Intestinal polyp is a swelling on the surface of the mucosa.
Usually no obvious symptoms, some patients may show abdominal distension, abdominal pain, change of bowel habit.
Not yet fully defined, may be related to inflammatory stimulation, genetic inheritance, etc.
Can be treated by endoscopic resection or surgery
What are intestinal polyps?
Definition
Intestinal polyps are swellings on the mucosal surface of the intestines, and are referred to as polyps until the nature of their pathology is determined.
They are usually asymptomatic and are often detected during colonoscopy.
Some patients may show changes in bowel habits, such as increased or decreased frequency of bowel movements, mucus stools or mucus blood stools, which may be accompanied by abdominal pain, abdominal distension and other symptoms. If the size of polyps is too large, intestinal collapse, intestinal obstruction and other manifestations can occur.
Intestinal polyposis: Generally caused by genetic factors, adenomatous polyps with a number of more than 100 in the intestinal tract are widespread and have their own special clinical manifestations, which is called familial adenomatous intestinal polyposis.
Classification and staging
Classification according to the site of occurrence
Can be divided into small bowel polyps, colon polyps, rectal polyps, etc.
Classification according to pathology
Can be divided into adenomatous polyps, inflammatory polyps, misshapen polyps, hyperplastic polyps and so on.
Adenomatous polyps: benign tumors occurring in the glandular epithelium, mostly adenomas in adults. It can be divided into tubular adenoma, villous adenoma, tubular villous adenoma according to histological characteristics, and the cancer rate of villous adenoma is higher.
Inflammatory polyp: it is caused by inflammatory response to stimulate intestinal epithelium, and can be secondary to any inflammatory response or infectious disease, and generally has no malignant tendency.
Dysplastic polyps: These include juvenile polyps and hyperpigmented polyp syndrome.
Hyperplastic polyps: common non-neoplastic polyps, usually small mound-like elevations <5 mm in diameter with a broad base and pale color.
Classification according to the number of polyps
Can be divided into sporadic polyps and polyposis.
Sporadic polyps: the number of polyps is less than 100.
Polyposis: the number of polyps is more than 100.
Classification according to endoscopic morphology
They can be categorized into types I, II, III, and IV (Yamada typing).
Type I: the base is flat, wide and slightly elevated above the surface of the intestinal wall.
Type II: the base is more prominent and the polyp is hemispherical.
Type III: the base is prominent, with an acute angle to the surrounding intestinal wall mucosa, and the polyp is spherical.
Type IV: the polyp is spherical in shape and is connected to the intestinal wall through the tip.
Classification according to Parisian typing
The bulging intestinal polyps can be categorized as: type Ip (with tips), type Isp (between type Ip and type Is), and type Is (broad base, without tips).
Morbidity
The disease is common in people over 50 years of age, and the incidence increases with age, with the highest incidence between 60 and 80 years of age, which can reach 40% to 60%.
Intestinal polyps can occur in any part of the intestinal tract, with colonic polyps being the most common, accounting for about 80%.
There are regional differences in the incidence of colorectal polyps, and the detection rate in China is 14.8% to 17.8%.
The incidence of intestinal polyps is higher in men than in women.
Questions you may be concerned about
What foods can I eat to cure intestinal polyps?
No food has been proven to have a therapeutic effect on intestinal polyps, but eating more fiber-rich foods is better for people with intestinal polyps.
Eating more fruits, vegetables and fiber-rich foods such as beans and high-fiber grains can help prevent intestinal polyps. Patients should eat less red meat, processed meats, and high-fat foods. Avoid spicy and stimulating foods such as chili peppers.
Pay attention to a light diet and balanced nutrition.
What are the symptoms of intestinal polyps?
Bowel polyps usually have no obvious symptoms, but can also manifest as changes in bowel habits, blood in the stool, abdominal pain, and so on.
The frequency of bowel movement may increase or decrease, and there may be mucus, pus and blood in secondary infection. Blood in the stool may vary depending on the location and amount of bleeding, and may be dark red or bright red. A few patients have recurrent abdominal pain.
Patients with rectal polyps may also have urgency and heaviness (even if the intention is obvious, but not able to defecate smoothly), and polyp prolapse during defecation.
