Although hyperplastic polyps are a common finding, especially in the distal colon and rectum, hyperplastic polyposis (HP) is a unique clinical entity with a predisposition to develop numerous hyperplastic polyps in all colon segments. Clinical criteria for the diagnosis of HP include (1) at least 5 hyperplastic polyps proximal to the sigmoid colon, 2 of which need to be > 1cm, (2) any number of hyperplastic polyps proximal to the sigmoid colon in an individual with a first-degree relative with HP, and (3) > 30 hyperplastic polyps of any size, but distributed throughout the colon (Burt and Jass, 2000).
HP is not as well characterized as the other polyposis syndromes. Although families have been described with HP, little is known of the hereditary attributes of the disease. There is no available genetic testing for this condition.
Typically, the hyperplastic polyps predominate, however, patients can also have serrated adenomas, pure adenomas, or mixed adenomas and hyperplastic polyps. CRC has been associated with HP, though the lifetime risk is not clear (Leggett et al,2001).
Because of the risk of colorectal neoplasms, we recommend routine colonoscopic surveillance in these patients with an attempt to control the polyp burden endoscopi-cally. Intervals between colonscopies vary from individual to individual and are largely determined by polyp burden, presence of adenomas and family history. However, when the polyp burden is difficult to manage, especially in the coexistence of adenomas, we recommend subtotal colectomy.
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