A hyperplastic polyp is a small, usually benign growth that can appear in the colon, rectum or stomach. Most hyperplastic polyps do not turn into cancer, but they may need to be checked because some can look similar to other types of polyps that have a higher cancer risk.
Hyperplastic polyps often do not cause symptoms and are commonly found during a colonoscopy or upper endoscopy. When symptoms happen, they are usually related to bleeding, anemia or digestive discomfort, especially when the polyp is in the stomach.
Treatment depends on the size, location and appearance of the polyp, as well as the biopsy results. Some polyps are only monitored, while others are removed during an endoscopy or colonoscopy to confirm the diagnosis and reduce future risk.
Main symptoms
Most people with a hyperplastic polyp do not have any symptoms, especially when the polyp is small. When symptoms do occur, they may include:
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Rectal bleeding
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Blood in the stool
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Abdominal discomfort
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Indigestion
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Nausea
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Vomiting
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Anemia
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Fatigue related to anemia
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Signs of stomach bleeding, such as dark stools
Symptoms are more likely when the polyp is larger, irritated or located in the stomach. However, these symptoms can also be caused by many other digestive conditions, so medical evaluation is important when they appear.
Possible causes
Hyperplastic polyps are usually linked to changes in the lining of the colon, rectum or stomach, often related to inflammation, tissue repair or long-term irritation.
This can happen as a result of:
1. Chronic inflammation
Hyperplastic polyps can form when the digestive lining responds to long-term inflammation or injury. In the stomach, this may happen with chronic gastritis, which causes the stomach lining to become irritated over time.
This irritation can lead to extra tissue growth as the lining tries to repair itself. The result may be a gastric hyperplastic polyp, which is a hyperplastic polyp that forms in the stomach.
2. H. pylori infection
H. pylori is a type of bacteria that can infect the stomach and cause chronic gastritis. This infection is linked to some gastric hyperplastic polyps.
Treating H. pylori may help some stomach hyperplastic polyps shrink or disappear. This is why testing for and treating this infection can be part of care when a gastric hyperplastic polyp is found.
3. Autoimmune gastritis
Autoimmune gastritis is another condition linked to gastric hyperplastic polyps. It happens when the immune system attacks cells in the stomach lining, leading to long-term inflammation.
Over time, this inflammation may change how the stomach lining heals and repairs itself. This can increase the chance of developing hyperplastic growths in the stomach.
4. Serrated polyp changes in the colon
In the colon and rectum, hyperplastic polyps are part of a broader group of growths called serrated lesions. Small hyperplastic polyps in the lower colon or rectum usually have very low cancer potential.
However, larger serrated lesions or lesions found in the upper colon may need closer review. Some lesions that first appear to be hyperplastic polyps may later be reclassified as sessile serrated lesions after more detailed pathology testing.
Confirming a diagnosis
A hyperplastic polyp is usually diagnosed during a colonoscopy, sigmoidoscopy or upper endoscopy. These exams allow the doctor to see the inside of the colon, rectum or stomach and identify small tissue growths.
The diagnosis is confirmed with a biopsy or by removing the polyp and sending it to a laboratory. A pathologist checks the tissue under a microscope to confirm whether it is a hyperplastic polyp or another type of polyp, such as an adenoma or sessile serrated lesion.
Doctors also consider the size, number and location of the polyps. This helps guide follow-up, because small distal hyperplastic polyps are usually low risk, while larger, multiple or upper-colon serrated lesions may require closer surveillance.
Treatment options
Treatment depends on where the hyperplastic polyp is found, how large it is, whether it is causing symptoms and what the biopsy shows.
1. Monitoring
Small hyperplastic polyps in the rectum or lower colon may not need special treatment after they are removed or confirmed to be low risk. Follow-up colonoscopy timing depends on the full colonoscopy findings and whether other types of polyps are present.
Monitoring may also be recommended when the polyp is small and does not show concerning changes. The doctor may use pathology results and guideline-based risk categories to decide the next exam date.
2. Polyp removal
Many hyperplastic polyps are removed during colonoscopy or endoscopy. Removal helps confirm the diagnosis and can prevent confusion with other types of polyps that may have a higher cancer risk.
Different endoscopic techniques may be used depending on the size and location of the polyp. These can include snare removal or endoscopic mucosal resection for larger or more complex lesions.
3. Treating H. pylori
When a gastric hyperplastic polyp is linked to H. pylori infection, treatment for the infection may be recommended. This treatment uses antibiotics and acid-reducing medicine to clear the bacteria from the stomach.
Treating the underlying infection can reduce inflammation in the stomach lining. In some cases, this may help the polyp shrink or go away.
When to see a doctor
Medical evaluation is recommended when there is blood in the stool, black stools, unexplained anemia, ongoing stomach pain, persistent indigestion, vomiting or unexplained fatigue. These symptoms do not always mean there is a polyp, but they can be signs of bleeding or another digestive condition.
A gastroenterologist can assess symptoms, recommend the right exam and decide whether a polyp should be removed or monitored. Follow-up is especially important when polyps are large, numerous, located in the upper colon or associated with abnormal biopsy findings.