Gastric Polyps and Familial Adenomatous Polyposis Risks

Gastric polyps and familial adenomatous polyposis?

Hello, Doctor.
I have a question.
I undergo gastroscopy every year, and each time the doctor mentions that I have dozens of gastric polyps, which seem to be increasing every year.
I have seen some information stating that having more than 20 gastric polyps should raise concerns about familial adenomatous polyposis (FAP).
However, I had a colonoscopy two years ago, and there was only one polyp.
Should I be concerned about familial adenomatous polyposis, or could it be possible for the number of colon polyps to suddenly increase in the past two years? If I do not have familial adenomatous polyposis, is it common for the number of gastric polyps to exceed dozens and continue to grow each year? Thank you.

Liao, 30~39 year old female. Ask Date: 2022/07/27

Dr. Lin Minghui reply Gastroenterology and Hepatology

Familial adenomatous polyposis (FAP) is an autosomal dominant genetic disorder characterized by the presence of hundreds to thousands of polyps in the colon.
Ninety percent of individuals will experience gastrointestinal symptoms before the age of 35, and around the age of 40, they are often diagnosed with colorectal cancer.
If you only have one colorectal polyp, it is unlikely to be familial adenomatous polyposis.

Regarding gastric polyps, it is important to differentiate the types of polyps present, such as fundic gland polyps, hyperplastic polyps, and tubular adenomas.
Biopsy can be performed for differentiation.
Fundic gland polyps may increase in number over time and could be related to individual constitution, medications, or diet.
Generally, they are benign, and only require removal if they cause symptoms such as bleeding or grow significantly.
Hyperplastic polyps are benign as well, but if they exceed 2 centimeters or present symptoms, they should be removed.
Tubular adenomas, on the other hand, should be excised.
Wishing you good health!

Reply Date: 2022/07/27

More Info

Gastric polyps, particularly fundic gland polyps, are generally benign growths that can occur in the stomach lining. Your concern about the increasing number of gastric polyps and the potential link to familial adenomatous polyposis (FAP) is valid, especially since FAP is characterized by the development of numerous polyps in the colon and rectum, which can also lead to gastric polyps. However, it is important to understand the context of your situation.

Firstly, the report you mentioned indicates that you have "few" polyps measuring 2-3 mm in size. In medical terminology, "few" typically refers to a small number, often less than five. Therefore, while you may have multiple polyps, the size and description suggest that they are not excessively large or numerous. The fact that they are fundic gland polyps is also reassuring, as these types of polyps are usually non-cancerous and often do not require removal unless they cause symptoms or are associated with other conditions.

Regarding familial adenomatous polyposis, it is characterized by the presence of hundreds to thousands of adenomatous polyps in the colon, which usually necessitates regular surveillance and often prophylactic colectomy due to the high risk of colorectal cancer. The presence of a single polyp during your last colonoscopy does not indicate FAP, especially if it was a tubular adenoma, which is a common benign polyp. The risk of developing FAP is significantly increased if there is a family history of the condition, so if you do not have such a history, it is less likely that you have FAP.

The increase in the number of gastric polyps over the years could be attributed to various factors, including dietary habits, the use of certain medications (like proton pump inhibitors), and other underlying conditions such as chronic gastritis or Helicobacter pylori infection. It is also worth noting that the development of gastric polyps can be sporadic and may not necessarily indicate a hereditary syndrome.

If you are concerned about the number of gastric polyps and their potential implications, it would be prudent to discuss this with your gastroenterologist. They may recommend regular surveillance endoscopies to monitor the polyps and assess any changes over time. Additionally, if there are any changes in your gastrointestinal symptoms or if you develop new symptoms, you should seek medical advice promptly.

In summary, while the presence of multiple gastric polyps can be concerning, the specific characteristics of your polyps, along with your colonoscopy findings, suggest that there is a low likelihood of familial adenomatous polyposis. Regular monitoring and open communication with your healthcare provider will be key in managing your gastrointestinal health.

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