Successful Management of Cap Polyposis with Eradication of <i>Helicobacter pylori</i> Relapsing 15 Years after Remission on Steroid Therapy

Abstract

A 37-year-old woman was evaluated at our hospital for a treatment-resistant proctosigmoiditis. Fifteen years previously, ulcerative colitis was suspected and she was cured by steroid therapy. Colonoscopy revealed multiple sessile polyps covered with white exudate from the rectum to the sigmoid colon. Histopathological examination revealed a mucosal surface cover of granulation tissue. Based on these findings, cap polyposis was diagnosed. She underwent Helicobacter pylori eradication therapy, and at 1 month after therapy, her symptoms had improved. We present a case of cap polyposis relapsing 15 years after remission with steroid therapy, and that was improved by H. pylori eradication therapy.

A Case of Cap Polyposis Remission by Betamethasone Enema aer Antibiotics erapy including Helicobacter pylori Eradication

“…Some authors hypothesized that its e cacy may be due to other bacteria reacting to the H. pylori eradication therapy or to a systemic immune response caused by sustained H. pylori infection. e intervals from eradication therapy to symptom relief and polyp disappearance were 3 days-1 month and 2-14 months, respectively [10][11][12][13][14].…”

Cap polyposis refractory to Helicobacter pylori eradication treated with endoscopic submucosal dissection

“…Géhénot et al[ 19 ] suggested the possibility of bacterial infection, reporting on a cap polyposis patient who had no evidence of colonic dysmotility and who was successfully treated with metronidazole. Of the myriad gut microbiota, although H. pylori is not detected in mucosa obtained from cap polyposis lesions[ 10 ], most cases of cap polyposis with H. pylori infection have resolved after H. pylori eradication therapy[ 10 , 11 , 15 , 16 , 18 ]. H. pylori infection is well-known to cause not only gastroduodenal diseases, but also diseases such as idiopathic thrombocytopenic purpura and chronic idiopathic urticaria[ 20 , 21 ].…”

“…The patient had no evidence of H. pylori infection by urea breath test, anti- H. pylori antibody, or endoscopic findings ( i.e ., gastric mucosal atrophy or diffuse redness of gastric mucosa). However, according to previous evidence that H. pylori eradication therapy was effective for patients with cap polyposis[ 10 , 11 , 15 , 16 ], H. pylori eradication therapy with vonoprazan 20 mg, amoxicillin 750 mg and clarithromycin 200 mg twice daily for 7 d was initiated. Abdominal symptoms ( i.e ., hematochezia and tenesmus), bowel habits, and endoscopic findings did not improve over the six months after therapy.…”

“…Some cases have been treated successfully by the avoidance of straining at defecation[ 8 ], antimicrobial agents ( i.e ., metronidazole)[ 9 ], steroids[ 2 ], immunomodulators ( i.e ., infliximab)[ 12 ], endoscopic therapy[ 13 , 14 ] and surgical resection[ 5 - 7 ]. Recently, the efficacy of Helicobacter pylori ( H. pylori ) eradication therapy for H. pylori- positive patients with cap polyposis has been reported[ 10 , 11 , 15 , 16 ], and in 2016 the Japanese Society for Helicobacter Research added cap polyposis as a possible H. pylori -associated disease in its treatment guidelines. However, no treatments for H. pylori -negative cap polyposis or H. pylori -positive cases refractory to eradication therapy have yet been established.…”

Rectal cap polyposis masquerading as ulcerative colitis with pseudopolyposis and presenting as chronic anemia: A case study with review of literature

“…Conservative treatment modalities like avoidance of straining at defecation, use of metronidazole, infliximab, Helicobacter pylori eradication therapy and endoscopic polypectomy have been shown to be beneficial in some cases. [1314] Surgical resection should be reserved for patients with recurrence or for those who don’t respond to conservative therapy. To conclude, rectal CP should be considered in the differential diagnosis of patients presenting clinically with intermittent rectal bleeding and rectal polyposis on endoscopic examination.…”