Hyperplastic Polyps of the Esophagus and Esophagogastric Junction

Abstract

Hyperplastic polyps of the esophagus and esophagogastric junction region (EGJ) are uncommon lesions characterized by hyperplastic epithelium (foveolar-type, squamous, or both) with variable amounts of inflamed stroma. They have been reported almost exclusively in the radiologic and clinical literature as occurring predominantly in association with gastroesophageal reflux disease (GERD). Comprehensive histologic and clinicopathologic evaluation of these polyps, their association with background mucosal pathology, and their association with Barrett's esophagus has not been previously performed. We studied 30 hyperplastic polyps from 27 patients and characterized the histologic, endoscopic, and clinical features of both the polyps and the background esophagus. Hyperplastic polyps were most common in the region of the EGJ (67%), followed by the distal esophagus (30%) and mid-esophagus (3%). Most (80%) were composed of predominantly cardiac-type mucosa, predominantly squamous mucosa (17%), or an admixture (3%). Intestinal metaplasia of the polyp was present in only 7% and low-grade dysplasia in only 3%. In the majority of cases (67%) hyperplastic polyps were associated with concurrent or recent ulcers or erosive esophagitis. In most cases (48%) esophageal injury was associated with GERD, but other potential etiologies included medications, infection, anastomotic or polypectomy sites, vomiting, and photodynamic therapy. Four patients (15%) had Barrett's esophagus, three of whom had or developed dysplastic Barrett's mucosa. These results underscore the pathogenesis of esophageal/EGJ region hyperplastic polyps as a mucosal regenerative response to surrounding mucosal injury. Careful clinical history and biopsy of the nonpolypoid mucosa are essential for determining the clinicopathologic context in which the polyps have developed.

Multiple Esophageal Hyperplastic Polyps in a Nigerian Woman

“…While Abraham et al reported 15% (4 out of 27 patients) association [8], Long and Odze reported a 33% (15 patients out of 46) association and suggested that the polyps may be a harbinger of BE because they were associated with either ultrashort (<1 cm) or short segment (1 to 3 cm) BE [11].…”

“…Buyukasik et al reviewed a total of 66 upper gastrointestinal polyps from 59 patients and found esophageal polyps to be less common as compared to gastric and duodenal polyps [29 in the Hyperplastic polyps of the gastric corpus and antrum usually develop in association with chronic gastritis but the pathogenesis of esophageal hyperplastic polyps is still not fully understood [10,11]. However, there is evidence to suggest that the lesion develops as a result of mucosal regenerative response to surrounding mucosal injury [5,6,8]. The lesion is commonly associated with erosive esophagitis/or hiatal hernia [4][5][6]8,12,13].…”

“…The lesion is commonly associated with erosive esophagitis/or hiatal hernia [4][5][6]8,12,13]. Other potential etiologies include eosinophilic esophagitis, Crohn's disease, medication-induced esophagitis, infection, anastomotic or polypectomy sites, photodynamic therapy, and type 1 neurofibromatosis [5,8,14,15].…”

“…Two studies that reported the frequency of association of esophageal hyperplastic polyps with Barrett's esophagus (BE) are conflicting [8,11]. While Abraham et al reported 15% (4 out of 27 patients) association [8], Long and Odze reported a 33% (15 patients out of 46) association and suggested that the polyps may be a harbinger of BE because they were associated with either ultrashort (<1 cm) or short segment (1 to 3 cm) BE [11].…”

“…Polypoid epithelial lesions of the esophagus are rare worldwide [4,7,8]. We encountered only a report of hyperplastic polyp of the esophagus from Nigeria in our literature review [9].…”