Intestinal Metaplasia - Causes, Symptoms, Diagnosis, and Treatment

Introduction

It is a disease condition in which cells that are present in the esophagus and stomach change. Researchers have found that cell change is a precursor for cancer formation. Intestinal metaplasia occurs when there is persistent inflammation or irritation of the esophagus (food pipe) and the stomach. The irritation or inflammation of the esophagus is due to the presence of acid reflux into the esophagus from the stomach. It occurs due to defective esophageal sphincter closure at the esophagus's bottom.

It is the main cause of the change of cells in the esophagus. When the cell change occurs in the esophagus, it is known as the Barrett's esophagus. For example, in the case of the stomach, a frequent attack of Helicobacter pylori infection leads to a change in cells of the stomach lining, . This change in the cells of the stomach is known as gastric intestinal metaplasia. These types of metaplasia sometimes appear confined to one area or may involve all the regions of the stomach and intestine extensively. The extensive spread is dangerous because it could quickly lead to cancer.

What Are the Causes and Risk Factors?

• The main cause of intestinal metaplasia is Helicobacter pylori infection, and chronic acid reflux is spotted. This H pylori causes problems in the stomach leading to changes in the cells. Acid reflux is a condition in which the backflow of acid occurs from the stomach to the esophagus, causing irritation to the cells and leading to intestinal metaplasia.

• Smoking also plays an important role in causing intestinal metaplasia. During smoking, the contents in tobacco and cigarettes irritate the esophagus and lead to a change in cells. It is commonly observed in chronic smokers.

• Patients with rheumatologic disease can be at risk for developing intestinal metaplasia.

• Intake of food containing high salts can lead to an increase in the risk of developing intestinal metaplasia.

• In chronic drinkers, the alcohol irritates the cells and leads to intestinal metaplasia.

• Autoimmune disease can be a cause for developing intestinal metaplasia. Autoimmune gastritis destroys cells in the stomach, which can lead to intestinal metaplasia.

• With progressing age, there is a chance of getting intestinal metaplasia.

• Patients with the same family history of intestinal metaplasia can be risk factors for developing it because genetics plays a major role.

• Men are more prone to develop intestinal metaplasia when compared to women.

• The food substances modified to improve the shelf life or the taste can be a causative factor. Usually, the shelf life increases when it is salted or by any fermenting agent added to it.

What Are the Symptoms?

Intestinal metaplasia patients present many symptoms. It sometimes remains asymptomatic in some patients and is identified during the diagnostic procedure for other digestive disorders.

• The patient presents with fullness in the stomach referred to as bloating.

• A bad taste is felt in the mouth due to the backflow of acid into the esophagus from the stomach. It is often noted as acid regurgitation.

• Due to this eructation of acid, a burning sensation is felt in the chest area, often called heartburn.

• The patient sometimes experiences pain while swallowing food due to chronic inflammation of the esophagus.

• The patient feels a loss of appetite due to fullness felt in the stomach.

• An urge to vomit is seen in the patients.

• Pain will sometimes be present along the esophagus and stomach area.

How to Come to a Diagnosis?

A good healthcare provider will arrive at the diagnosis and select proper treatment. First, the healthcare provider asks about the patient's conditions, including symptoms and aggravating and relieving factors. The doctor would question the history of gastritis and acid reflux before. After history has been taken, the doctor conducts a physical examination. In order to confirm the diagnosis, certain tests, and endoscopic procedures may also be performed.

• Blood testing is done to rule out the antigens present against H. pylori bacteria. It also looks into the different blood counts to see if any inflammation or infection is present.

• Testing of fecal matter is done to rule out H pylori bacteria from the sample of stool collected.

• Endoscopic procedures and biopsies are done to confirm the diagnosis of intestinal metaplasia.

• In endoscopy, a long flexible tube is inserted through the mouth into the esophagus, the upper part of the stomach. At the tip of the tube, it holds a camera known as an endoscope which helps the doctor view the upper gastrointestinal tract. The doctor looks for any changes or abnormalities in these areas. Then, scrapings are taken from the area of abnormalities and sent for biopsy. A biopsy helps in definitive diagnosis.

What Are the Treatment Modalities?

• The treatment aims to remove the irritation or inflammation-causing substances. It also focuses on the fact that intestinal metaplasia does not change into a cancerous situation, as it is a premalignant condition.

• If the causative factor is H. pylori, destruction of it should be considered to reduce inflammation or irritation. H. pylori infection can be treated with antibiotics like Amoxicillin or Metronidazole.

• If the patient has a habit of drinking alcohol, it should be avoided.

• Acid production that irritates can be reduced with the help of antacids, proton pump inhibitors, and histamine blockers.

• Antacids are medications that are prescribed to patients to neutralize the acid produced.

• Proton pump inhibitors are the other drug of choice. It acts by blocking the acid production in the stomach. The commonly used drugs are Omeprazole and Pantoprazole.

• Histamine blockers (H-2 blockers) are also considered. It acts by decreasing the acid produced in the stomach. The mainly used drugs are Famotidine and Cimetidine.

• If habitual of smoking, the patient should quit smoking.

• Following a good diet is suggested by the patients with high fiber and low-fat content. The diet should exclude intake of high salt or any processed food items. The patient should have antioxidants in their diet for which fruits and vegetables are good sources.

• Food substances that can induce acid production or acidity should be avoided. For example, fried items and tapioca chips.

Conclusion

Intestinal metaplasia is a premalignant condition affecting the esophagus and stomach.

Proper follow-up and strictly following the treatment plan allow intestinal metaplasia to be controlled to some point. However, intestinal metaplasia is not a cancerous stage. A good diet and avoiding irritating and inflammation-causing agents provide good results for intestinal metaplasia.