Müjde SOYTÜRK, Seda Akkaya ÖZDİNÇ, Sülen SARIOĞLU, Özgül SAĞOL, Gözde Derviş HAKİM, Ömer TOPALAK

Endoskopik incelemede saptanan mide poliplerinin yerleşimi, histopatolojik tipleri ve Heli kobakter pilori infeksiyonu ile ilişkisi

Amaç: Gastrik polipler genellikle asemptomatiktir ve endoskopik girişimler sırasında yaklaşık %2-6 oranında rastlanmaktadır. Midede en sık fundik gland polipleri ile hiperplastik polipler görülmektedir. Çalışmanın amacı DEÜTF Gastroenteroloji kliniğinde yapılan üst gastrointestinal sistem endoskopileri sırasında saptanmış mide poliplerinin yerleşim yerini, histopatolojik tiplerini ve Helikobakter pilori infeksiyonu ile olan ilişkilerini araştırmaktır. Gereç ve Yöntem: Ocak 2010 - Haziran 2011 tarihleri arasında DEÜTF Gastroenteroloji Kliniği'nde yapılan endoskopik incelemeler sırasında mide polibi saptanmış olan 80 hasta (63 K, 17 E, Ort. Yaş: 60.12±12.76) ve bu hastalardan çıkarılmış olan toplam 174 polibe ait veriler retrospektif olarak gözden geçirilmiştir. Bulgular: Mide polipleri 51 olguda (%64) korpus, 19 olguda (%24) fundus, 16 olguda (%20) antrumda yerleşmiştir. Histolojik olarak; 38 olguda (%47,5) hiperplastik polip, 16 olguda (%20) fundik gland polibi, 7 olguda (%8,8) nöroendokrin tümör, 2 olguda (%2,5) adenomatöz polip, 1 olguda (%1,3) hamartamatöz polip, 1 olguda (%1,3) inflamatuar fibroid polip ve 17 olguda (%21,3) faveolar hiperplazi saptanırken 1 olguda (%1,3) polip spesifiye edilememiştir. Hiperplastik polipler genellikle tek bulunma eğiliminde iken fundik polipler multipl olma eğilimindeydi. Tartışma: Midede en sık görülen polipler hipeplastik poliplerdir. Hiperplastik poliplerin Helikobakter pilori enfeksiyonu ile midedeki gastrit ve intestinal metaplazi ile ilişkisi mevcuttur. Midede nöroendokrin tümör sıklığı artmaktadır.

Anahtar Kelimeler:

Mide, polip, Helikobakter pilori, hiperplastik, fundik

Location of endoscopic examination-detected gastric polyps, histopathological types and association with Helicobacter pylori infection

Background/aims: Gastric polyps are usually asymptomatic and found in approximately 2-6% of upper gastrointestinal endoscopic procedures. Hyperplastic polyps and fundic gland polyps are the two most common subtypes of gastric polypoid lesions. The aim of this study was to determine the characteristics of patients with gastric polyps diagnosed through endoscopy, the histological characteristics and location of the polyps and the presence or not of Helicobacter pylori infection. Materials and Methods: Dyspeptic patients with gastric polypoid lesions detected by upper gastrointestinal endoscopy at Dokuz Eylül University Gastroenterology Clinic between January 2010 and June 2012 were analyzed retrospectively. Data including the patients' age and sex, the number, location and histopathologic type of polyps and the presence of Helicobacter pylori infection were recorded. Eighty patients with gastric polypoid lesion (63 F, 17 M, mean age: 60.1±12.8 years) were enrolled in the study. One-hundred and seventy-four gastric polypoid lesions were identified in 80 patients. Results: Polypoid lesions were commonly located in the corpus (64%), followed by fundus (24%) and antrum (20%). The most frequently encountered histopathologic subtype of gastric polypoid lesions was hyperplastic polyp (48%), followed by foveolar hyperplasia (21%), fundic gland polyps (20%), neuroendocrine tumor (9%), adenoma (1%), hamartomatous (1%) and inflammatory fibroid polyp (1%). Hyperplastic polyps were primarily single, whereas fundic gland polyps tended to be multiple. Hyperplastic polyps were associated with Helicobacter pylori infection, chronic active gastritis and intestinal metaplasia. Conclusions: The most frequently encountered histopathologic subtype of gastric polypoid lesions was hyperplastic polyp. The prevalence of neuroendocrine tumors seems to be higher than that reported earlier, most likely because of the widespread use of proton pump inhibitors.

Keywords:

Gastric polyp, endoscopy, Helicobacter pylori, hyperplastic, fundic,

PDF

___

Goddard AF, Badreldin R, Pritchard DM, et al. The management of gas- tric polyps. Gut 2010;59:1270-6.
Carmack SW, Genta RM, Schuler CM, Saboorian MH. The current spec- trum of gastric polyps: a 1-year national study of over 120,000 patients. Am J Gastroenterol 2009;104:1524-32.
Gencosmanoglu R, Sen-Oran E, Kurtkaya-Yapicier O, et al. Gastric poly- poid lesions: analysis of 150 endoscopic polypectomy specimens from 91 patients. World J Gastroenterol 2003;9:2236-9.
Archimandritis A, Spiliadis C, Tzivras M, et al. Gastric epithelial polyps: a retrospective endoscopic study of 12974 symptomatic patients. Ital J Gastroenterol 1996;28:387-90.
Morais DJ, Yamanaka A, Zeitune JM, Andreollo NA. Gastric polyps: a ret- rospective analysis of 26,000 digestive endoscopies. Arq Gastroenterol 2007;44:14-7.
Jalving M, Koornstra JJ, Wesseling J, et al. Increased risk of fundic gland polyps during long-term proton pump inhibitor therapy. Aliment Phar- macol Ther 2006;24:1341-8.
Carmack SW, Genta RM, Graham DY, Lauwers GY. Management of gas- tric polyps: a pathology-based guide for gastroenterologists. Nat Rev Gastroenterol Hepatol 2009;6:331-41.
Ljubicic´ N, Banic´ M, Kujundzic´ M, et al. The effect of eradicating Helico- bacter pylori infection on the course of adenomatous and hyperplastic gastric polyps. Eur J Gastroenterol Hepatol 1999;11:727-30.
Ohkusa T, Takashimizu I, Fujiki K, et al. Disappearance of hyperplastic polyps in the stomach after eradication of Helicobacter pylori. A rando- mized, clinical trial. Ann Intern Med 1998;129:712-5.
Oberhuber G, Stolte M. Gastric polyps: an update of their pathology and biological significance. Virchows Arch 2000;437:581-90.
Lawrence B, Gustafsson BI, Chan A, et al. The epidemiology of gastroen- teropancreatic neuroendocrine tumors. Endocrinol Metab Clin North Am 2011;40:1-18.
Kokkola A, Sjoblom S, Haapiainen R, et al. The risk of gastric carcinoma and carcinoid tumours in patients with pernicious anaemia: A prospec- tive follow-up study. Scand J Gastroenterol 1998;33:88-92.
Laine L, Ahnen D, McClain C, et al: Potential gastrointestinal effects of long-term acid suppression with proton pump inhibitors. Aliment Phar- macol Ther 2000;14:651-68.