"Intestine" talks a lot

In recent years, the public has gradually paid more attention to gastric and intestinal examinations, and the number of patients undergoing gastric and colonoscopy examinations has also increased. However, most people still lack specific medical knowledge, especially knowledge about intestinal treatment! It is said that polyps and cancer are close relatives. The most common questions asked by patients are: Can polyps be removed? Does it hurt to remove polyps? Will they become cancerous? Colorectal polyps are closely related to the occurrence of colorectal cancer. Morson's adenoma-carcinoma hypothesis believes that colorectal polyps are an important cause of colorectal cancer[1]. In my country, 1.4% to 20.4% of colon polyps will become malignant[2]. Under such hidden dangers, we should strengthen our knowledge of intestinal polyps.

What are intestinal polyps?

Intestinal polyps refer to any protruding lesions in the intestinal lumen. Generally, polyps are localized protrusions originating from the mucosal epithelium [3].

What types of intestinal polyps are there?

Depending on whether they are related to tumors, they can be divided into neoplastic polyps and non-neoplastic polyps. Non-neoplastic polyps can be divided into metaplastic polyps, inflammatory polyps, immune polyps and other types of polyps. Neoplastic polyps can be divided into adenomatous polyps and hamartomatous polyps. Adenomatous polyps can be divided into tubular adenomas, villous adenomas and mixed adenomas according to their components.

How do intestinal polyps form?

The occurrence of intestinal polyps is related to gender, lifestyle, smoking history, drinking history, high BMI, Helicobacter pylori infection and a history of polyps [2, 4-7]. The incidence of colorectal polyps will increase significantly in people who have a high-fat, high-protein, low-fiber diet for a long time. There are also genetic factors. When a family member has adenomatous polyps, the possibility of other family members developing colorectal polyps increases significantly. In addition, chronic inflammatory lesions of the colon mucosa are the main cause of inflammatory polyps.

What should I do if I find intestinal polyps?

Endoscopic treatment is the main treatment. If the patient has no contraindications, the doctor will choose endoscopic treatment first. When polyps are found during the examination, they can be removed. Except for a very small number of polyps that are too large in diameter, have obvious malignant changes in endoscopic appearance, or are too numerous, intestinal polyps can generally be completely removed under endoscopy. At present, the technology of colonoscopic polyp removal is very mature, and there are many methods of polyp removal, such as argon knife cauterization, snare extraction, high-frequency electrocautery ((electrocoagulation, biopsy forceps coagulation, snare coagulation, EMR, ESD), microwave therapy and laser therapy), etc. Most of them can completely remove polyps.

Do you need to take medicine? A few inflammatory polyps need to be treated with anti-inflammatory drugs, but most intestinal polyp drugs cannot treat the polyps themselves.

Surgery is needed in the following situations:

For those who have been confirmed to have cancer or suspected cancer by pathological examination;

Large adenoma;

The adenoma is basal;

Patients with a large number of adenomas densely distributed in a certain intestinal segment, as well as patients with colorectal adenomas such as polyposis and adenomatosis that cannot be removed by endoscopy alone, should receive surgical treatment.

What should I pay attention to after polyp removal?

Patients who undergo colonoscopy generally feel bloating, and some patients may experience dull abdominal pain. If you only feel bloating, it is recommended that you do some moderate exercise to alleviate the symptoms.

If the patient cannot move, it is recommended to massage the abdomen in a clockwise circular motion to promote the discharge of flatulence. If necessary, follow the doctor's advice to perform anal tube venting. If the abdominal pain is severe, report it to the doctor immediately. If there is persistent abdominal pain, or a lot of blood in the stool, tell the doctor in time. Remove a small amount of small polyps, fast for 2 hours as prescribed by the doctor, drink a small amount of warm water after 2 hours, and eat easily digestible food only when there are no discomfort symptoms. Do not exercise vigorously within three days and get enough rest.

Follow-up examination: Follow the doctor's instructions for regular follow-up examinations, usually every 3-6 months.

How to prevent and screen early?

The "Guidelines for Colorectal Cancer Screening, Early Diagnosis and Treatment in China" is the first guideline for colorectal cancer screening in my country. It recommends that the general population receive colorectal cancer risk assessment from the age of 40; it recommends that people assessed as medium- and low-risk receive colorectal cancer screening at the age of 50 to 75; it recommends that people assessed as high-risk receive colorectal cancer screening at the age of 40 to 75. If one or more first-degree relatives have colorectal cancer, the recommended starting age for colorectal cancer screening is 40 years old or 10 years earlier than the youngest patient among the first-degree relatives. If there are no polyps in the intestine, it is recommended to have a high-quality colonoscopy every 5 to 10 years. People over 40 years old, especially those who have a long-term high-protein and fat diet and long-term alcoholics, should have a colonoscopy during a routine physical examination to detect some asymptomatic early colorectal cancers as early as possible.

What should we pay attention to in daily life?

Regular review

Adjust your diet

Avoid spicy, fried, greasy, high-protein and irritating foods. Eat more fresh vegetables and fruits to keep bowel movements smooth and regular. Avoid constipation caused by low fiber. The longer the constipation lasts, the more likely it is to stimulate the enlargement of polyps or the recurrence of polyps. In addition, alcohol stimulation will also aggravate the stimulation of polyps.

Exercise properly

Since the right colon is mainly distributed with parasympathetic nerves, moderate exercise can increase the excitability of the parasympathetic nerves, thereby strengthening intestinal peristalsis, reducing the time that feces stay in the right colon, reducing the effects of some neoplastic substances in the feces on the intestinal mucosa, and reducing the incidence and recurrence rates of polyps.

Keep a good mood

When people's nerves are overly tense, the sympathetic nerves that control the peristalsis of internal organs are excited, which will inhibit gastrointestinal peristalsis and slow down the speed, thus leading to constipation. Constipation will increase the occurrence of intestinal polyps. Therefore, face the reality and try to relax. As long as you have a moderate diet, make reasonable arrangements, have regular checkups, and promptly discover and deal with it, you can greatly reduce the chance of cancer.

References:

Morson B.C. Evolution of cancer of the colon and rectum［J］． Cancer, 1974, 34(3): suppl: 845-849

Zhang Qian, Ren Junyao, Xing Jie, et al. Analysis of risk factors related to colorectal polyps［J］． China Medical Herald, 2021, 18(21): 50-53, 66．

Lai Maode. Classification of colorectal polyposis and adenomas and problems in diagnosis[J]. Journal of Clinical and Experimental Pathology, 2008, 24(5): 515-517.

An Junping, Liu Bin, Shi Aili, et al. Clinical pathological characteristics of colon polyps and their correlation with canceration［J］． Chinese Journal of Physician, 2017, 19(7): 1035-1037, 1042．

Li Yanping, Li Ji, Gai Xiaorong, et al. Analysis of risk factors for colorectal polyps［J］． Journal of Capital Medical University, 2013, 34(5): 684-688．

Wu Wenqi, Wan Yuantai. Current status of research on factors related to the occurrence and development of colorectal polyps［J/CD］． Journal of Digestive Oncology (Electronic Edition), 2021, 13(2): 148-152.

Pan J, Cen L, Xu L, et al. Prevalence and risk factors for colorectal polyps in a Chinese population: a retrospective study［J］． SciＲp, 2020, 10(1): 6974.