An Overview of Intestinal Metaplasia

A Pre-Cancerous Condition of the Stomach and Esophagus

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Intestinal metaplasia is a condition in which epithelial cells (the cells that line the stomach and esophagus) become altered or replaced by other cells, called goblet cells. Goblet cells are large round hollow cells, normally found in the intestines; they should not reside in the stomach or esophagus. The function of goblet cells is to preserve and protect the mucus layer of the intestines by producing and secreting a thick mucus layer. Many medical experts consider intestinal metaplasia to be a precancerous condition. Although the exact underlying cause of intestinal metaplasia is unknown, there is a strong theory that the cause of the condition may be linked with a specific type of bacteria, namely, Helicobacter pylori (H. pylori).

Symptoms of Intestinal Metaplasia

Most people do not experience noticeable symptoms of intestinal metaplasia, in fact, the condition is not typically associated with any adverse symptoms. Others may have symptoms of stomach distress, such as acid reflux, ulcers, gastritis, or gastroesophageal reflux disease (GERD), but these symptoms could evolve from a different underlying cause (other than intestinal metaplasia).

Causes

Although the exact cause of intestinal metaplasia is not yet been proven, an infection by H. pylori is commonly thought of as the primary underlying culprit. But what causes H. pylori and what are the risk factors for H. pylori developing into intestinal metaplasia?

What Is H. Pylori?

According to the journal Gastroenterology, over 50% of people worldwide may have H. pylori infection. H. pylori is a bacteria that infects the stomach. It usually occurs during childhood and is a very common cause of peptic (stomach) ulcer disease. In fact, a 2019 study of people in Africa with H. pylori discovered that approximately 90% to 100% of all duodenal ulcers (ulcers in the first segment of the small intestine) and 70% to 80% of peptic ulcers were caused by H. pylori infection. This study also discovered that 38.6% of those with intestinal metaplasia were also diagnosed with H. pylori infection.

H. pylori bacteria are known to attack the lining of the stomach; this is one reason many experts believe that the infection is directly linked to the development of intestinal metaplasia. Another study, performed in China, involved over 1600 healthy participants (at an average age of 42) with H pylori infections. They were found to have a prevalence rate of intestinal metaplasia in 29.3% of the cases.

Risk Factors

Intestinal metaplasia is very common across the globe; one in every four people who have had an upper endoscopy (a flexible tube inserted into the nose, then down into the upper digestive system) for diagnostic purposes, were found to have intestinal metaplasia. Specific factors found to increase the risk of intestinal metaplasia include:

  • The presence of H. pylori infection
  • Those with first-degree relatives with gastric cancer
  • Lack of vitamin C in the diet
  • Smoking
  • Age (the risk increases with age)

Intestinal metaplasia is a condition that may be precancerous. When left untreated, the abnormal cells in the digestive tract undergo a stage referred to as dysplasia. Dysplasia is the presence of abnormal cells in a tissue, which may constitute a stage that is present right before the cell becomes cancerous. The reduction of risk factors is may lower the possibility of getting intestinal metaplasia, as well as reducing the chance that these cells will progress from the dysplasia to the cancer cell stage. The risk factors include:

  • Genetic factors: The risk of intestinal metaplasia progressing to cancer may be more likely to occur when a person has a family history of stomach cancer or other conditions of the intestinal tract
  • Alcohol consumption
  • Long term incidence of acid reflux
  • Secondhand smoke (and other toxins in the environment)
  • Smoking: This lifestyle factor may increase the risk of developing many health-related conditions, including increasing the risk of intestinal metaplasia in the esophagus—known as Barrett’s esophagus. Smoking increases the rate of stomach cancer in the upper portion of the stomach, near the esophagus; the rate of stomach cancer is double in smokers.

Diagnosis

In many instances, intestinal metaplasia is diagnosed when the healthcare provider is investigating the cause of other digestive problems (other than intestinal metaplasia). Because intestinal metaplasia is so likely to be asymptomatic (without symptoms), diagnosis is not very feasible without the use of a diagnostic tool called an upper endoscopy (a long, thin tube with a camera and a viewing platform that is inserted into the mouth, through the esophagus and into the stomach), as well as a histological examination (microscopic examination of the stomach epithelial cells).

Treatment

Prevention

According to a study in the World Journal of Gastrointestinal Oncology, gastric (stomach) cancer is the second most common cause of cancer-related death in the world. As well, the paper note that intestinal metaplasia is considered a precancerous lesion which increases the risk of stomach cancer six-fold. Therefore, screening and prevention measures are vital. Follow-up measures on precancerous lesions to ensure that cancer cells have not begun to grow, and to diagnose any cancerous cell growth early on, is a key prevention component.

There is not enough clinical research to date to definitively prove that lifestyle changes are effective in the treatment of intestinal metaplasia. However, preventative type treatment modalities may be prescribed, including a change of diet to lower the acid level in the stomach. The diet is thought to help prevent the progression of intestinal metaplasia to gastric (stomach) cancer, because chronic (long-term) acid reflux and conditions such as GERD (involving an excessive amount of stomach acid) may increase the risk of the abnormal cells in the stomach becoming cancerous.

Dietary changes thought to lower the risk factors for intestinal metaplasia (while possibly helping to lower the growth of H. pylori) may include;

  • A bland diet (a non-spicy diet, low in fats and oils)
  • A high fiber, whole foods diet (rich in fresh fruits and vegetables, without processed, sugary, fatty foods)
  • A diet with plenty of fresh vegetables, nuts, and fruits
  • A diet with whole grains (instead of foods made from white flour)
  • A low salt diet (some studies show a low salt diet may lower the risk of stomach cancer)

Treatment

The authors of a 2019 study reported, “Finding ways to get rid of H. pylori bacteria may help reduce the risk of intestinal metaplasia.”

If a person with intestinal metaplasia tests positive for H. pylori infection, antibiotics are the treatment of choice to clear up the H. pylori. Antibiotic therapy is usually given for approximately 14 days and may include drugs such as:

  • Amoxicillin
  • Metronidazole
  • Clarithromycin
  • Tetracycline

Another treatment that may be given for intestinal metaplasia may include medications that lower the acid in the stomach and esophagus to lower inflammation of tissues that endure the effects of the high acidity levels from excess stomach acid on a long-term basis. Over-the-counter drugs that reduce acid may include:

  • Pepto Bismol (bismuth subsalicylate)
  • Prilosec (omeprazole)

A Word from Verywell

It's important to note that H. pylori is a common type of bacteria that grows in the digestive tract. But when it begins to rampantly multiply, that is when it can cause an imbalance in the intestinal flora (which often leads to an infection). So, one key for prevention of intestinal metaplasia is to get regularly tested for H. pylori. Eating a healthy diet rich in whole foods and low in saturated fats and unhealthy sugar is another measure aimed at lowering the risk of getting intestinal metaplasia.

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