| Background and Purpose: Intestinal polyps are lesions which hump from intestinal mucosal surface. Based on the histopathological types they are divided into inflammatory polyps, hyperplastic polyps, adenomatous polyps etc.Benign intestinal polyp is a common clinical disease, but belongs to one of the precancerous polyps.The polyp-adenoma-adenocarcinoma sequence has evolved as the well-accepted model of colonic cancer development. Their clinical manifestations lack specificity,colonoscopic examination and pathological biopsy can be diagnosed.Endoscopic colonic polyps resection in the treatment of early detection in parallel, can effectively prevent intestinal adenoma(CRA) and colorectal cancer(CRC) occurrence. Gastric polyps are benign lesions which originated from the gastric mucosa.It is a common digestive disease,and approved that can increase the risk of colon polyps.Many researches confirmed that the occurrence rate of intestinal adenomas is higher in the patients with gastric fundic gland polyps(FGP) or gastric adenomatous polyps than those without gastric polyps.Gastricadenoma is related to the occurrence of intestinal adenoma.The mechanisms of the association between these two types ofpolypsarestill unknown.Geneticfactors and the differences in living conditions may be involved.There is no consensus about which factors can be screened for the detection of colonic polyps by colonoscopy and whether the patients with gastric polyps should be advised for colonoscopy, and how to screen for colonic polyps or cancer in these people. Previous studies have focused on the risk factors of simple gastric polyps,simple colonic polyps, adenoma and carcinoma.Report on the relationship between colonic polyp and gastric polyp was not seen. It is still not clear whether the characteristics of gastric polyps coincident with colonic polyps are different from those of mere colonic polyps. It is still not known if other pathologic types of gastric polyps besides FGP and adenoma can add the risk of colonic polyps. Therefore, It is necessary to solve the above problems through research and analysis.Through the research to seek out the risk factors of colonic polyps in patients with gastric polyps and expose the characteristics of gastrointestinal tract polyps, and analyse the relationship between pathological types of gastric polyps and colonic polyps. This may help medical practitioners to find out colonic polyps in patients with gastric polyps.Methods:The research comprise two parts. 1. Part I: A total of 256 hospitalized patients from the Department of Gastroenterology from January 2012 to January2014 were enrolled. All of them underwent gastric endoscopy and colonoscopy. Adopt case-control study. Patients with gastric and colonic polyps were treated as patient group(n=73), patients with gastric polyp only were as control group 1(n=107), and patients with colonic polyp only were as control group 2(n=76). Collect and analyse demography(gender, age, smoking, drinking) and clinical data(HP infection,hypertriglyceridemia, hypercholesterolemia, hypertension, diabetes) of all research subjects. 2. Part II: Retrospectively analysis gastrointestinal endoscopy reports of research subjects. Collect and analyse the number of gastrointestinal polyps(single,multiple), location, and pathology of all the subjects. 3. Conduct statistical analysis of the above results. Data were expressed as X ± S or percentage. Among the three groups,the differences were calculated by X2test。Logistic regression was conducted and the relative risk(OR) as well as 95% CI were calculated. A P value of <0.05 was treated as statistical significance.Results:Part I1.The demographical results from the research subjects1)Gender and age: a. The patient group consisted of 46 females(63.01%) and 27males(36.99%) with the age range of 24 to 86 years old(average 63±13.16 years old).b. The control group 1 consisted of 79 females(73.83%) and28 males(26.17%)with the age range of 25 to 86 years old(average 68.52±11.01 years old).c.The control group 2 consisted of 33 females(43.42%) and 43 males(56.58%)with the age range of 40 to 85 years old(average 63.41±11.89 years old).2)The age distributionThe research objects were divided into groups based on their age, i.e. ≤ 40 years old, 41 ~ 50 years old, 51 ~ 60 years old, 61 ~ 70 years old, 71 ~ 80 years and over 81 years old. The cases with ages of 61 ~ 70 years old were the largest proportion(27.40%) in the patient group, followed by those with ages of 71 to 80 years old(24.66%).In control group1, cases with ages of 51 ~ 60 years old were the largest proportion(35.51%), followed by those with ages of 41 to 50 years old(25.23%). In control group 2, cases with ages of 71 ~ 80 years old were the largest proportion(35.51%), followed by those with ages of 51 to 60 years old(25.00%).Senior cases with the age over 60 years in the patient group, control group 1, and control group 2 were 60.27%, 35.51% and 59.21% respectively.2. Analysis of risk factors1) Comparison with the control group1:a. Results of X2test: In case group, cases with the age over 60 years, the ratios of HP infection, smokers, alcohol consumers,hypercholesteremia