- the surface of the polyp is uneven and bumpy;
- the mucous membrane is whitish, in some cases - with erosions and hemorrhages, hyperemic;
- the base of the polyp is wide, passing into the surrounding mucous membrane without a visible border.

A biopsy is necessary to make a definitive diagnosis.

Peutz-Jeghers Syndrome: autosomal dominant inheritance, melanin pigmentation of the skin and mucous membranes, gastrointestinal polyposis.

Gardner syndrome: widespread adenomatous polyposis, multiple osteomas of the skull, epidermal cysts, soft tissue tumors (fibromas) of the skin.

Cronkhite-Canada Syndrome: multiple widespread polyposis, diarrhea, anemia, skin pigmentation, brittle nails, edema, hypoproteinemia due to exudative enteropathy with loss of large amounts of serum protein.

Familial (diffuse) polyposis: adenogenic polyps are localized mainly in the large intestine, the stomach is involved in the process in less than 5% of cases.

Juvenile polyposis: usually develops in childhood, polyps (hamartomas) are more often localized in the large intestine, less often in small intestine and stomach.

To exclude widespread polyposis, when gastric polyps are detected, a thorough examination of all parts of the digestive tract is necessary.

polyps of the stomach with wide base should be differentiated from benign submucosal tumors (fibromas, myomas, lipomas, etc.), as well as from dystopic pancreas.
intramural tumors, unlike polyps of the stomach, usually solitary. The tumor is covered with a smooth mucous membrane of normal color; the mucosa is not soldered to the tumor.
Dystopic pancreas characterized by the presence of the mouth of the outlet duct in the center of the hemispherical formation (detected by X-ray or endoscopic examination).

Complications

1. Malignization- Rarely develops in non-adenomatous polyps. Against the background of chronic gastritis, which is manifested by hyperplastic polyps, epithelial dysplasia and the formation of adenomas (true benign tumors).
Hyperplastic polyps are often found outside the tumor in gastric cancer. In this regard, the detection of hyperplastic polyps is a reason for careful monitoring of the patient.
Macroscopically, it is extremely difficult to differentiate benign and malignant polyps (especially at the beginning of malignancy).

Signs of malignant polyps:
- the diameter of the polyp is more than 2 cm;
- absence of a leg and a wide base of the polyp;
- bumpy, nodular surface;
- corroded contours and irregular outlines of the polyp.

As a rule, multiple polyposis indicates a benign disease, but the possibility of malignancy of one of the polyps should not be ruled out.
To determine the nature of the polyp, it is necessary morphological study material taken from several places of the polyp of the stomach and from the most suspicious for the degeneration of multiple polyps. Malignancy is possible both at the top of the polyp and at its stalk.

The risk of malignancy for hyperplastic polyps is 0.6-4.5%, for glandular polyps of the fundus of the stomach, the risk of malignancy depends on size, but does not exceed 0.5% in sporadic cases. With familial polyposis, the risk of malignancy of glandular polyps of the fundus of the stomach increases slightly.

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According to the WHO classification of benign tumors of the stomach /1977/ the development of polyps is referred to as tumor-like processes.

Polyps are any pathological formations towering above with a mucous membrane. Polyps of the stomach can be:

Ø neoplasms proper /adenomatous polyps/,

Ø the result of inflammation /inflammatory/,

Ø result of hyperplasia /hyperplastic/,

Ø hamartroms,

Ø heterotopias.

Polyps develop in all parts of the stomach, most often they are localized in the antrum.

adenomatous polyp - see tubular adenoma.

Hyperplastic polyp- the epithelium is represented by elements of the integumentary-pit type. Pyloric /antral/ glands may be present.

It is characterized by uneven hyperplasia of the glands. found in hyperplastic polyps cystic changes. Phenomena of intestinal metaplasia are rare, have a focal character.

Heterotopia - penetration of pancreatic tissue into the wall of the stomach. Accessory pancreas in the wall of the stomach is often located in distal parts between the serous and muscular layers. The diameter of such a tumor is from 1-2cm. up to 6-7 cm.

The accessory pancreas has the same histological structure, which is the main one.

Hamartomas- incorrectly formed embryonic tissue complexes that are located in organs where these complexes should not be located,

Classification of polyps of the stomach according to the shape and severity of the legs / T. Yamada /, 1971, which distinguishes 4 types of polyps:

I. type:

Ø Flat, plaque-like formations on a wide base, which do not differ in color from the surrounding tissue.

Ø Have a hemispherical shape.

Ø Often multiple.

Ø The size does not exceed 3-6 mm in diameter.

II. Type of:

Ø Hemispherical polyps of a round or oval shape, connected to the mucous membrane by a leg, the length and diameter of which is not greater than the polyp itself.

Ø The diameter of polyps of this type can be 1.5 - 2.0 cm.

Ø The mucous membrane is often brighter, may be covered with small erosions.

III. Type of:

Ø short stalked papillary-shaped polyp with a characteristic cone-shaped apex.

IV. Type of:

Ø long stalked polyp.

Ø There is a well-shaped leg of various lengths.

In addition, polyps are subdivided

/V.A.Rusakov, 1976/:

By the multiplicity factor:

1. Single,

2. Nested,

3. Multiple,

4. Polypos.

By form:

1. round on a leg,

2. round on a wide base,

3. flat,

4. villous,

5. ulcerated.

By size:

1. small up to 1.0 cm,

2. medium 1.0-2.0cm,

3. large 2.0-6.0cm,

4. giant - more than 6 cm.

By localization:

1. cardia.

2. stomach body,

3. pyloric department,

4. 12 duodenal ulcer.

The significance of the division of gastric polyps into hyperplastic polyps and adenomas lies in their significantly different precancerous potential. Malignant transformation is rarely noted in hyperplastic polyps.

Malignant degeneration of gastric adenomas is observed frequently, on average up to 41%.

The incidence of cancer increases with the size of the adenoma. It is noticed that multiple polyps are reborn 5 times more often than single ones.

Malignancy at diffuse polyposis reaches 81%.

Gastric polyps require differential diagnosis with submucosal tumors and carcinoma.

Polypoid cancer - this is:

Ø A well-defined exophytically growing tumor with a wide base of a cylindrical or hemispherical shape.

Ø The surface of the tumor can be smooth, bumpy and nodular.

Ø Often there are ulcerations various forms and size, covered with a dirty gray necrotic coating.

Ø The color of the tumor varies from grayish yellow to red,

Ø size varies from 3 to 8 cm.

Ø More often, tumors are solitary, less often - multiple and are separated from each other by areas of unaffected mucous membrane.

Ø The base of the tumor is clearly contoured and delimited from the surrounding tissues.