Premalignant Conditions

As with colorectal adenocarcinoma, certain gastric polyps are considered premalignant. Most gastric polyps are asymptomatic. When they are symptomatic the most common complaint is of vague upper abdominal pain. Hemorrhage is infrequent and complications are rare.

Hyperplastic polyps are fairly common, occurring in about 0.5 to 1% of the general population. Hyperplastic polyps account for about 70-80% of all gastric polyps. They represent an overgrowth of normal gastric mucosa. Atypia is rare and they do not have malignant potential.

Adenomatous polyps are associated with an increased incidence of malignant disease. Mucosal atypia is more common. Dysplasia and carcinoma in situ may develop over time. Larger polyps and numerous polyps are associated with a higher risk of developing malignant disease. Endoscopic removal is indicated and considered sufficient for pedunculated lesions if the polyp is completely removed and no invasive cancer is found on pathologic examination. Endoscopic surveillance is indicated in the patient who demonstrates adenomatous polyps. Approximately 50% of patients with familial adenomatous polyposis have gastric polyps.

Some forms of chronic gastritis are also associated with gastric adenocarcinoma. Patients with type A chronic gastritis associated with pernicious anemia have a risk of carcinoma about twice that of the general population. Fundic mucosal atrophy, hypochlorhydria, loss of parietal and chief cells, and hypergastrinemia characterize this form of chronic gastritis. Routine surveillance of these patients is not generally performed but any new symptoms warrant aggressive work-up. Conversely, type B (antral) gastritis is not considered a risk factor for the development of carcinoma.

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