and concurrent hypertension were higher than those in the control group,the difference was significant(P = 0.001, 0.002, 0.014, 0.024,<0.01,0.043, respectively).There were no significance in male proportion composition,number of patients with high serum triglycerideor and diabetes(P = 0.094, 0.590,0.568).b.Results of logistic regression analysisThe risk factors make patients with gastric polyps occur colonic polyps ea sily are age, HP infection, high cholesterol(P = 0.008、0.003、0.006); the risk factors are as follows:HP infection(OR=3.099,95%CI:1.479—6.496),highcholester ol(OR=3.009,95%CI:1.373—6.593),age(OR=2.757,95%CI:1.308—5.813).2)Comparison with the control group2:The case group compared with th e control group, the HP positive rate is higher,with the differences are significa nt(P=0.016,<0.01). In the patient group, the proportions of male cases, cases with the age of over 60, smokers, alcohol consumers, cases with hypertriglycer idemia、hypercholesteremia,hypertension or diabetes were no significance when compared with control group 2(P = 0.05, 0.885, 0.154, 0.733, 0.273, 0.053,0.322, 0.718, respectively).Part II1.The characteristics of gastric polyps in case group and the control group11)In case group,there were 54 cases(73.93%)suffered with single gastric polyp and 19 cases with multiple polyps(26.03%). The predilection sites were gastric body(38 polyps, 46.91%), fundus of the stomach(28 polyps, 34.57%), gastric antrum(7 polyps, 8.64%), cardia(5 polyps, 6.17%) and gastric angle(3 polyps, 3.71%)respectively. Histology disclosed that the polyps included are consisted of 54 inflammatory polyps(66.67%), 15 fundic gland polyps(18.51%), 10 hyperplastic polyps(12.35%), and 2 adenomatous polyps(2.47%).In control group1,there were 91 cases(85.05%) suffered with single gastric polyps, 16 cases(14.95%)with multiple gastric polyps. The predilection sites were gastric body(73 polyps, 60.33%), fundus of the stomach(28 polyps, 23.14%), gastric antrum(12 polyps, 9.92%), cardia(5 polyps, 4.13%), and gastric angle(3 polyps,3.48%) respectively. Histologically, there were 65 inflammatory polyps(54.17%), 28 fundic gland polyps(23.14%), 26 hyperplastic polyps(21.67%), 2 adenomatous polyps(1.68%).There were no significant differences in the number, location and histology of gastric polyps between these two groups(P>0.05).2.The characteristics of colonic polyps in patient group and the control group 2(1)In case group, there were 68 cases(93.15%) suffered with solitary colonic polyps,5 cases(6.85%) with multiple colonic polyps. The predilection sites were 64cases(62.14%) with left colon and 31 patients with right colon(30.10%), 8 cases with rectal(7.77%). According to the pathological types were 58 adenomatous polyps(56.31%), non adenomatous polyps 45(43.69%).In control group2,73 cases(96.05%) were solitary intestinal polyps,3 cases of multiple intestinal polyps(3.95%). There were 61 cases(61.61%) with polyps located in left colon and 34 patients with polyps in right colon(34.34%), and 4 cases with polyps in rectum(4.05%). Histology of the polyps showed that 64 polyps(64.64%)were adenomatous and 35 polyps(45.36%) were non-adenomatous.There were no significant differences in number, location and histology of colonic polyps between patient group and control group 2(P>0.05).(2)In patient group,the occurrence rate of adenomatous polyp in right colon(67.74%)was significantly more than that in the left colon(51.39%)(P=0.014). In control group 2, the occurrence rate of adenomatous polyps in left colon(69.23%)was higher than that in the right colon(55.88%), but no significance was detected(P=0.058).Conclusion:1.The risk factors that correlated gastric polyps with colonic polyps are age elder than 60 years old,HP infection and hypercholesteremia. The factors listed in a descending order of risk as follows: HP infection, hypercholesteremia,and age.2.HP infection is the risk factors of the coexistence of gastric and colonic polyps,patients should be suggested eradicate HP infection.3.The characteristics of gastric polyps in patients with coexistent gastric and colonic polyps are identical with single gastric polyps. It is frequently present at the body of stomach, gastric fundus, gastric antrum, cardia, and gastric angle.Histologically, the gastric polyp is usually present as inflammatory polyp, fundic gland polyp, hyperplastic polyp, or adenomatous polyp.4. The characteristics of colonic polyps in patients with coexisted gastric andcolonic polyps are identical with single colonic polyps. Solitary polyps are common.The colonic polyps are frequently seen at the left colon, the right colon, and rectum.Adenomatous polyps are most frequently seen in histology.5. The histology of gastric polyps does not affect the onset of colonic polyps.The presence of gastric polyps does not increase the risk of colon polyps.6. Adenomatous polyps are more likely to occur in the right colon when the patients suffer with gastric polyps and colonic polyps simultaneously. Therefore, more attention should be paid to the right colon when a patient with gastric polyp undergo colonoscopy. |
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