Acid Reflux / GERD Cancer / Oncology

What is intestinal metaplasia?

Intestinal metaplasia occurs when cells in the tissues of the upper digestive tract, often in the stomach or esophagus, change and become more like cells from the intestines. Some doctors consider intestinal metaplasia to be a precancerous condition.

Intestinal metaplasia is more common in people who have chronic acid reflux or gastroesophageal reflux disease (GERD).

Some doctors think bacteria called H. pylori causes this change in the digestive tract. An interaction between the bacteria and the food in the digestive system might produce certain chemicals that cause the cells to change.

There is a range of risk factors that may lead to intestinal metaplasia. Changes in the diet and other medical treatments may also help prevent symptoms.

Symptoms

People will often have no noticeable symptoms.

Some people may develop symptoms, but these can be caused by other gastrointestinal problems, such as acid reflux or GERD. An underlying H. pylori infection may also cause noticeable symptoms.

A doctor will often discover intestinal metaplasia while screening for other digestive disorders, or when taking biopsies to check for cancerous tissues in the digestive tract.


Causes and complications

H. pylori infection may cause intestinal metaplasia
An H. pylori infection may be a cause of intestinal metaplasia.

The exact cause of intestinal metaplasia is still uncertain.

Some healthcare professionals believe an H. pylori infection causes intestinal metaplasia, but there is also a range of risk factors that may increase the risk of developing it.

Perhaps the biggest concern for those with intestinal metaplasia is that it might be precancerous.

The abnormal cells in the digestive tract may go through a stage called dysplasia if left untreated. These abnormal cells may or may not progress to cancerous cells.

Reducing or eliminating risk factors may reduce the likelihood of these cells progressing.

H. pylori infection

The bacteria H. pylori is common in the digestive tract, but it can grow out of control if there is an imbalance in intestinal bacteria.

According to a systematic review in the journal Gastroenterology, over 50 percent of the world’s population is infected with H. pylori.

H. pylori may not cause symptoms in many people, but some people may develop digestive disorders, such as ulcers, gastritis, and GERD.

The bacteria tend to attack the lining of the stomach, which is why some doctors believe they are a direct risk factor for intestinal metaplasia. One study in Gastroenterology Research and Practice noted that 38.6 percent of people with intestinal metaplasia also had an H. pylori infection.

The study also added that chronic H. pylori infections may develop over many years, progressing from gastritis to internal metaplasia, and even gastric cancer. Finding ways to get rid of H. pylori bacteria may help reduce the risk of intestinal metaplasia.

Genes

Genetics may also be responsible for intestinal metaplasia. People who have a family history of gastric issues or even gastric cancer may be more likely to develop similar conditions.

Smoking

Smoking is a conscious lifestyle choice that may affect the progression of intestinal metaplasia.

Smoking may damage the esophagus (food pipe), which could increase the risk of intestinal metaplasia in the esophagus, known as Barrett’s esophagus.

One study in the United European Gastroenterol Journal found that people with acid reflux problems who smoked tobacco were three times as likely to experience Barrett’s esophagus than non-smokers.

However, people who already have a diagnosis of intestinal metaplasia may still be at risk due to smoking. Another study in the journal Gastroenterology found that people with Barrett’s esophagus who smoked were twice as likely to progress to esophageal cancer than people who did not use tobacco.

Quitting smoking may significantly reduce the risk for some forms of intestinal metaplasia or cancer.

Other factors for intestinal metaplasia may include:

  • environmental toxins, such as secondhand smoke or chemicals
  • high salt intake
  • alcohol consumption
  • chronic acid reflux

Diagnosis

Doctors who discover intestinal cell tissue in the stomach or food pipe may also check other areas of the digestive tract to see whether they contain any of these abnormal cells.


Treatment

upper endoscopy
Before treatment for intestinal metaplasia, a doctor may recommend an endoscopy.

To properly treat the disorder, a doctor will want to get a better picture of how far the intestinal metaplasia in the digestive system has progressed.

To do this, a doctor will probably do an endoscopy, which involves inserting a long tube through the mouth into the food pipe and stomach.

A small camera on the end of the tube allows doctors to see the tissues up close. They may also remove some tissues for testing, using a small needle-like tool.

Once the diagnosis is confirmed, doctors will recommend various treatment methods to help reduce the progression of intestinal metaplasia.

If doctors suspect an H. pylori infection is causing intestinal metaplasia, they may recommend a course of antibiotics, including:

  • amoxicillin
  • metronidazole
  • clarithromycin
  • tetracycline

Antibiotic treatment usually lasts about 2 weeks.

Doctors may also recommend drugs that reduce acid in the body to help the stomach lining or food pipe heal.

This may include over-the-counter (OTC) drugs such as bismuth subsalicylate (Pepto Bismol) or prescription drugs, such as omeprazole (Prilosec).

How does diet play a role?

Researchers are still studying the effect of the diet on intestinal metaplasia.

Some dietary changes might help prevent or treat intestinal metaplasia or keep H. pylori in check.

This typically includes eating a diet rich in whole, natural foods, such as vegetables, fruits, nuts, and whole grains.

These foods contain more nutrients and antioxidants than processed foods, which may be helpful for risk factors of intestinal metaplasia.

Some people with intestinal metaplasia should avoid specific foods based on personal risk factors or other complications.

People who have gastrointestinal disorders such as GERD may find relief by avoiding fried, greasy, or spicy foods.

Cutting out these foods may help reduce the inflammation that could be damaging the stomach.

Salty foods may also be a culprit for intestinal metaplasia. Reducing salt intake may lead to an overall better diet, which may support the prevention of intestinal metaplasia.


Takeaway

Intestinal metaplasia can be severe. The transformation of the cells of the gastric lining puts a person at a much higher risk of developing gastric cancer.

While it is not possible to avoid some risk factors such as genetics, people can avoid other risk factors, including diet, H. pylori infection, and smoking.

The sooner a diagnosis is made, the sooner treatment can begin. Early treatment might prevent the cells from becoming malignant, while other treatments may reverse the condition.

Doctors will likely base a person’s treatment on their personal history and symptoms.

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