Overview
An elevated lesion protruding from the surface of the gastric mucosa in the cardia.
Most of them are asymptomatic, but some of them may have symptoms such as abdominal discomfort and dysphagia.
Causes include genetic factors, Helicobacter pylori infection, etc.
Mainly treated by endoscopic resection
Definition
A cardia polyp is a raised lesion that protrudes from the mucosal surface of the cardia.
Most cardia polyps are benign, but a few have a tendency to become malignant.
The cardia is located at the esophagogastric junction, which is usually defined as 2 cm above and below the esophagogastric junction.
Classification
At present, there is no uniform classification standard, but it can be classified according to morphology and histology:
Classification according to morphology
Cardia polyps are often categorized into 4 types according to their shape by Yamada typing method:
Type I: mound-shaped, with a smooth elevated starting part and no clear boundary.
Type II: hemispherical, with a clear border at the elevation.
Type III: subtypical, with a slightly smaller elevation forming a subtypus.
Type IV: with a subtympanic area, with a clear subtympanic part of the elevation.
Classification according to histology
Currently, the World Health Organization classifies cardia polyps into the following categories based on histology:
Proliferative polyps
It is an inflammatory reactive proliferation of crypt epithelial cells.
Pathologic manifestations include prolonged, twisted or cystic dilatation of the glandular crypts, disordered arrangement, and a small amount of inflammatory cell infiltration in the interstitium.
The surrounding gastric mucosa showed chronic gastritis with Helicobacter pylori infection, and intestinal chemosis or heterogeneous hyperplasia at different sites could be observed.
Adenomatous polyp
Adenomatous polyp is a type of neoplastic polyp.
Pathologically, it is lined with heteroproliferative epithelial cells and may contain heteroproliferative cup cells, mural cells, and Panniculus cells.
Fundic gland polyp
Consists of dilated gastric fundus acid-urinary glands.
Pathologically, they are lined with disorganized flattened wall, principal cells, or cervical mucous cells, while the surface is lined with normal gastric recess epithelium.
There is no atrophic gastritis or intestinal epithelial hyperplasia in the surrounding gastric mucosa.
Inflammatory polyps
The polyp is characterized by proliferation of spindle cells, small blood vessels and inflammatory cells.
Dysplastic polyp
Composed of hyperplastic glands.
Pathologically, the gland walls are covered with vesicular epithelium separated by smooth muscle branch-like nuclei and accompanied by atrophy of the deeper glandular portions.
Pathogenesis
Gastric polyps are detected in about 2% to 3% of gastroscopies, and cardia polyps are detected in about 0.34% of gastroscopies [1,4-5].
Etiology
Causes
The exact etiology of cardia polyps is unclear, and is currently thought to be related to the following factors:
Genetic factors
Studies have shown that the occurrence of cardia polyps is related to genetic factors to a certain extent, which may be related to the abnormal expression of p16, Ki67, etc., the mutation of oncogene p53 and oncogene Ras, and the abnormality of transduction pathway.
Helicobacter pylori infection
Studies have shown that there is a relationship between the occurrence of cardia polyps and Helicobacter pylori (HP) infection.
H. pylori infection can lead to long-term inflammatory stimulation of the gastric mucosa, causing excessive regeneration of gastric epithelial cells leading to the development of the disease.
Pepsinogen (PG)
Some studies have shown a clear association between serum PG levels and cardia polyps.
When cardia polyps are accompanied by carcinoma, serum PG Ⅰ and PG Ⅰ/PG Ⅱ will show a significant decrease.
The decrease in PG level is closely related to the severity of gastric mucosal atrophy.
Serum G-17 level
Studies have shown that serum G-17 level is closely related to the occurrence of cardia polyps.
A short-term increase in serum G-17 can lead to the development of cardia polyps.
Others
Chronic superficial gastritis, atrophic gastritis, gastric ulcer, bile reflux and other diseases, bad lifestyle habits, long-term use of proton pump inhibitors (PPI) and other factors also have a certain relationship with the occurrence of cardia polyps.
Pathogenesis
The specific pathogenesis of cardia polyp is not clear, and it is currently believed to be caused by excessive regeneration of mucosal tissue after injury.
Symptoms
Main symptoms
Most of them have no obvious symptoms, and most of the patients are found accidentally during gastroscopy, barium meal imaging or surgery for other reasons.
Those with symptoms mainly have abdominal discomfort, acid reflux, heartburn, epigastric vague pain, abdominal distension, nausea, and loss of appetite as the main clinical symptoms. Symptoms are mostly unrelated to polyps.
Larger cardia polyps may obstruct the cardia and present with dysphagia.
Complications
Upper gastrointestinal bleeding
Upper gastrointestinal bleeding can be caused by polyp surface erosion and ulceration.
Symptoms such as vomiting coffee-colored material, vomiting blood and black stool may occur.
Malignant tumor
Some cardia polyps have malignant tendency and can lead to cancer.
Symptoms such as emaciation, abdominal mass, abdominal pain, vomiting blood and black stool may occur.
Consultation
Department of Medicine
Gastroenterology
If you experience abdominal discomfort, nausea, poor appetite, difficulty in swallowing, etc., it is recommended that you consult a doctor promptly.
If cardia polyps are found during physical examination or gastroscopy, it is recommended to consult a doctor promptly.
Preparation for medical treatment
Consultation: Registration, Preparation of documents, Frequently Asked Questions
Tips for medical treatment
It is recommended to have a light diet before going to the doctor.
Preparation List
Symptom list
Pay particular attention to the time of onset of symptoms, special manifestations, etc.