What should I pay attention to after removal of intestinal polyps?
The removal of intestinal polyps requires postoperative care and regular follow-up.
Fasting may be required for 1~2 days after polypectomy, and the recovery of gastrointestinal function will be gradual in the order of fluids – semi-fluids – normal diet.
Take rest after the operation to avoid complications such as intestinal bleeding and perforation caused by excessive activities. As there may be a certain amount of bleeding when removing the polyps, there is no need to worry too much if there is a small amount of blood in the stool or black stool after the operation.
After the removal of intestinal polyps, regular follow-up examinations are needed to detect new polyps at an early stage.
Causes
Causes
The cause of intestinal polyps is not yet clear. Previous studies have shown that the development of polyps may be related to inflammatory stimuli (e.g. ulcerative colitis, intestinal tuberculosis, Crohn’s disease, schistosomiasis, etc.), genetic inheritance and so on.
Predisposing factors
Lifestyle habits
A high-fat, low-fiber diet, smoking, alcohol abuse, obesity and physical inactivity can lead to an increased incidence of polyps.
Age
The incidence of intestinal polyps increases significantly with age.
Metabolic factors
Elevated uric acid, diabetes, etc.
Others
Helicobacter pylori infection, bile reflux, chronic diarrhea, chronic constipation, etc.
Symptoms
Main Symptoms
Most patients have insidious onset of disease, no obvious symptoms, a few may have changes in bowel habits, occasional abdominal pain, abdominal distension.
Change of bowel habit
The manifestations are increased or decreased frequency of bowel movement; secondary inflammation and infection can be accompanied by a large amount of mucus or mucus-pus-blood stool; rectal polyps can appear in the anxious and heavy (lower abdominal discomfort before defecation; defecation has a poor discharge, the anus heavy feeling of falling), stool thinning and other manifestations.
Blood in stool
Blood in stool is one of the most common clinical symptoms, which can be bright red or dark red depending on the location and amount of bleeding.
Rectal bleeding is the most common, mostly painless blood in stool, small amount, only positive fecal occult blood test or attached to the surface of feces.
Abdominal pain
A small number of patients may have symptoms such as abdominal distension and discomfort, hidden pain.
Other symptoms
Belching, nausea, vomiting, weight loss and other manifestations.
Polyps may prolapse from the anus if they have long tips or are located near the anus.
Complications
Anemia
Prolonged intestinal bleeding can lead to anemia, with symptoms such as easy fatigue, pallor, dizziness, etc. A large amount of bleeding in a short period of time can lead to indifference or even coma.
Intussusception, intestinal obstruction
Large colon polyps can affect the rhythm of intestinal peristalsis and increase proximal intestinal peristalsis, thus causing intussusception, abdominal cramps, bloody stools and abdominal masses. As the disease progresses, abdominal distension, nausea and vomiting, and cessation of defecation and bowel movement will gradually appear as manifestations of intestinal obstruction.
Jaundice
Adenoma in the papilla of duodenum may cause obstructive jaundice due to compression or obstruction of the lower end of the common bile duct, which is manifested by yellowing of the skin and mucous membranes all over the body, darkening of the urine color, and lightening of the stool color.
Consultation
Department of Medicine
Gastroenterology
If intestinal polyps are found during colonoscopy, prompt consultation is recommended.
If symptoms such as abdominal pain, blood in the stool, or change in bowel habits occur, prompt medical attention is recommended.
Preparation for medical treatment
Preparation for consultation: registration, preparation of documents, FAQs
Tips
If there is blood in the stool, you should pay attention to whether the blood mixes with the stool, the color of the blood in the stool, etc., and tell the doctor about the situation.
Preparation Checklist
Symptom list
Pay particular attention to the time of onset of symptoms, special symptoms, etc.
Are there any symptoms such as abdominal pain or bloating?
How many times and what is the shape of the stool, and is there any blood in the stool?
Have you had any tests and what were the results?
Have you had any treatment, how was it done, and what were the results?
Have you taken certain medications recently, such as salicylates, anticoagulants, etc.?
List of medical history
Any other intestinal diseases?
Have parents and other family members suffered from intestinal polyps?
