Portal hypertensive polyps: distinct entity

Amarapurkar, Anjali D; Amarapurkar, Deepak; Choksi, Mehul; Bhatt, Nirav; Amarapurkar, Pooja

doi:10.1007/s12664-013-0324-3

Cited by 22 publications

(36 citation statements)

References 12 publications

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“…McCormack et al coined, for the first time in 1985, the term "portal hypertensive gastropathy" for congestion-related gastric mucosal alterations with no inflammation seen during endoscopy [5,6]. Although its mechanism has yet to be exactly known, it was shown to be histologically characterized by the dilatation of mucosal and submucosal gastric vessels [3,4]. Gastric mucosal response to mucosal damage alters in the stomach, and a complex of structural alterations is seen in all the components of the gastric wall in PHG.…”

Section: Discussionmentioning

confidence: 99%

“…Although the exact pathogenesis of PHG is unclear, it is held to mainly involve local or generalized alterations in vascular hemodynamics [1]. In addition to such findings, polypoid lesions in the stomach have rarely been defined as endoscopic findings in patients with liver cirrhosis [2][3][4]. The results of certain studies have revealed that such polypoid formations were characterized histologically by the dilatation in the mucosal and submucosal vessels of the stomach [3,4].…”

Section: Introductionmentioning

confidence: 99%

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Portal Hypertensive Polyps as Gastroscopic Finding in Liver Cirrhosis

Topal

Akbulut

Karahanli

et al. 2020

Gastroenterology Research and Practice

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Background. Portal hypertensive polyps in patients with portal hypertension are described. Aims. The most significant and serious complication in liver cirrhosis proves to be portal hypertension. Polypoid lesions, which can be seen in the stomach as endoscopic finding in patients with portal hypertension, have not quite been defined in the literature. The aim of this study, therefore, was to define polypoid lesion formation due to portal hypertension in the upper gastrointestinal system in patients with portal hypertension. Study Design. Cross-sectional study. Methods. The study covered a group of patients with liver cirrhosis and a healthy control group that did not have portal hypertension. All individuals covered by the study received upper GI endoscopy, while the endoscopic features and pathological characteristics of the identified polypoid lesions were defined. Standard histological criteria were used in polyp diagnosis. Results. A total of 400 individuals were included in the study. Upper GI endoscopy was performed for 200 patients with liver cirrhosis and another 200 healthy individuals with no portal hypertension in the control group. When the cases were gastroscopically assessed with regard to polypoid lesion presence, it was seen that a total of 87 (21.8%) individuals had polyps. While 67 (33.5%) cirrhotic patients were identified to have polyps, 20 (10%) individuals in the healthy control group had polyps. When the results of those with liver cirrhosis who received esophageal variceal endoscopic band ligation (EVL) and who did not were compared, it was observed that a higher number of individuals in the group with EVL had polypoid lesions. When the patient and control groups were compared as to Helicobacter pylori presence, the results showed that it was slightly higher in the dyspepsia group but the difference was not statistically significant (p>0.05). Conclusion. Portal hypertension-associated polypoid lesions are common in advanced liver cirrhosis cases. The pathological analyses of these polyps pointed out that they were all benign and no malignant cases were detected. It was argued that these polypoid lesions, referred to as portal hypertensive polyps, were associated with elevated angiogenesis in the gastric mucosa.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Portal Hypertensive Polyps as Gastroscopic Finding in Liver Cirrhosis

Topal

Akbulut

Karahanli

et al. 2020

Gastroenterology Research and Practice

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“…5 These hyperplastic polyps have also been spotted in patients with portal hypertension, but they tend to exhibit a larger blood vessel diameter. 9,10 Multiple hyperplastic polyps are typically observed in the antrum. 5 Macroscopically, they are smooth and dome-shaped and usually range in size from 0.5 to 1.5 cm, although rarely may exceed 2 cm.…”

