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Management of Intestinal Metaplasia in Older People

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Intestinal metaplasia is a chronic condition of the stomach and esophagus. Older people are at high risk for intestinal metaplasia. Read below to know more.

Medically reviewed by

Dr. Vasavada Bhavin Bhupendra

Published At July 3, 2023
Reviewed AtJuly 17, 2023

What Is Intestinal Metaplasia?

Intestinal metaplasia is a condition where the cells in the lining of the stomach and esophagus get replaced with cells similar to those in the intestine, such as goblet cells. This change in the cells can increase the risk of cancer. So, in most cases, it is considered a precancerous condition. Intestinal metaplasia commonly occurs due to Helicobacter pylori infection, smoking, acid reflux, etc. When intestinal metaplasia occurs in the esophagus, it is termed Barrett's esophagus, whereas when it occurs in the stomach, it is called gastric intestinal metaplasia. Certain risk factors are associated with intestinal metaplasia, including old age, as the metaplasia has more time to advance in older people.

What Are the Causes of Intestinal Metaplasia in Older People?

The exact underlying cause of intestinal metaplasia is still being researched. However, certain risk factors can enhance the progression of the disease. Some of them are:

  • Smoking: Smoking can damage the cells of the esophagus and can increase the risk of esophageal intestinal metaplasia or Barrett's esophagus. Studies found that people who smoked had two times more risk of developing esophageal cancer than people who never smoked.

  • Gastroesophageal Reflux Disorder (GERD): It is a condition where the acid in the stomach comes into the esophagus, causing symptoms like a bitter taste in the mouth, regurgitation, etc.

  • Helicobacter Pylori Infection: H. pylori is commonly known to cause ulcers in the stomach. Studies also found that H. pylori infection also has an increased risk for intestinal metaplasia. This bacteria can directly attack the epithelial lining of the gastrointestinal tract. Hence, it is considered the direct risk factor for the disease.

  • Family History: People with a close relative with gastric cancer have a good chance of getting intestinal metaplasia. Hence, genetics play an important role in intestinal metaplasia.

  • Alcoholism: Increased alcohol consumption is a risk factor as alcohol irritates the gastrointestinal tract.

  • High Salt Intake: Increased salt intake can cause inflammation in the stomach, which in turn can predispose intestinal metaplasia.

What Are the Symptoms of Intestinal Metaplasia?

Intestinal metaplasia usually doesn't present with any symptoms. However, if it's caused due to H. pylori infection or GERD (Gastroesophageal reflux disease), some symptoms can occur. So, the symptoms of intestinal metaplasia depend on the cause. Following are the commonly seen symptoms of intestinal metaplasia:

  • Painful ulcers in the stomach.

  • Difficulty in swallowing due to severe pain.

  • Heartburn.

  • Stomach pain.

  • Nausea.

  • Bloating.

  • Acid regurgitation.

How Is Intestinal Metaplasia Diagnosed?

In most cases, intestinal metaplasia is diagnosed accidentally during the examination of other gastrointestinal problems. It is usually diagnosed when the patient undergoes endoscopy for any other symptoms related to the gastrointestinal system. Endoscopy and biopsy are performed for the diagnosis of intestinal metaplasia.

Endoscopy is a diagnostic procedure in which an endoscope, a small thin tube, is introduced into the digestive tract through the mouth. It is done to visualize any abnormality in the gastrointestinal tract. For this purpose, a tiny camera and light are attached to the thin tube. To diagnose intestinal metaplasia, upper endoscopy is done. An endoscope is inserted into the throat through the esophagus to the stomach and duodenum. The entire procedure of the endoscopy, including sedation, may take 30 minutes.

A biopsy is a procedure where a sample of cells or tissues is extracted from the diseased body part for diagnostic purposes. A sample for the biopsy can be taken during the endoscopy of the esophagus and stomach. The extracted tissue sample is then examined under the microscope to detect Helicobacter pylori bacteria. The presence of goblet cells, inflammation, dysplasia, and metastasis can also be checked with biopsied tissue samples.

The diagnosis of intestinal metaplasia is confirmed by the presence of goblet cells. Goblet cells are found only in the intestine. Only in the cases of intestinal metaplasia it will be present in the stomach and esophagus.

What Is the Treatment for Intestinal Metaplasia in Older People?

Intestinal metaplasia can be treated if it is diagnosed early. The treatment of intestinal metaplasia is focused on dietary modifications and medications.

  • Dietary Modifications: Diet change aims to lower the level of acid in the stomach. Patients are advised to consume food that is rich in fiber, such as fruits, vegetables, nuts, etc. These foods also contain a good amount of nutrients and antioxidants. A non-spicy diet with low fat and oils is preferred. Fried and greasy foods should be avoided. A whole grain diet rather than food made from flour should be preferred. As salt is found to be a culprit for stomach cancer, patients with intestinal metaplasia should add very minimal salt to their diet.

  • Medications: If the biopsied sample shows the presence of H. pylori bacteria, then the doctor will prescribe antibiotics that have to be taken for two weeks. The following are the commonly prescribed antibiotics:

  • Amoxicillin.

  • Metronidazole.

  • Clarithromycin.

  • Tetracycline.

Medications to lower the acid content and stomach inflammation are also prescribed for the treatment of intestinal metaplasia.

How Can Older People Prevent Intestinal Metaplasia?

Intestinal metaplasia occurs commonly as a result of prolonged inflammation of the stomach. The risk of developing intestinal metaplasia and its progression can be prevented in the following ways:

  • Healthy Diet: Unhealthy diet is a major risk factor for any diseases related to the gastrointestinal tract. Eating certain foods, such as berries, tomatoes, cherries, apples, grapes, peaches, etc., can prevent the development of intestinal metaplasia to a certain extent. However, foods like ketchup, soy sauce, salty chips, processed meats, etc., have to be avoided.

  • Quitting Alcohol and Smoking: Avoiding alcohol and tobacco can prevent many diseases. People who already have the habit of smoking and drinking should initially minimize the frequency and later should quit it permanently.

  • Regular Checkups: As intestinal metaplasia presents commonly without any symptoms, it is important to get regularly checked during old age. If symptoms such as swallowing difficulties, stomach pain, acid regurgitation, etc., occur, seek medical help.

Conclusion:

Intestinal metaplasia is a chronic condition where the cells in the esophagus and stomach get replaced by intestinal cells or goblet cells. Older people are at higher risk for intestinal metaplasia. It is considered a precursor for stomach cancer and must be treated immediately when diagnosed. If diagnosed early, intestinal metaplasia can be treated by dietary changes and medications.

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Dr. Vasavada Bhavin Bhupendra
Dr. Vasavada Bhavin Bhupendra

Surgical Gastroenterology

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