Are there any symptoms of abdominal discomfort such as acid reflux, heartburn, vague pain in the upper abdomen, bloating, etc.?
Are there symptoms of nausea and vomiting?
What is the frequency and amount of vomiting?
How is the vomit?
Is there any symptom of loss of appetite or decreased food intake?
Is there any difficulty in swallowing?
Medical History Checklist
Any history of gastric polyps in first-degree relatives such as parents, siblings, etc.?
Any history of Helicobacter pylori infection, chronic superficial gastritis, atrophic gastritis, gastric ulcer, bile reflux?
Any long-term use of proton pump inhibitors such as omeprazole and lansoprazole?
Any bad lifestyle habits such as irregular diet, hot food, smoking, alcoholism, etc.?
Checklist
Test results in the last six months, which can be brought to the doctor’s office
Laboratory tests: serum PG test, serum G-17 level test, etc.
Imaging tests: X-ray barium contrast.
Other tests: gastroscopy, pathology examination, etc.
List of medications used
Medication used in the last 3 months, if there is a medication box or package, you can bring it to the doctor’s office
Proton pump inhibitors: omeprazole, rabeprazole, pantoprazole, etc.
Diagnosis
Diagnosis based on
medical history
Prevalent in the following population:
Parents, siblings, and other first-degree relatives with a history of gastric polyps.
History of Helicobacter pylori infection, chronic superficial gastritis, atrophic gastritis, gastric ulcer, and bile reflux.
Long-term use of proton pump inhibitors such as omeprazole and lansoprazole.
Poor lifestyle habits such as irregular diet, hot food craving, smoking, alcoholism, etc.
Clinical manifestations
Symptoms
Most patients have no obvious symptoms, and some may experience the following symptoms:
Symptoms of abdominal discomfort such as acid reflux, heartburn, vague pain in the epigastrium and abdominal distension may occur.
Nausea and vomiting of stomach contents may occur.
Loss of appetite and decreased food intake may occur.
Difficulty in swallowing may occur when the polyp is large.
Laboratory Tests
Serum PG test
Purpose: To find out the level of serum PG.
Significance: Reduced level is closely related to the severity of gastric mucosal atrophy. When accompanied by carcinoma, serum PG Ⅰ and PG Ⅰ / PG Ⅱ will be obviously reduced.
Serum G-17 level
Purpose: To find out the level of serum G-17.
Significance: Serum G-17 may be elevated, and the change of serum G-17 level can be used to evaluate the malignant tendency of cardia polyps.
Imaging
Gastrointestinal barium angiography
Purpose: To detect large polyps.
Significance: It will show filling defects in cardia polyps. Gas-barium double low-tension contrast can detect polyps ≥lcm. However, it is less sensitive for smaller lesions and is unable to assess the benign or malignant nature.
Gastroscopy
Purpose: Direct observation of polyps and obtaining tissue for pathologic biopsy.
Significance: A raised lesion protruding from the mucosal surface of the cardia, most of which have a dark reddish color and may be tipped or untipped.
Pathologic examination
Pathologic biopsy can clarify the type of pathology.
Differential diagnosis
Cardia polyps need to be differentiated from carcinoma, especially early carcinoma. Carcinoma is a malignant lesion that occurs in the mucosal epithelium, and biopsy can be sent to pathologic histology to confirm the diagnosis.
Cardia polyps should also be distinguished from submucosal elevated lesions, in which the surface color of the polyp is different from that of the surrounding mucosal tissue, while the surface color of submucosal elevated lesions is the same as that of the surrounding mucosa.
Treatment
Aim of treatment: timely treatment to avoid malignant transformation.
Treatment principle: endoscopic resection is usually adopted.
Endoscopic treatment
Polyps with a diameter of <2cm can be treated with high-frequency electrocoagulation, laser, argon knife and endoscopic mucosal resection under gastroscope.
For polyps with wide base and large tumor, endoscopic submucosal dissection and other treatments are feasible.
Surgical treatment
Polyps that cannot be removed endoscopically are generally treated with surgical resection.
Prognosis
Cure
Most of the polyps are benign, and most of them have good prognosis after active treatment.
Some of them have malignant tendency (especially adenomatous polyps) and may develop into malignant tumors with poor prognosis if treatment is not timely.
Daily management
Daily Management
Dietary management
Wash hands before and after meals.
Try to eat cooked food that has been heated at high temperature, avoid drinking raw water, wash and peel fruits and vegetables when eating raw, and avoid unclean diet.
Give light and easy-to-digest food, such as millet porridge, noodles, fresh fruits and vegetables.
Avoid spicy and stimulating food (e.g. chili, mustard, etc.), greasy food (e.g. animal offal, animal oil, etc.).
Life Management
Regular work and rest.
Stop smoking and drinking.
Follow-up
Follow your doctor’s instructions for regular checkups so that your doctor can evaluate your condition and adjust your treatment plan.
The follow-up period is usually 6 to 12 months, depending on the patient’s condition.
The follow-up examination is usually a gastroscopy.
Prevention
Use communal chopsticks and share meals at gatherings.
Sterilize dishes regularly.
Combined with Helicobacter pylori infection, gastritis, gastric ulcer, bile reflux and other diseases should be actively treated to control the condition.
Long-term use of PPI will increase the incidence of cardia polyps, so avoid unnecessary long-term use of PPI drugs in daily life.
People with the above risk factors should have regular gastroscopy screening (usually recommended once a year) to facilitate early detection, diagnosis and treatment.