Section: Discussionmentioning

confidence: 99%

Prolapsing Gastric Polyp Causing Intermittent Gastric Outlet Obstruction

Kosai¹,

Gendeh²,

Norfaezan³

et al. 2015

International Surgery

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Gastric polyps are often an incidental finding on upper gastrointestinal endoscopy, with an incidence up to 5%. The majority of gastric polyps are asymptomatic, occurring secondary to inflammation. Prior reviews discussed Helicobacter pylori (H pylori)-associated singular gastric polyposis; however, we present a rare and unusual case of recurrent multiple benign gastric polyposis post H pylori eradication resulting in intermittent gastric outlet obstruction. A 70-year-old independent male, Chinese in ethnicity, with a background of diabetes mellitus, hypertension, and a simple renal cyst presented with a combination of melena, anemia, and intermittent vomiting of partially digested food after meals. Initial gastroscopy was positive for H pylori; thus he was treated with H pylori eradication and proton pump inhibitors. Serial gastroscopy demonstrated multiple sessile gastric antral polyps, the largest measuring 4 cm. Histopathologic examination confirmed a benign hyperplastic lesion. Computed tomography identified a pyloric mass with absent surrounding infiltration or metastasis. A distal gastrectomy was performed, whereby multiple small pyloric polyps were found, the largest prolapsing into the pyloric opening, thus explaining the intermittent nature of gastric outlet obstruction. Such polyps often develop from gastric ulcers and, if left untreated, may undergo neoplasia to form malignant cells. A distal gastrectomy was an effective choice of treatment, taking into account the polyp size, quantity, and potential for malignancy as opposed to an endoscopic approach, which may not guarantee a complete removal of safer margins and depth. Therefore, surgical excision is favorable for multiple large gastric polyps with risk of malignancy.

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“…In a retrospective study from Canada, only 12 cases were identified over 20 years [3]. The two studies under review, only one of them prospective, found PHP in 1.01 % to 2.53 % of patients undergoing upper endoscopy for PH over 15-33 months [1,2]. PHP are, therefore, not really uncommon, and while gastroscopy has been a routine diagnostic procedure in PH for decades now, PHP has clearly remained unappreciated till recently.…”

mentioning

confidence: 99%

“…The latest entry to this slowly lengthening list of abnormalities is the 'portal hypertensive polyp' (PHP), described in two reports in the current issue of this Journal [1,2]. As with any newly described entity, a bevy of questions immediately comes up.…”

mentioning

confidence: 99%

Portal hypertensive polyp—what is in a name?

Pai

2013

Indian J Gastroenterol

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Draining as it does into the portal venous system, it is not surprising that most of the gastrointestinal tract should show a variety of changes in portal hypertension (PH). The latest entry to this slowly lengthening list of abnormalities is the 'portal hypertensive polyp' (PHP), described in two reports in the current issue of this Journal [1, 2]. As with any newly described entity, a bevy of questions immediately comes up.PHP have been reported to occur in the stomach and less commonly elsewhere in the bowel [3,4]. They have most often been associated with cirrhotic PH but do occur in extrahepatic portal venous obstruction too [5]. Are they a distinct entity? The reports under review, dealing with gastric and duodenal lesions, and a handful of preceding ones make a case that they are. However, there have been no clear diagnostic criteria for PHP. Microscopically, gastric PHP have been diagnosed based on the presence of variable foveolar hyperplasia of the epithelium along with underlying vascular proliferation. So the question arises: are these lesions unique to PH or do they simply represent hyperplastic polyps arising on a background of vascular changes of PH such as portal hypertensive gastropathy (PHG) or gastric antral vascular ectasia (GAVE)? The latter possibility certainly cannot be ruled out. In their retrospective analysis, on 631 patients with PH, Amarapurkar et al. found gastric and duodenal polyps in 16 (2.53 %) patients. Nine of these were diagnosed as PHP, six as hyperplastic polyp, and one as fundic gland polyp. On comparing PHP with PHG mucosa devoid of polyps, the authors found that the density and diameter of capillaries in the lamina propria were similar but that such changes were significantly more frequent (p<0.001) in these two groups compared to polyps in patients without PH. The morphometric and special staining characteristics of PHP presented in the paper do not provide any support to the contention that the vascular changes seen in PHP are distinct from those seen in PHG or GAVE. Nor does the comparison, less detailed nonetheless, between hyperplastic polyps and PHP as reported by Lam et al. in an earlier report confirms that these two lesions are distinct. Did the six hyperplastic polyps reported by Amarapurkar et al. differ from the PHP in any characteristics other than the vascularity? The paper does not comment on this. Again, there was no difference in the age, gender, the frequency of polyps, and their histological types in the portal hypertensive and non-portal hypertensive groups. The fact that the prevalence of all types of polyps in the portal hypertensive and non-portal hypertensive group (2.53 % vs. 3.3 %, p=0.4) was similar also casts doubts as to whether these are unique lesions developing in the presence of PH over and above the other types of polyps seen in the general population. Also, PHP in the stomach and those in the small bowel may not show similar histological features except for the increased, dilated subepithelial capillaries. For example, some earlier repo...

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Portal hypertensive polyps: distinct entity

Abstract: PHP are definite identifiable lesion in patients of cirrhosis with PH. PHP are probably related to increased angiogenesis in gastric mucosa.

Cited by 22 publications

References 12 publications

Portal Hypertensive Polyps as Gastroscopic Finding in Liver Cirrhosis

Portal Hypertensive Polyps as Gastroscopic Finding in Liver Cirrhosis

Prolapsing Gastric Polyp Causing Intermittent Gastric Outlet Obstruction

Portal hypertensive polyp—what is in a name?

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