Peutz-Jeghers syndrome

Definition

Peutz-Jeghers syndrome (PJS) is a disorder often passed down through families (inherited) in which the person develops intestinal polyps and is at a significantly higher risk for developing certain cancers.

Alternative Names

PJS

Causes, incidence, and risk factors

It is unknown how many people are affected by PJS. However, the National Institutes of Health estimates that it affects about 1 in 25,000 to 300,000 births.

There are two types of PJS:

• Familial PJS is due to a mutation in a gene called STK11. The genetic defect is passed down (inherited) through families as an autosomal dominant trait. That means if one of your parents has this type of PJS, you have a 50:50 chance of inheriting the bad gene and having the disease.
• Sporadic PJS is not passed down through families and appears unrelated to the STK11 gene mutation.

Symptoms

• Brownish or bluish-gray pigmented spots on the lips, gums, inner lining of the mouth, and skin
• Clubbed fingers or toes
• Cramping pain in the belly area
• Dark freckles on and around the lips of a newborn
• Blood in the stool that can be seen with the naked eye (occasionally)
• Vomiting

Signs and tests

The polyps develop mainly in the small intestine, but also in the colon. A colonoscopy will show colon polyps. The small intestine is evaluated with either a barium x-ray (small bowel series) or a small camera that is swallowed and then take multiple pictures as it travels through the small bowel (capsule endoscopy).

Additional exams may show:

• Intussusception (part of the intestine folded in on itself)
• Noncancerous tumors in the ear (exostoses)

Laboratory tests may include:

• Complete blood count -- may reveal anemia
• Genetic testing
• Stool guaiac
• Total iron-binding capacity (TIBC)

Treatment

Surgery may be needed to remove polyps that cause long-term problems. Iron supplements help counteract blood loss.

Persons with this condition should be monitored by a health care provider and be checked periodically for cancerous polyp changes.

Expectations (prognosis)

There may be a significant risk of these polyps becoming cancerous. Some studies link PJS and cancers of the gastrointestinal tract, lung, breast, uterus, and ovaries.

Complications

• Intussusception (part of the intestine folds in on itself)
• Polyps that lead to cancer
• Ovarian cysts
• Sex cord tumors

Calling your health care provider

Call for an appointment with your health care provider if you or your baby have symptoms of this condition. Severe abdominal pain may be a sign of an emergency condition such as intussusception.

Prevention

Genetic counseling is recommended if you are planning to have children and have a family history of this condition.

References

Goldman L, Ausiello D. Cecil Textbook of Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007.