Fundic Gland Polyps - Classification, Symptoms, Diagnosis, and Treatment

Introduction:

Gastrointestinal lesions are mainly classified into polyps and tumors. The proliferation of cells from polyps can develop into adenoma and further progress into cancerous lesions like adenocarcinoma. A fundic gland polyp is a raised projection seen on the stomach lining. The fundic polyp is seen in the fundus region of the stomach. However, it can also occur anywhere in the gastrointestinal system. The polyps lie intact on the surface in a semi-circular pattern.

What Are Fundic Glands?

The stomach is a sac-like gland with infoldings to absorb the food bolus. The stomach lining produces enzymes like lipase, protease, amylase, and nuclease, which help digestion. Apart from enzymes, the stomach also produces acids like hydrochloric acid, electrolytes, and glycoproteins for its function. The fundus is present in the head of the stomach or at the roof of the stomach in a curvature form. It is close to the mid-rib or fifth rib. The fundus is responsible for storing food and collecting digestive gasses.

What Are Fundic Gland Polyps?

Polyps are bud-like structures seen in the vocal cords, esophagus, colon, and very rarely in the stomach region. Gastric polyps occur in the older population.

Complications: The most common complication noted in fundic polyps is the development of peptic ulcer disease due to hyper-acidity. The mucosa gets excavated or eroded due to constant stress and gradually sheds its outer layer. The epithelium changes in appearance with dysplasia and hyperplasia. Depending on the nature of proliferation, they are classified as follows:

• Hyperplastic Polyps: These polyps occur in a group of lesions. Hyperplastic polyps are benign lesions. They are mainly caused by gastritis or Helicobacter pylori infection.

• Fundic Gland Polyps: These polyps are seen in the fundus of the stomach. They occur in a group. Fundic polyps are benign. However, multiple adenomas indicate a hereditary condition known as familial adenomatous polyposis (FAP). This can develop into adenocarcinoma of the intestine. Around 47 percent of gastric polyps are fundic gland polyps. They are also known as incidental polyps, discovered accidentally during endoscopy procedures or autopsies. They rarely cause symptoms and cause minimal obstruction. They measure from 0.1 to 0.8 mm in size.

• Adenomatous Polyps: These polyps are highly susceptible to turning into cancerous lesions. As the adenomatous polyp size increases, it has a greater cancer risk. They are located at the distal end of the stomach.

• Sporadic Polyps: They have a high potential for turning into adenocarcinomas. This occurs due to prolonged antacid drug abuse.

• Proton Pump Inhibitor Polyps: The proton pump inhibitors drugs like anti-gastric (for example, Omeprazole) can lead to polyps. They are the same as sporadic polyps.

• Syndromic Polyps: Polyps associated with familial histories, like familial adenomatous polyposis (FAP). Multiple polyps of around a hundred are seen forming at the same time.

How Does a Fundic Polyp Appear?

The clinical features of gastric polyps are as follows:

• Mucosal damage of the epithelium is seen.

• The inflamed stromal layer is seen.

• It appears as small hematomas, which are non-cancerous tumor cells.

• Multiple polyps occur in a localized area.

• Fundic polyps adhere to the mucosal lining.

• They are translucent and epithelial-colored projections.

• High gastric pH.

What Leads to Fundic Gland Polyps?

Factors that cause fundic gland polyps are as follows:

• Patients having long-term gastric ulcers can cause inflammation of the stomach lining. This eventually causes stress leading to polypoid lesions.

• Affects the older population. People over 50 to 60 years old are more likely to get fundic polyps.

• Seen more commonly in middle-aged women.

• Infections caused by Helicobacter pylori and other bacterial infections can lead to inflammation. Inflammation of the gastric epithelium gives rise to polyp formation.

• Dysfunction of fundic glands can lead to malabsorption of B12. A deficiency of B12 is associated with pernicious anemia. This can trigger polyp formation.

• Drugs such as Omeprazole can lead to gastric polyps.

• Other diseased conditions like gastroesophageal reflux reaction (GERD) and gastritis can cause reduced production of stomach acids by inhibiting the proton pump inhibitors. This also leads to the formation of polyps.

What Are the Symptoms of Fundic Gland Polyp?

Fundic gland polyps usually do not show any symptoms. Some presenting symptoms are:

• Pain or tenderness while pressing the abdomen.

• Nausea.

• Bloody stools.

• Anemia (a condition in which the number of red blood cells or the concentration of hemoglobin in them is lower than normal).

What Are the Microscopic Features Seen in the Biopsy Sample of Fundic Gland Polyp?

The fundic gland polyps are usually sporadic with no signs of malignancy. The collected biopsy sample on microscopic examination displays the following characteristic features.

• The non-neoplastic lesions exhibit a diffuse pattern forming a mass of tissue.

• The gastric mucosal fold in the fundic area shows an enlargement of the rugae.

• In familial adenomatous polyposis syndrome (FAP), there is increased polyp formation of more than a hundred polyps occurring together. This is a hereditary disorder where there is an abnormal mutation of genes associated with it.

• In acquired conditions like sporadic cases where the proton pump inhibitor is activated due to antacid drugs like Omeprazole, there is hyperplasia noted in the G-cells of the stomach.

What Are the Diagnostic Tests Present to Check for Fundic Polyps?

Various diagnostic tests are available to evaluate the condition, such as:

• Endoscopy: A device is inserted into the stomach to view the internal structure.

• Gastroscopy: This test is done to check the upper part of the digestive tract.

• Biopsy: Multiple tissue samples are collected and studied for malignancies.

How Can the Fundic Gland Polyp Be Treated?

If the polyp is single and smaller than one centimeter, it does not require any treatment. But if a polyp is more than one centimeter, it is surgically removed. If multiple polyps are present, it is advised for surgical management to remove them with endoscopy.

Conclusion:

Gastric polyps have an increased risk of turning into malignant tumors. It is hard to diagnose fundic gland polyps due to their asymptomatic nature. A proper diet should be maintained, and avoid unnecessary intake of gas tablets for a more extended period. Frequent burping should be checked with a physician for abnormalities.