What are IBD pseudopolyps?

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Crohn’s disease and ulcerative colitis cause chronic inflammation in the colon. During flare-ups of these conditions, inflammatory processes can lead to the formation of IBD pseudopolyps.

Episodes of inflammation cause ulcerations and damage to colon walls. As the body heals these lesions, pseudopolyps can develop.

IBD pseudopolyps have distinct characteristics that set them apart from cancer-causing polyps. Unlike typical polyps with a stalk-like structure, pseudopolyps tend to be flatter and present as raised bumps.

Individuals with IBD pseudopolyps may experience various symptoms. However, in some cases, there are no noticeable signs.

Symptoms may depend on the size, location, and number of pseudopolyps and the overall disease activity in IBD.

Common symptoms associated with IBD pseudopolyps include:

• rectal bleeding
• abdominal pain and discomfort
• changes in bowel habits

These symptoms can overlap with those of the underlying inflammatory bowel disease, making the polyps challenging to diagnose.

In rare instances, IBD pseudopolyps can provoke serious complications, such as intestinal blockages. They are also associated with a more severe type of IBD.

Both inflammatory polyps and pseudopolyps can occur in the context of IBD. However, they have distinct characteristics and origins.

Inflammatory polyps arise from inflammation within the intestinal lining. They develop as a localized response to IBD inflammation and are typically small, smooth protrusions from the intestinal surface.

Conversely, IBD pseudopolyps are not true polyps. Instead, they are areas of regenerated mucosa. They result from the process of healing and scarring from chronic inflammation in the gastrointestinal tract.

Although scientists do not fully understand the exact causes of IBD pseudopolyps, their development is closely associated with underlying chronic inflammation in the gastrointestinal tract.

The continuous and prolonged inflammation of IBD can lead to ulcerations and tissue damage, and pseudopolyps are part of the subsequent healing process.

While anyone with IBD can develop pseudopolyps, they are less common in Crohn’s disease compared with ulcerative colitis.

Diagnosing IBD pseudopolyps involves a comprehensive evaluation by a gastroenterologist. These specialists can order a sigmoidoscopy or a colonoscopy to examine the intestine visually. This can help them identify any abnormalities, including pseudopolyps.

During these procedures, a doctor inserts a flexible tube with a light and camera into the rectum and guides it through the colon.

They may also perform a biopsy, which involves taking a small tissue sample from the colon. They then send the samples to a pathology laboratory for microscopic analysis. This can help confirm the presence of IBD pseudopolyps and rule out other conditions.

IBD pseudopolyps do not have specific treatments for the lesions themselves.

However, their presence may indicate severe IBD that necessitates a more aggressive treatment approach. This may involve surgery, medication, or both.

Surgery aims to remove the affected portion of the colon and address any associated complications. It can include segmental resection, which involves removing part of the colon, or in severe cases, a total colectomy. This refers to the removal of the entire colon.

For individuals with severe IBD and pseudopolyps, biologic medications may help.

These drugs, such as anti-tumor necrosis factor (TNF) agents, target specific immune system components involved in the inflammation process. Anti-TNF agents can help with:

• reducing inflammation
• managing symptoms
• preventing the formation of pseudopolyps

Individuals with IBD pseudopolyps need to maintain regular communication with their healthcare team. There are also specific situations in which they should promptly contact a doctor.

These include:

• Worsening symptoms: If the severity or frequency of IBD symptoms increases, it could be a sign of disease progression or complications that require further evaluation and management.
• New or persistent symptoms: If individuals experience new symptoms or if existing symptoms persist despite ongoing treatment, it is crucial to seek medical attention.
• Effects on emotional and psychological well-being: Managing a chronic condition such as IBD can significantly affect an individual’s emotional and psychological well-being. A doctor can offer advice and support if a person experiences any of the following:
  • increased stress
  • anxiety
  • depression
  • other mental health concerns

IBD pseudopolyps are common in individuals with ulcerative colitis and Crohn’s disease. They are noncancerous lesions that develop due to chronic inflammation, healing, and scarring in the gastrointestinal tract.

Diagnosing IBD pseudopolyps involves a thorough evaluation by a gastroenterologist, typically through sigmoidoscopy or colonoscopy with biopsies.

Although they are not a direct cause for concern, their presence may indicate more severe disease activity and the need for more intensive IBD treatments.