Introduction:
Preneoplastic conditions are the conditions seen before the formation of neoplasm. When these conditions affect the gastrointestinal tract (a passage of the digestive tract that begins from the mouth and ends at the anus), they are known as preneoplastic gastrointestinal conditions. Some preneoplastic stomach conditions are gastric atrophy (GA), intestinal metaplasia, etc.
What Are Preneoplastic Gastrointestinal Conditions?
Preneoplastic conditions are frequently recognized as the risk factors for cancer. This is why they are known as preneoplastic conditions. Some of the preneoplastic gastrointestinal conditions are described below:
Gastric Atrophy: Gastric atrophy is also known as atrophic gastritis. It is a chronic inflammatory condition in which the stomach lining gets thinner, and the cells of the stomach lining resemble the cells of the intestine. Atrophic gastritis can be divided into environmental metaplastic gastritis (EMAG) and autoimmune atrophic gastritis (AAG). EMAG and AAG can potentially develop an increased risk of forming small neuroendocrine tumors (NETs) in the stomach. NETs are generally non-cancerous (benign). EMAG and AAG can also elevate the risk of stomach cancer (gastric cancer). EMAG and AAG are described below in detail:
1. Environmental Metaplastic Atrophic Gastritis (EMAG): This condition is seen when H. pylori (Helicobacter pylori) bacteria cause chronic infection. Chronic inflammation is caused by certain environmental factors also in this condition. H. pylori bacteria disrupt the mucus that generally protects the stomach's lining via acidic juices released during digestion. In a longer time, this acid destroys the cells in the stomach lining, causing EMAG. Its prevalence can be seen more in people of 70 years or older, who take a diet high in salt content, have had H. pylori infection, reside in a crowded area, smoke regularly, etc. People with this disease often experience abdominal pain, iron deficiency anemia, loss of appetite, nausea, vomiting, peptic ulcers, etc.
Diagnosis: It can be done by certain blood tests, endoscopy, biopsy, etc.
Treatment: It can be done by prescribing antibiotics for H. pylori infection and advising medications to reduce the acid formed in the stomach.
2. Autoimmune Atrophic Gastritis (AAG): Itis another form of atrophic gastritis. It is seen when the immune system harms the cells of the stomach lining. Doctors might also recognize this condition as autoimmune gastritis (AIG) or metaplastic atrophic gastritis (AMAG). Autoimmune atrophic gastritis's prevalence can be seen more in females who have a history of the same, due to genetic mutations or due to some other autoimmune diseases such as autoimmune thyroid (Hashimoto, or Graves disease), Addison's disease, Type diabetes, etc. The usual symptoms seen in this disease are chest pain, dizziness, nausea, vomiting, pale skin, rapid pulse, tingling sensation or numbness in the limbs, etc.
Diagnosis: It can be diagnosed with the help of a blood test, endoscopy, etc.
Treatment: Autoimmune atrophic gastritis can be treated by advising vitamin B12 injections to raise the vitamin level and by iron infusion.
3. Intestinal Metaplasia (IM): Intestinal metaplasia is seen due to the changes occurring in the cells in the lining of the upper digestive tract, frequently the stomach or the esophagus (food pipe). It is called intestinal metaplasia since the cells become more similar to those that line the intestines. Intestinal metaplasia occurs due to chronic irritation caused to the cells. This irritation can be due to various environmental factors such as smoking and alcohol, H. pylori bacteria, gastric acid, etc. Mostly, this condition remains asymptomatic initially. Intestinal metaplasia is seen in the esophagus (Barrett's esophagus) due to the chronic acid reflux from the stomach into the esophagus. It is more likely to develop in people with chronic acid reflux disease (GERD), smoking, or drinking. In the stomach, it is known as gastric intestinal metaplasia. Gastric intestinal metaplasia can be further categorized, based on the degree of cellular transformation as:
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Complete Intestinal Metaplasia: It is also known as Type I, which indicates that the new cells in the stomach become similar to the small intestine cells. This is regarded as the initial stage of intestinal metaplasia.
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Incomplete or Type II IM: This indicates that the new cells are similar to the large intestine (colon) cells. This is regarded as an advanced stage of IM and is more prone to develop into dysplasia.
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Type III IM: It iscategorized based on a mild difference in the configuration of cells. Type III can also be categorized as the category of incomplete IM.
Some symptoms associated with intestinal metaplasia in later stages are stomach pain, bloated stomach, nausea, vomiting, etc.
Diagnosis: This condition remains asymptomatic initially, so it becomes challenging to diagnose it or is discovered accidentally while testing for other diseases. An upper abdominal endoscopy generally identifies it. The doctor sees tongues of salmon-colored lining which extend into the esophagus. In the stomach, IM is seen as abnormal patches. The doctor takes a biopsy of the abnormal tissue to confirm the disease. If a person has a history of chronic gastritis or acid reflux, the doctor might suggest an upper abdomen endoscopy to detect IM.
Treatment: This condition is treated by eliminating the irritating factors that cause it. By this, intestinal metaplasia can be prevented from progressing into severe disease. Tissues can recover from the chronic inflammation that triggers metaplasia by quitting smoking and drinking alcohol, treating acid reflux, and eradicating H. pylori infections. If metaplasia progresses to dysplasia, doctors might advise the removal of the affected tissue to prevent it from developing into a cancerous disease.
Conclusion:
Preneoplastic conditions are the conditions seen before the development of neoplasm. When these conditions occur in the gastrointestinal tract, they are known as gastrointestinal preneoplastic conditions. Examples of such conditions include gastric atrophy and intestinal metaplasia. Gastric atrophy and intestinal metaplasia show various symptoms, such as abdominal pain, nausea, vomiting, etc. A blood test, or endoscopy, can diagnose these if a suspected neoplasm biopsy is recommended. Treatment of these conditions can be done as per the underlying cause. If the atrophy is due to H. pylori bacteria, antibiotics are prescribed, and in other cases, medications to reduce acid reflux if that is the reason. Quit smoking and alcohol intake for better results.
