Possible relationship between Helicobacter pylori infection and cap polyposis of the colon.
BACKGROUND
Cap polyposis is a rarely encountered disease characterized by multiple distinctive inflammatory colonic polyps located from the rectum to the distal colon. The etiology of this disease is still unknown, and no specific treatment has been established.


OBJECTIVE
We report three cases of cap polyposis that were cured following eradication therapy for Helicobacter pylori infection.


RESULTS
Three women were referred to Shinshu University Hospital because of mucoid and/or bloody diarrhea. Laboratory data showed hypoproteinemia in all cases; markers of inflammation such as C-reactive protein were negative. Colonoscopy revealed multiple sessile polyps with mucus adherent on the apices of the mucosal folds in the rectum and/or the sigmoid colon. The intervening mucosa was normal. Microscopic examinations of biopsy specimens taken from sessile polyps revealed inflamed mucosa with elongated tortuous crypts attenuated towards the mucosal surface. A granulation tissue 'cap' was observed on the surface of the mucosa. Various treatments were unsuccessful, including administration of metronidazole or prednisolone, avoidance of straining at defecation, and surgical or endoscopic resection. All were diagnosed with H. pylori infection in the stomach. Helicobacter pylori was not detected in the biopsy specimens from the colonic inflammatory polyps by immunohistochemical study using polyclonal anti-H. pylori antibody. After successful eradication therapy the clinical symptoms improved. Disappearance of cap polyposis was confirmed by colonoscopy in all three cases.


CONCLUSIONS
We speculate that H. pylori infection might play a role in the pathogenesis of cap polyposis.
Akamatsu
Taiji
T
Department of Endoscopy, Shinshu University Hospital, Shinshu University School of Medicine, Matsumoto, Japan. ta07260@hsp.md.shinshu-u.ac.jp
Nakamura
Naoshi
N
Kawamura
Yoko
Y
Shinji
Akihiro
A
Tateiwa
Nobuyuki
N
Ochi
Yasuhide
Y
Katsuyama
Tsutomu
T
Kiyosawa
Kendo
K
D000328:Adult; D000368:Aged; D005260:Female; D016481:Helicobacter Infections / Q000150:complications* / Q000188:drug therapy* / Q000473:pathology; D016480:Helicobacter pylori / Q000302:isolation & purification / Q000472:pathogenicity; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology; D044483:Intestinal Polyposis / Q000382:microbiology* / Q000473:pathology; D008875:Middle Aged