Intestinal Metaplasia: An Overview

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 that are 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 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).

intestinal metaplasia
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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). However, these symptoms could also evolve from a different underlying cause than intestinal metaplasia.


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

What Is H. Pylori?

According to a study published in the journal Gastroenterology, over 50% of people worldwide may have an H. pylori infection. H. pylori is a bacteria that infects the stomach. Infection with it usually occurs during childhood and is a very common cause of peptic (stomach) ulcer disease. In fact, a 2019 study in Africa of people with H. pylori found 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 the infection is directly linked to the development of intestinal metaplasia. Another study performed in China involved over 1,600 healthy participants (at an average age of 42) with H. pylori infections. Nearly a third of the participants (29.3%) were found to have intestinal metaplasia.

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), are found to have intestinal metaplasia. Aside from the presence of an H. pylori infection, specific factors that increase the risk of intestinal metaplasia include:

  • Having a first-degree relative with gastric cancer
  • Lack of vitamin C in the diet
  • Smoking
  • Older age (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 change 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 may lower the possibility of getting intestinal metaplasia, as well as reducing the chance that these cells will progress from dysplasia to the cancer cell stage.

The progression of intestinal metaplasia to cancer may be more likely to occur when the following risk factors exist.

  • Genetics: having 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 also double in smokers.


In many cases, intestinal metaplasia is diagnosed when a 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 test called an upper endoscopy, in which a long, thin tube with a camera and a viewing platform is inserted into the mouth, through the esophagus, and into the stomach. A histological examination (microscopic examination of the stomach epithelial cells) is also required to establish a diagnosis.


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. In addition, the study noted that intestinal metaplasia increases the risk of stomach cancer six-fold.

Therefore, it's important to treat intestinal metaplasia in order to prevent a progression to stomach cancer. This includes following up on precancerous lesions to ensure that cancer cells have not begun to grow.

Dietary Changes

There is not enough clinical research to date to definitively prove that lifestyle changes are effective in treating intestinal metaplasia. However, your healthcare provider may recommend a change of diet to lower the acid level in the stomach.

Diet is thought to help prevent the progression of intestinal metaplasia to gastric (stomach) cancer, because chronic acid reflux and conditions such as GERD (involving an excessive amount of stomach acid) may increase the risk of abnormal cells in the stomach becoming cancerous.

Dietary changes thought to treat 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, or 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)


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, antibiotics are the treatment of choice to clear up the infection. Antibiotic therapy is usually given for approximately 14 days and may include drugs such as:

  • Amoxicillin
  • Metronidazole
  • Clarithromycin
  • Tetracycline

Treatment for intestinal metaplasia may also include medications that lower the acid in the stomach and esophagus to reduce inflammation in 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 stomach acid include:

In May 2022, the Food and Drug Administration (FDA)  approved two treatments for H. pylori infection in adults: Voquezna Triple Pak (vonoprazan, amoxicillin, clarithromycin) and Voquezna Dual Pak (vonoprazan, amoxicillin). Vonoprazan is a potassium-competitive acid blocker (P-CAB), and amoxicillin and clarithromycin are antibiotics used to kill the bacterium.

A Word From Verywell

It's important to note that H. pylori is a very common type of bacteria that grows in the digestive tract. But when it begins to 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 may also lower the risk of intestinal metaplasia.

Frequently Asked Questions

  • Is intestinal metaplasia a sign of cancer?

    Intestinal metaplasia, a condition in which the cells lining the stomach are abnormal and may be a sign that you are at risk for developing cancer; however, it does not necessarily mean that you have cancer. You may also have intestinal metaplasia without ever developing stomach cancer. 

  • Are there foods should I avoid with intestinal metaplasia?

    In general, a healthy lifestyle and a well-balanced diet seem to help with intestinal metaplasia. This may include avoiding high-fat and fried or greasy foods. Guidelines that help keep H. pylori in check may benefit people with intestinal metaplasia.

  • Does drinking alcohol cause intestinal metaplasia?

    No. There doesn’t seem to be a connection between alcohol consumption and intestinal metaplasia.

  • What are the types of intestinal metaplasia?

    Incomplete and complete intestinal metaplasia are two types that describe the cells in the stomach. With complete intestinal metaplasia, cells in your stomach look like those in the small intestine. Incomplete intestinal metaplasia has cells that look like the cells from your colon.

  • How long does it take for intestinal metaplasia to turn to cancer?

    Some studies report that intestinal metaplasia can turn into cancer between four and a half and five years later. Keep in mind, though, that most cases won't turn into cancer.

  • What percentage of intestinal metaplasia turns into cancer?

    According to researchers, the annual incidence of stomach cancer is 0.25% for patients with intestinal metaplasia. The rate of cancer after 10 years of follow-up is 1.8%.

11 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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By Sherry Christiansen
Sherry Christiansen is a medical writer with a healthcare background. She has worked in the hospital setting and collaborated on Alzheimer's research.