Gastric polyps
- Lesion
Most stomach polyps are harmless overgrowths from gastritis or acid-lowering drugs; gastric adenomas, though, often turn into cancer.
What it is
Polyps are found in a few percent of upper endoscopies. They arise from epithelial or stromal hyperplasia, inflammation, ectopia or neoplasia. The three most common gastric types differ in their background and in cancer risk, so the pathologist's label decides what happens next.
Structure
- Hyperplastic polyps: smooth ovoid surface; inflammatory polyps often eroded.
- Fundic gland polyps: small, well circumscribed, smooth, single or many.
- Adenoma: low-grade or high-grade dysplasia; high grade with budding and cribriform glands.
The common gastric polyps
| Polyp | Background | Histology | Cancer risk |
|---|---|---|---|
| Inflammatory or hyperplastic | Chronic gastritis, H. pylori | Elongated, cystic, corkscrew foveolar glands in oedematous inflamed lamina propria | Low; higher above one centimetre |
| Fundic gland polyp | Proton pump inhibitors, FAP, MUTYH | Cystically dilated glands lined by parietal, chief and foveolar cells; little inflammation | Negligible when sporadic; dysplasia possible in FAP |
| Gastric adenoma | Atrophy and intestinal metaplasia | Dysplastic epithelium: elongated, stratified, hyperchromatic nuclei | High, rising with size |
Clinical notes
- Peutz–Jeghers and juvenile polyps can also occur in the stomach; they are covered with the intestinal polyps.
- Many fundic gland polyps in a young person should raise the question of FAP.
Test yourself
Think of the answer, then tap the question to see it.
Which drug class has made sporadic fundic gland polyps more common?
Proton pump inhibitors, which raise gastrin and stimulate oxyntic gland growth.
Which gastric polyp carries the highest risk of adenocarcinoma?
The gastric adenoma, especially when larger than two centimetres.
On what background do gastric hyperplastic polyps arise?
Chronic gastritis, most often H. pylori gastritis.
Connections
Educational content on the mechanisms of disease; not a diagnostic or treatment guide and no substitute for a health professional's advice. No doses are given.
Sources: Gastric Cancer (StatPearls (NCBI Bookshelf), 2025).
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Representative model, for educational purposes only.