Checklist
Test results for the last six months, which can be brought to the doctor’s appointment
Colonoscopy, pathology report card
Electrocardiogram
Blood test, fecal occult blood, pre-transfusion test
Rectal palpation
Medication list
Medications used in the last 3 months, if available in boxes or packages, bring with you to the doctor’s office
Family history of intestinal polyps or colorectal cancer, etc.
Clinical manifestations
Changes in bowel habit, such as increased or decreased frequency of bowel movement, mucus stool or mucus-pus-blood stool, occasional abdominal pain, abdominal distension.
Physical examination, most of them have no positive signs, and very few of them may have abdominal mass and localized pressure pain.
Laboratory tests
Fecal occult blood test
To determine whether gastrointestinal bleeding occurs.
If the fecal occult blood test is positive for 3 consecutive times, further examination is needed.
3 days before the test, abstain from eating meat and animal blood, and abstain from taking iron, vitamin C, etc.
Rectal fingerprinting
To find out whether there is any lesion in the anal canal and rectum.
Can be palpable mucosal surface to the cavity of the protruding or elevated mass, with or without the tip, soft, easy to move. If the hardness or poor mobility often suggests that the polyp may be malignant, if the polyp site is high, then the rectal fingerprinting can not be touched.
The perianal skin can be cleaned in advance before rectal examination.
Imaging
Barium enema, ultrasound and CT examination are commonly used.
It helps to understand the location of polyps, infiltration depth and invasion of neighboring organs.
Colonoscopy
To understand the location, size, number and morphology of intestinal polyps, it can be performed at the same time with pathological biopsy, clamping part of the diseased tissue for pathological examination, or direct polypectomy to determine the nature of polyps.
Fasting is required on the day of colonoscopy. Before the examination, take bowel cleanser as required by the doctor.
Differential Diagnosis
Hemorrhoids
Internal hemorrhoids are mostly characterized by intermittent discharge of fresh blood after defecation, while external hemorrhoids are characterized by anal moisture, itching and pain. Mixed hemorrhoids combine the symptoms of both internal and external hemorrhoids, which can be differentiated by rectal fingerprinting and anorectoscopy.
Enlarged anal papilla
Anal papilla hypertrophy is characterized by anal swelling during defecation, accompanied by perianal wetness, itching and blood in stool. The prolapsed anal papilla can be touched by rectal palpation, and the white swelling in the dentate line can be identified by anorectoscopy.
Rectal cancer
Mostly seen in middle-aged and old people, manifested by change of bowel habit, anal falling sensation before defecation, urgency and heaviness, feeling of incomplete defecation, bloody stool, bloody stool, etc. Some patients may also have abdominal pain, abdominal distension, abdominal mass, difficulty in defecation and intestinal obstruction. The diagnosis can be confirmed by colonoscopy and biopsy.
Treatment
Aim of treatment: polyp resection is the mainstay of intestinal polyps. Early resection and clear diagnosis can prevent the occurrence of colorectal cancer.
Adenomatous polyps are precancerous lesions, even if they are small, they should be removed.
Proliferative and misshapen polyps, although rarely malignant, should also be removed as far as possible to make a clear diagnosis.
Inflammatory polyps without obvious symptoms can be considered for regular review.
Treatment principle: The vast majority of intestinal polyps can be removed endoscopically. For those who are not suitable for endoscopic resection, if the polyp is located in the rectum, it can be resected by anal surgery; if the polyp is located in the colon, it can be resected laparoscopically or by open surgery; for those who have difficulty in locating the polyp, it is feasible to locate the polyp with intraoperative colonoscopy.
General treatment
Mainly to improve the lifestyle.
Diet: light diet, high protein and high fiber food, reduce the intake of high-fat food.
Life: quit smoking and drinking, moderate exercise, increase physical activity, obese people should reduce weight appropriately.
Endoscopic treatment
Indications
Broad-based adenomatous polyps with tips or diameter <2 cm can be removed endoscopically.
Endoscopic treatment methods
Including endoscopic mucosal resection, endoscopic mucosal dissection, trap removal of polyps method.
Surgery
Indications for surgery
Wide base polyp diameter >2 cm, polyps located in special parts of the endoscopic resection difficulties.
Gastrointestinal polyposis syndrome, such as familial adenomatous polyposis.
