A234 A CASE OF OBSCURE GASTROINTESTINAL BLEEDING CAUSED BY BENIGN GASTRIC HYPERPLASTIC POYLPS

An 81 year-old female on Apixaban for atrial fibrillation was referred to gastroenterology for a persistently dropping hemoglobin, requiring blood transfusions. She symptomatically felt weak but was otherwise hemodynamically stable. She denied any history of hematemesis, melena, or blood per rectum. She underwent a push enteroscopy and colonoscopy which did not find a source of bleeding. A capsule endoscopy was then performed which did not find a source of bleeding, but showed 2 red polyps in the stomach. An upper endoscopy was then repeated and 10 gastric polyps were seen, ranging from 0.5 to 1.5cm. Pathology showed them to be non-dysplastic hyperplastic polyps. After the removal of these polyps, her hemoglobin stabilized, and she was able to re-start her Apixaban with no further bleeding and no further transfusions over the next 6 months. To describe a rare cause of obscure GI bleeding from a commonly benign GI pathology. Retrospective case study and literature review. Gastric polyps are abnormal growths of tissue projecting from the gastric mucosa. They are found in 5–7% of patients undergoing gastroscopy. Hyperplastic polyps account for 17% of all discovered gastric polyps. They are classically associated with atrophic gastritis; secondary to either H. pylori infection, or autoimmune gastritis. In recent years though, these polyps have been found in normal or reactive mucosa, with no evidence at all of current or prior H.pylori infection. Endoscopically, they are often smooth, dome-shaped, and between 0.5–1.5cm. If they are large enough, they can become lobulated, pedunculated, and their surface epithelium can become eroded, which has been described to lead to chronic blood loss and iron-deficiency anemia. Up to 20% of hyperplastic polyps can have some level of dysplasia. While the prevalence of carcinoma is less than 2%, this risk increases in polyps greater than 2cm. Hence, polyps larger than 1cm are often removed completely. Biopsies of unaffected mucosa should also be obtained to determine if there is H.pylori associated gastritis. If present, and H.pylori is eradicated, any small remaining hyperplastic polyps will likely regress or disappear. Hyperplastic polyps have been rarely described to be the source of gastrointestinal blood loss. Cases have been described whereby patients’ anemia did not correct with treatment of other potential bleeding sources, but their anemia did resolve after removal of hyperplastic gastric polyps. Hyperplastic gastric polyps, although relatively common in older populations, are present in only a small percentage of patients undergoing investigation for gastrointestinal blood loss. While often overlooked, they should be recognized as a potential treatable cause of anemia and obscure GI bleeding especially in patients on anticoagulant and antiplatelet medications. Capsule endoscopy picture of red hyperplastic polyp None

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