Juvenile Polyposis

Juvenile polyposis (JP) is another polyposis syndrome inherited as an autosomal dominant disease. Juvenile polyps characterize this disease, though this type of polyp can be found in otherwise normal children. The clinical criteria for the diagnosis of JP include: (1) at least five juvenile polyps in the colorectum, (2) juvenile polyps throughout the GI tract, and (3) any number of juvenile polyps in a person from a family with known JP. The syndrome is due to genetic mutations in SMAD 4 (15% of families) or

BMP1R (38% of families). The remainder of clinically diagnosed JP families have unknown genetic mutations. Genetic testing is available for JP. Histologically, the surface mucosa is nondysplastic with abundant lamina propria. There are elongated, benign cystically dilated glands that lack a smooth muscle core. Endoscopically, polyps are usually round, reddish and smooth and often they have a white exudate on their surface (Figure 95-3). On cut surface, the polyps contain cystic spaces filled with mucin. The surface mucosa is nondysplastic with abundant lamina propria. There are elongated, benign cystically dilated glands that lack a smooth muscle core.

Like PJS, polyps can occur throughout the GI tract, but in JP they are most common in the colon. They can bleed, infarct or intussuscept with subsequent obstruction. GI malignancy is believed to arise from juvenile polyps. Lifetime risk of colon cancer has been reported to be as high as 68%. Cancers in other organs, including stomach, duodenum, and the pancreaticobiliary tree, have been associated with JP.

Cancer surveillance is recommended as summarized in Tables 95-1 and 95-2. Polyp management can be done endoscopically, though sometimes surgery is necessary when the polyp burden becomes too high. This applies mainly to colon polyps, but possibly the upper GI tract as well.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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