Endoscopic Removal of a Giant Complicated Hyperplastic Gastric Polyp.

The patient, a 40-year-old male, was referred to our clinic with intermittent nausea, vomiting and symptomatic anemia for 4 months. Notable hematological indices were low hemoglobin levels of 9.6 g/dl and hematocrit levels of 35.8%, while after receiving two units of concentrated red blood cells, at discharge; they achieved levels of 15.2 g/dl and 42.3%, respectively. Esophagogastroduodenoscopy revealed a 3 cm antral pedunculated polyp, prolapsing into pylorus thus causing intermittent pyloric obstruction and anemia. Histological examination revealed a hyperplastic polyp without evidences of malignancy. No atrophy, metaplasia, dysplastic changes or Helicobacter pylori infection were detected in samples taken from the antrum and the corpus; however, the examination provided evidence for gastritis. Follow-up endoscopy was provided after 12 weeks to see polypectomy site after a course of Pantoprazole administration, and to define symptom-free time after polypectomy. Endoscopic removal of complicated gastric polyps should be considered at the time of initial diagnostic endoscopy. Endoscopic resection of polyps enables to determine the exact histopathologic type as well as to effectively treat symptomatic gastric outlet obstruction and anemia.

Effectiveness of proton pump inhibitors in the treatment of patients with endoscopic esophagitis.

Gastroesophageal reflux disease (GERD) is a common disorder, typically diagnosed by a history of chronic heartburn. Proton pump inhibitors (PPIs) eliminate symptoms and heal esophagitis more frequently and more rapidly than other agents. The aims of this study were to evaluate the effectiveness of proton pump inhibitors (PPIs) in terms of symptom resolution and endoscopic healing in patients with erosive reflux disease. In this prospective study we included 380 patients with positive history for the main symptoms of erosive reflux disease. Symptoms were evaluated before and after treatment with PPI on the period of three months and were recorded with heartburn system score and regurgitation score. All patients were classified according to Los Angeles classification for erosive reflux disease, before and after the three months treatment with PPI and were conducted for their healing of erosive oesophagitis in the finish of the treatment. Before the treatment, 95% of patients were with heartburn, 90% with regurgitation and 70% with epigastric pain. Quantification for pyrosis and regurgitation were obtained in each patient. After treatment of these patients with PPIs, resolution for pyrosis was from 95% to 25%, for regurgitation from 90% to 20% and for epigastric pain from 70% to 10%. In 71.67% of patients was found complete healing of erosive oesophagitis and minimal progression in 1.05% of patients. Results of this study showed that PPI treatment of patients with erosive reflux disease can influence on very good symptomatic and mucosal resolution after three months. Epigastric pain was shown not to bee specific for erosive reflux disease.