Intestinal Metaplasia: Description, Indications, Therapy, Nutritional Guidelines
Intestinal metaplasia (IM) is a condition that affects the lining of the upper digestive tract, often found in the stomach or esophagus. Recent research suggests that diet, smoking, and a persistent infection with the bacterium *Helicobacter pylori* (H. pylori) may play significant roles in the development and progression of IM.
Persistent H. pylori infection is central to the risk factors of IM. This bacterium causes chronic inflammation in the stomach lining, leading to molecular changes such as aberrant DNA methylation and the activation of NF-κB pathways. These changes promote the progression to IM and increase the risk of gastric cancer [2][4][5].
Smoking is another risk factor linked to an increased risk of IM and its progression to gastric cancer. Smoking may exacerbate inflammation and DNA damage in the gastric mucosa [1][5]. High salt intake is specifically associated with an increased risk of IM, as salt may aggravate gastric mucosal damage and inflammation [2][3].
In addition to these factors, advancing age, male sex, chronic acid or bile reflux, chronic gastritis or ulcers, environmental toxins, a family history of digestive neoplasms, and gastrointestinal disorders like GERD contribute independently to the risk of IM [1][3][4][5].
Diagnosing IM typically involves an endoscopy, where a long tube with a camera and a small needle-like tool for tissue sampling is used. Treatment often includes eradicating H. pylori infection, which may be achieved through antibiotics such as amoxicillin, metronidazole, clarithromycin, and tetracycline, lasting about 2 weeks [6].
Other treatments may aim to reverse the condition or prevent the cells from becoming malignant. Doctors may prescribe drugs that reduce acid in the body, such as omeprazole (Prilosec), to help the stomach lining or food pipe heal. Over-the-counter drugs like bismuth subsalicylate (Pepto Bismol) may also be recommended [6].
Quitting smoking may significantly reduce the risk for some forms of IM or cancer, as smoking may damage the esophagus and increase the risk of intestinal metaplasia in the esophagus (Barrett's esophagus) [7]. 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.
It is important to note that the exact cause of IM is still uncertain. People with gastrointestinal disorders like GERD may find relief by avoiding fried, greasy, or spicy foods, as well as salty foods [8].
In summary, understanding the risks, causes, and treatment options for intestinal metaplasia is crucial in managing this condition. Persistent H. pylori infection is the central and most critical risk factor due to its role in causing chronic inflammation that induces epigenetic and histologic changes leading to IM. Smoking and diet (notably high salt intake) further heighten this risk, alongside other demographic and clinical factors. Management often includes eradication of H. pylori infection to reduce progression risk [2][3][4].
- The persistent infection with the bacterium H. pylori is a key risk factor for the development and progression of intestinal metaplasia (IM), which can, in turn, lead to gastric cancer [2][4][5].
- In addition to H. pylori, smoking and a high salt intake are also associated with an increased risk of IM [1][5]. Smoking exacerbates inflammation and DNA damage in the gastric mucosa, potentially contributing to the onset of IM.
- Intestinal metaplasia may also occur in the esophagus, particularly in individuals who smoke and have gastrointestinal disorders like GERD. Quitting smoking can help reduce the risk of both IM and certain cancers [7].
- Early diagnosis of IM is essential for effective treatment, which usually involves eradicating H. pylori infection. This can be achieved through antibiotics such as amoxicillin, metronidazole, clarithymycine, and tetracycline [6].
- Health and wellness initiatives focusing on nutrition can play a significant role in managing gastrointestinal conditions like IM. Avoiding high salt intake, fried, greasy, or spicy foods, and salty foods may provide relief for those with GERD [8].
