Esophageal Polyps: Concerns and Treatment Options - Gastroenterology and Hepatology

Pyloric polyp?

Two weeks ago, I underwent an upper gastrointestinal endoscopy at the clinic, where I was diagnosed with a gastric ulcer and gastroesophageal reflux disease (GERD).
During the procedure, a 1 cm polyp was removed from the fundus of my stomach, but the doctor mentioned that there were two polyps at the gastroesophageal junction that were not removed, which has left me quite worried.
I have been experiencing recurrent GERD symptoms over the past few years.
Is there a concern regarding the polyps at the gastroesophageal junction, especially since they were not excised?
I have been taking ulcer medications for two weeks, including enteric-coated tablets, digestive aids, and gastric comfort tablets, which have slightly improved my bloating symptoms, but they still fluctuate.
During my follow-up visit yesterday, the doctor changed my medication and prescribed a one-month supply: taking Lanpo capsules (30M) before bed, Mosapin F.C.
before breakfast, and Aluzaine tablets.
I feel that the medication I was previously prescribed at the hospital, Nizatidine, was more effective, but this clinic does not have it available.
They mentioned that the medications they prescribed are second-generation proton pump inhibitors (PPIs), while Nizatidine is a first-generation drug.
Is there a distinction between first and second-generation PPIs? What are the differences between them?
Can I obtain my endoscopy report and go to the hospital to request a prescription for Nizatidine? I look forward to your response.
Thank you.

Grace, 40~49 year old female. Ask Date: 2022/10/30

Dr. Hu Guozheng reply Gastroenterology and Hepatology

Dear Grace, there are many types of gastric polyps, and most of them are benign.
The decision to perform a biopsy or removal typically relies on the judgment of the endoscopist.
Since a significant number of small benign gastric polyps have an extremely low risk of malignant transformation and often occur in multiples, it is generally unnecessary to remove all benign gastric polyps.
After all, each polyp removal increases the risk of complications such as bleeding.
If your other polyps appear similar, the doctor may choose to biopsy or remove one for examination, and if it is confirmed to be benign, you can feel reassured.
Additionally, unless the polyp located at the gastroesophageal junction is large, it may not necessarily be the cause of your gastroesophageal reflux symptoms.
There are many causes of gastroesophageal reflux, which are related to lifestyle, diet, and habits.
Medications are merely supportive; even the strongest gastric medications may not work well for some individuals, so it is important to discuss with your physician whether there are other factors that can be improved.
Currently, proton pump inhibitors (PPIs) on the market are very effective in controlling gastric acid.
However, individual PPIs may have different pharmacokinetics or drug interactions that can lead to variability in effectiveness among different patients.
Generally, they should not be completely ineffective; the differences may lie in the timing or duration of their effects.

Reply Date: 2022/10/30

More Info

Esophageal polyps, particularly those found in the context of gastroesophageal reflux disease (GERD) and gastric ulcers, can raise several concerns regarding their nature and potential implications for your health. It’s understandable to feel anxious about the presence of polyps, especially when they are discovered alongside other gastrointestinal issues.

Understanding Esophageal Polyps
Esophageal polyps are abnormal growths that can occur in the esophagus. They can be benign (non-cancerous) or malignant (cancerous), and their presence can be associated with various conditions, including chronic inflammation from GERD. In your case, the polyps found at the gastroesophageal junction (the area where the esophagus meets the stomach) may not necessarily be the direct cause of your reflux symptoms. Many small polyps are benign and do not require removal unless they exhibit concerning features or symptoms.

Concerns Regarding Your Polyps
The fact that your doctor chose not to remove the polyps during your endoscopy suggests that they may not have exhibited characteristics that warranted immediate intervention. Typically, polyps that are small, asymptomatic, and appear benign on examination may be monitored rather than removed. However, it is essential to maintain regular follow-ups to monitor any changes in size or appearance.

Treatment Options and Management
Your current treatment regimen, which includes medications like proton pump inhibitors (PPIs) and other gastric protective agents, is aimed at managing your GERD and associated symptoms. PPIs are effective in reducing stomach acid production, which can help alleviate symptoms of reflux and promote healing of any ulcers present. It’s important to follow your doctor’s recommendations regarding the duration of PPI therapy, especially since you have experienced some symptom relief.

Differences Between PPI Generations
Regarding the differences between first-generation and second-generation PPIs, the primary distinction lies in their pharmacokinetics and side effect profiles. First-generation PPIs, such as omeprazole (Prilosec), have been widely used for many years and are well-studied. Second-generation PPIs, like lansoprazole (Prevacid) or rabeprazole (AcipHex), may offer advantages in terms of faster onset of action or fewer drug interactions. However, both generations are effective in reducing gastric acid secretion. If you feel that a specific medication, such as esomeprazole (Nexium), has worked better for you in the past, it is reasonable to discuss this with your healthcare provider. They may consider prescribing it if appropriate.

Next Steps and Recommendations
1. Follow-Up Endoscopy: Given your history of GERD and the presence of polyps, it is advisable to have regular follow-up endoscopies as recommended by your physician. This will help monitor the polyps and ensure that no malignant changes occur.

2. Medication Review: If you feel that your current medications are not providing adequate relief, discuss this with your doctor. They may adjust your treatment plan or consider alternative medications that could be more effective for your symptoms.

3. Lifestyle Modifications: Alongside medication, lifestyle changes can significantly impact GERD symptoms. Consider dietary adjustments, weight management, and avoiding triggers such as caffeine, alcohol, and spicy foods.

4. Communication with Your Doctor: If you have concerns about the polyps or your treatment plan, do not hesitate to bring these up with your healthcare provider. Open communication is key to managing your health effectively.

In conclusion, while the presence of esophageal polyps can be concerning, many are benign and manageable with appropriate monitoring and treatment. Regular follow-ups, medication adherence, and lifestyle modifications will be essential in managing your GERD and overall gastrointestinal health.

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