A gastrointestinal polyp is a protrusion from the intestinal wall into the lumen, which may cause abdominal pain. However, the majority of polyps remain asymptomatic and do not present clinical manifestations.
Gastrointestinal polyps are classified microscopically as either benign or malignant.
Types of Gastrointestinal Polyps
1. Malignant Polyps
These include benign or malignant adenomatous polyps, while non-malignant polyps may be either inflammatory or vascular tumors.
A definitive diagnosis of a polyp type is made through microscopic examination. Complete excision of the polyp is crucial for accurate clinical assessment. Factors such as the polyp’s type, number, and location in the gastrointestinal tract are important considerations.
2. Inflammatory Polyps
These are the most common polyps in children, often referred to as juvenile polyps, and typically appear in children aged 2 to 5 years, with a higher prevalence in males.
The primary symptom is painless rectal bleeding, though some cases may present with abdominal pain, rectal prolapse, itching, diarrhea, or constipation.
Most inflammatory polyps are located in the colon and rectum, and multiple polyps may be present. However, these polyps do not undergo malignant transformation.
3. Lymphoid Polyps
These polyps are similar to inflammatory polyps, commonly occurring in the rectum. They may recur after excision but do not pose significant long-term health risks.
4. Juvenile Polyposis Syndrome (JPS)
This syndrome is characterized by multiple inflammatory polyps throughout the colon. It may be either hereditary or sporadic, though the specific genetic cause remains unidentified.
Clinical manifestations include severe gastrointestinal bleeding and rectal prolapse. These polyps have a potential for malignant transformation.
Distinguishing JPS from familial adenomatous polyposis (FAP) can be challenging, as JPS polyps may be more widely distributed throughout the gastrointestinal tract, leading to intestinal obstruction, malabsorption, and bleeding.
Due to the increased malignant potential, regular endoscopic surveillance and polypectomy are essential, and family members should undergo screening.
5. Familial Adenomatous Polyposis (FAP)
FAP is an autosomal dominant genetic disorder, characterized by the presence of hundreds to thousands of adenomatous polyps in the colon, with possible extraintestinal manifestations such as retinal abnormalities.
Polyps typically begin to develop in adolescence, leading to symptoms such as diarrhea, abdominal pain, and rectal bleeding.
If left untreated, the risk of developing colorectal cancer by age 55 approaches 100%.
Since the responsible gene is known, genetic screening for at-risk family members is available. Additionally, FAP polyps may develop in the upper gastrointestinal tract, necessitating endoscopic surveillance and polypectomy when necessary.
Symptoms of Gastrointestinal Polyps in Children
Common symptoms include:
Painless rectal bleeding, sometimes leading to iron deficiency anemia due to chronic blood loss.
Abdominal pain.
Diarrhea with mucus.
Rectal prolapse, where the polyp partially protrudes from the anus while remaining attached to the intestinal wall.
Causes and Risk Factors
1. Peutz-Jeghers Syndrome (PJS)
PJS is an autosomal dominant disorder, characterized by hamartomatous polyps in the gastrointestinal tract and hyperpigmented brown spots on the lips, oral mucosa, and skin.
Polyps may also develop in the respiratory tract, gallbladder, and urinary system. The risk of malignant transformation in the gastrointestinal tract ranges between 2% and 3%, particularly in the duodenum.
2. Cowden Syndrome
Another autosomal dominant disorder, Cowden syndrome presents between ages 10 and 30, causing vascular-type polyps throughout the gastrointestinal tract. These polyps have low malignant potential.
3. Other Risk Factors
Family history of intestinal polyps or colorectal cancer.
Chronic gastrointestinal diseases, such as inflammatory bowel disease (IBD) or Crohn’s disease.
Obesity and smoking.
Complications of Gastrointestinal Polyps in Children
Potential complications include:
Benign colonic tumors.
Gastrointestinal bleeding.
Intestinal obstruction.
Diarrhea.
Malignant transformation.
Intestinal perforation (in rare cases).
Diagnosis of Gastrointestinal Polyps in Children
Polyps are often detected incidentally during screening for another condition or colorectal cancer surveillance. If polyps are found, further evaluation using:
Colonoscopy (to visualize and remove polyps).
CT colonography (to examine the entire colon).
Treatment of Gastrointestinal Polyps in Children
1. Colonoscopy and Polypectomy
The primary treatment for most polyps is endoscopic removal (polypectomy).
During a colonoscopy, a flexible colonoscope is inserted into the rectum, allowing visualization of the colon. Polyps are excised using a wire loop with an electrical current to either burn (cauterize) or cut the polyp.
This procedure is painless.
2. Surgical Removal
Surgery may be required in rare cases when:
The polyp exhibits precancerous changes.
The polyp is too large for endoscopic removal.
The patient has multiple polyps.
After removal, the polyps are analyzed in a pathology lab to determine:
Complete excision status.
Risk of recurrence.
Presence of malignant changes.
If malignancy is detected, additional oncologic evaluation and treatment may be necessary.
Prevention of Gastrointestinal Polyps in Children
1. Healthy Lifestyle Choices
Increase intake of fruits, vegetables, and whole grains.
Reduce dietary fat consumption.
2. Calcium and Vitamin D Supplementation
Increased calcium intake may help reduce colonic polyp recurrence, though its effect on colorectal cancer prevention remains unclear.
3. Regular Medical Check-ups
Genetic counseling is recommended for individuals with a family history of colorectal polyps.
Early colonoscopic surveillance is crucial for patients with hereditary polyp syndromes.
By adhering to regular screening, timely intervention, and lifestyle modifications, the risks associated with gastrointestinal polyps in children can be significantly reduced