Isolated diffuse hyperplastic gastric polyposis presenting with severe anemia
© Jayawardena et al; licensee BioMed Central Ltd. 2008
Received: 19 July 2008
Accepted: 28 August 2008
Published: 28 August 2008
Gastric polyps exist in a wide variety of types, most of which are small and often benign. Discovery of gastric polyps during Endoscopy necessitates biopsies.
We present a case report of an isolated diffuse hyperplastic gastric polyposis in a 26 years old Hispanic female when she was investigated for profound anemia. The Esophagogastroduodenoscopy revealed numerous gastric polyps filling the entire stomach. She was treated with near-total gastrectomy and her anemia resolved
Isolated diffuse hyperplasic gastric polyposis with normal gastrin level is a rare entity and can present with severe anemia.
Gastric polyps include hyperplastic polyps, adenomatous polyps, and inflammatory polyps unlike polyps of the colon are rare and have an incidence of less than 1%. Endoscopic excision of gastric polyps provides a minimally invasive approach to diagnosis and treatment. Hyperplastic polyps are the most common histologic type found among gastric polyps. The association of hyperplastic polyps and anemia has not been well established.
A 26 years old Hispanic female with no significant past medical history came to the emergency room with complaint of weakness and lethargy for 3 weeks. She denied nausea, vomiting, abdominal pain, melena, rectal bleed, heavy menstrual periods or loss of weight. Family history was significant for father having colon cancer at the age of 50 yrs.
Gastric polyps are rare as compared to colonic polyps (Scott-Conner 2006) . Among the different types of Gastric polyps the hyperplastic polyps are the most common. Although these hyperplastic polyps do not harbor malignancy, there is rare chance of malignancy especially when associated with pernicious anemia (Rickes, Gerl et al. 2000) . Gastric polyps can also be part of polyposis syndromes such as juvenile polyposis, Gardner, Peutz-Jeghers, and Cronkhite-Canada syndromes. Diffused gastric polyposis is a rare entity with only a few cases being reported (Hu, Hsu et al. 2002) . These polyps also run in families and are a part of familial polyposis syndromes. In our patient, she herself did not have a history of gastrointestinal adenoma or carcinoma but the father had colon cancer. The other major association of gastric polyps is with pernicious anemia (Rickes, Gerl et al. 2000) . Thermal injury to the stomach seen in laser therapy for watermelon stomach can also give rise to gastric polyps (Geller, Gostout et al. 1996) . Gastric polyposis can present with iron deficiency anemia like in our patient, hypoproteinemia, high gastrin levels and even gastric outlet obstruction (Kepczyk and Kadakia 1995) (Covotta, Paoletti et al. 1995) [5, 6]. Gastritis associated with Helicobacter pylori infection can also lead to gastric polyps which are amenable to H. pylori eradication therapy (Isomoto, Furusu et al. 2005) . Use of proton pump inhibitors, especially in children can give rise to gastric polyps and/or nodules (Pashankar and Israel 2002) .
Association between Hyperplastic gastric polyposis, hypergastrinemia and colorectal malignancy has been described, but in our patient the serum gastrin level was normal (Niv, Delpre et al. 2003) . Another interesting observation is the development of hyperplastic gastric polyps in patients who undergo solid organ transplantation and immunosuppressive therapy. The association of these polyps with the immunosuppressive therapy has not yet been well established (Amaro, Neff et al. 2002) . Our patient was not exposed to any immunosuppressive therapy and did not undergo any organ transplant.
Isolated diffuse hyperplasic gastric polyposis with normal gastrin level is a rare entity and can present with severe anemia. Total gastrectomy or near-total gastrectomy to prevent further occult blood loss and regular surveillance with endoscopy is necessary as there is a possibility of malignancy developing in these polyps.
A written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent will be made available on request
Red Cell Distribution Width
Total Iron Binding Capacity.
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