Polyps with carcinomatosis, invading the deep submucosal layer. Pathologically confirmed polyps with carcinoma invading the deep submucosal layer (infiltration depth >1 mm) should be treated according to the principle of radical treatment of colorectal cancer.
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Postoperative care
Diet: Eat in the order of light fluids to low-fat fluids and then low-fat semi-fluids, and then eat plain food after the gastrointestinal function gradually recovers, and avoid spicy and stimulating food.
Life: Avoid excessive physical activity for 2 weeks after the operation, and take bed rest and stay in the hospital for observation for 1 to 2 days 6 hours after the larger polypectomy.
To avoid infection, do not touch water at the anus for 3 days after surgery.
Follow up regularly as required.
Surgical Complications
Intestinal perforation
It mainly manifests as severe abdominal pain and distension. Once occurs should immediately perform a caesarean section and repair the bowel perforation.
Bleeding
Including intraoperative bleeding and postoperative bleeding, manifested as bloody or black stool. A small amount of bleeding can be stopped by enteroscopy with high-frequency electric knife electrocoagulation or internal conservative treatment, if the bleeding is large, open abdominal surgery should be carried out to investigate.
Chinese medicine treatment
According to the TCM diagnosis and treatment method, it can be categorized into Damp-Heat Injection, Qi Stagnation and Blood Stasis, and Spleen-Qi Deficiency. Different types of TCM treatments can be chosen, such as Huang Lian Xie Du Tang with addition and subtraction, Shaobing Yi Yu Tang with addition and subtraction, Sen Ling Bai Zhu San with addition and subtraction, and so on.
According to the number of polyps, Chinese herbal enema can be chosen to relieve symptoms.
Prognosis
Cure
For single benign intestinal polyps, endoscopic resection of polyps can basically be cured. The probability of recurrence is similar to that of the general population, with a recurrence rate of 15% to 60% within 4 years, and regular rechecking is recommended.
For familial adenomatous polyposis and other diseases that cannot be completely cured, surgical removal of the corresponding intestinal segment can effectively prevent cancer.
Harmfulness
Symptoms of intestinal irritation: constipation or increased frequency of bowel movements, affecting daily life.
Anemia: long-term blood in stool will cause anemia, and those with large amount of bleeding will experience dizziness and shock, which is life-threatening in serious cases.
Intussusception, intestinal obstruction: Larger polyps may cause intussusception, intestinal obstruction and other symptoms such as abdominal distension, abdominal pain, blood in the stool, and cessation of defecation.
Some adenomatous polyps are at risk of becoming cancerous.
Daily
Daily management
Dietary management
Eat a light diet, less stimulating and high-fat food, and more fiber-rich vegetables and brown rice.
Exercise Management
Being sedentary is not conducive to good health. Reduce sedentary time and move moderately every half an hour.
Those who are overweight need to reduce their weight through exercise. They can formulate an exercise program under the guidance of a professional doctor and stick to it.
Strengthen the resistance by exercising appropriately.
Follow-up and review
Intestinal polyps are prone to recurrence and require regular follow-up and colonoscopy after surgery.
Depending on the risk level of the polyp, the time of follow-up should be decided according to the doctor’s treatment plan.
For a single benign polyp, it is best to repeat the colonoscopy once a year after removal, and then once every 3 years.
Multiple benign intestinal polyps should be examined by colonoscopy once a year.
In the case of intestinal polyps that are prone to recurrence and cancer, they should be rechecked 3 months after surgery; if there is no abnormality, this can be extended to every 6 months to 1 year.
If the symptoms do not decrease or even worsen, it is necessary to consult a doctor in time.
Screening: Most patients with colon polyps and early colorectal cancer do not have obvious symptoms, so it is recommended that people over 50 years of age should undergo colonoscopy regardless of whether they have symptoms or not.
Prevention
A good lifestyle is helpful in preventing intestinal polyps. Regular medical checkups can detect intestinal polyps as early as possible.
Eat a light diet with less greasy, spicy and irritating foods, and quit smoking and drinking.
Exercise appropriately. If you are overweight, you can formulate recipes and exercise programs under the guidance of a professional doctor to reduce your weight.
Have regular colonoscopies, especially for those with a family history of intestinal polyps.