S2949 Hematemesis! Unique Presentation of Hyperplastic Gastric Polyps

Abstract

INTRODUCTION: Hyperplastic gastric polyps are usually diagnosed during routine upper gastrointestinal endoscopy. They cause gastric outlet obstruction and chronic blood loss leading to iron deficiency anemia. However, a presentation as an acute severe upper gastrointestinal bleeding is rare. We report a presentation of severe hematemesis and melena diagnosed by EGD showing multiple, pedunculated, sessile, and vascular polyps with bleeding in the entire examined stomach. CASE DESCRIPTION/METHODS: A 68-year-old female with type 2 diabetes mellitus and hypertension presented with 4 hours of nausea, vomiting, hematemesis of bright red blood, melena, and crampy abdominal pain. She was on carvedilol, clonidine, losartan, metformin, and nifedipine. Her history included appendectomy, hernia repair, cholecystectomy, hysterectomy. She denied alcohol, tobacco, and illicit drug use. Examination and vital signs were unremarkable otherwise. Hemoglobin was 10.3 g/dL. ECG and chest x-ray were normal. Intravenous fluids and pantoprazole, metoclopramide, and ondansetron were begun. EGD showed multiple 5-30 mm pedunculated, sessile, and vascular polyps with bleeding in the entire examined stomach. The heaviest bleeding polyp was in the mid-body along the greater curvature with a base of the gastric circumference. One polyp on a long pedicle was prolapsed into and obstructing the duodenum. Larger polyps had nodular/botryoidal surfaces with marked hypervascularity typical of inflammatory hyperplastic polyps. The patient declined surgical management and instead opted for endoscopic polypectomy. Histopathology was benign and consistent with hyperplastic gastric polyps. DISCUSSION: Gastric polyps have been reported in about 5% of upper gastrointestinal endoscopies. The majority of gastric polyps are fundic gland polyps which have been attributed to proton pump inhibitor use. In other areas with high prevalence of Helicobacter pylori, hyperplastic polyps have been reported more frequently. However, our patient had a negative for Helicobacter pylori test and didn’t use proton pump inhibitors. This presentation with acute severe upper gastrointestinal bleeding is exceedingly rare and suggests that benign hyperplastic gastric polyps can cause severe spontaneous bleeding and obstruction.Figure 1.: The surface epithelium may also contain erosions or ulcerations leading to gastrointestinal bleeding.Figure 2.: 40 X histology Gastric hyperplastic polyps may contain pyloric glands, chief cells, and parietal cells, and their histologic appearance can overlap with hamartomas and inflammatory conditions.Figure 3.: Polyps as seen per EGD.