What is intestinal metaplasia?

The normal epithelium on the surface of the esophagus or gastric mucosa is replaced by intestinal epithelium.

Intestinal metaplasia can occur in the esophagus or the stomach:

• Intestinal metaplasia in the lower esophagus near the dentate line is called "Barrett's esophagus": It refers to the replacement of the normal stratified squamous epithelium covering the distal esophagus with intestinal epithelium.
• Intestinal metaplasia in the stomach is usually associated with chronic gastritis.

Which department should I visit for intestinal metaplasia?

English name: Intestinal metaplasia

Alias: Intestinalization

Department: Gastroenterology

What are the causes of intestinal metaplasia?

1. Intestinal metaplasia in the lower esophagus near the dentate line, i.e., "Barrett's esophagus," is caused by "gastroesophageal reflux disease (GERD)." Long-term, repeated stimulation from gastric acid reflux leads to changes in local cells and tissues.
2. The occurrence of "intestinal metaplasia" in the stomach is closely related to chronic gastritis. Helicobacter pylori infection is a major cause of chronic gastritis.

Who is commonly affected by intestinal metaplasia?

1. The average age of diagnosis for Barrett's esophagus is about 55 years, and the prevalence in men is 2–3 times higher than in women. The condition is rare in children, especially those under 5 years old.
2. In regions with high Helicobacter pylori infection rates, the prevalence of gastric intestinal metaplasia increases to nearly twice the average. The prevalence slightly rises with age, and the rates are almost equal between men and women.

What are the main symptoms of intestinal metaplasia?

Intestinal metaplasia usually does not cause symptoms and is typically discovered during gastroscopy performed for issues like indigestion.

1. Intestinal metaplasia in the lower esophagus near the dentate line, i.e., "Barrett's esophagus," commonly presents with symptoms such as acid reflux, heartburn, belching, and upper abdominal fullness or discomfort.
2. "Intestinal metaplasia" in the stomach itself does not cause discomfort. However, it may be associated with functional dyspepsia, leading to symptoms like abdominal pain, bloating, belching, or recurrent abdominal discomfort.

How is intestinal metaplasia diagnosed?

• Under white-light endoscopy, intestinal metaplasia may appear as rough, villous, clustered, island-like, or white thin mucosal deposits. Under chromoendoscopy, such as narrow-band imaging (NBI), it may show "light blue crests" or "white opaque substance." Experienced endoscopists can accurately identify metaplastic lesions and perform necessary biopsies.
• The gold standard for diagnosing intestinal metaplasia is histological evaluation of biopsy samples, i.e., pathology. It manifests as the replacement of esophageal squamous epithelium/gastric surface epithelium by intestinal epithelium.

How is intestinal metaplasia treated?

Treatment primarily targets the underlying causes:

For intestinal metaplasia in the lower esophagus near the dentate line, i.e., "Barrett's esophagus," treatment focuses on managing "gastroesophageal reflux."

• First, lifestyle and dietary adjustments:
  • Quit smoking and maintain a healthy weight through exercise if overweight.
  • Avoid alcohol, spicy, greasy, overly acidic, or sweet foods.
  • Avoid eating within two hours before bedtime.
• Second, medication:
  • Proton pump inhibitors: Omeprazole, lansoprazole, etc.
  • Antacids: Aluminum magnesium carbonate, magnesium-aluminum suspension, etc.

For "intestinal metaplasia" in the stomach, if Helicobacter pylori infection is present, standardized "quadruple therapy" is recommended to ensure eradication.

• Dietary advice includes eating bland foods, avoiding excessive salt-preserved, processed, or overly salty foods, reducing alcohol intake, and increasing vitamin C-rich vegetables and fruits to promote gastric mucosal repair.
• Regular gastroscopy follow-ups are necessary based on the severity of gastric mucosal lesions.

What is the prognosis for intestinal metaplasia?

"Barrett's esophagus," i.e., intestinal metaplasia in the lower esophagus near the dentate line, generally has a good prognosis if there is no "dysplasia" and GERD symptoms are well-controlled. A gastroscopy every three years is sufficient. If biopsy reveals "dysplasia," careful endoscopic evaluation is required, followed by endoscopic or surgical treatment as needed.

"Intestinal metaplasia" in the stomach is a "precancerous lesion," and its severity correlates with the extent of metaplasia.

• If extensive atrophy and metaplasia are present in the stomach, the risk of gastric cancer increases, warranting close endoscopic monitoring.
• If dysplasia is found alongside metaplasia, endoscopic treatment may be necessary.
• Small, focal areas of metaplasia in the stomach usually have a good prognosis and require regular follow-ups.

How can intestinal metaplasia be prevented?

1. The development of "Barrett's esophagus" is related to long-term, chronic gastroesophageal reflux. Therefore, adopting healthy lifestyle and dietary habits—such as eating regular meals, avoiding overweight/obesity, quitting smoking and alcohol, and reducing spicy or irritating foods—can significantly decrease the frequency and severity of reflux, thereby preventing "Barrett's esophagus."
2. "Intestinal metaplasia" in the stomach is often associated with chronic Helicobacter pylori infection. Preventive measures include avoiding raw or unclean foods, drinking untreated water, actively testing for and treating H. pylori, reducing high-salt diets, and minimizing rough or irritating foods to protect the gastric mucosa.