Intestinal Metaplasia: When to Seek Further Gastrointestinal Evaluation

Intestinal metaplasia issues?

Hello, doctor.
I underwent an upper gastrointestinal endoscopy (NBI) at the end of December 2018, which revealed intestinal metaplasia in the gastric antrum.
The report indicated: 1.
Larynx: no significant abnormalities 2.
Esophagus: gastroesophageal reflux disease 3.
Stomach: a.
superficial gastritis (erythema in the lower part of the gastric body) b.
multiple gastric erosions with scattered intestinal metaplasia in the gastric antrum c.
moderate hiatal hernia 4.
Duodenal bulb: a.
duodenitis (erythema in the bulb) b.
multiple duodenal ulcers scattered in the bulb and descending part: no significant abnormalities 5.
Helicobacter pylori test was negative.
Recently, I have been experiencing some discomfort in my stomach again, and I have a habit of drinking beer daily.
Should I undergo another endoscopy, or is medication sufficient?

Michael, 30~39 year old female. Ask Date: 2023/03/22

Dr. Yang Zhichao reply Gastroenterology and Hepatology

You can undergo an upper gastrointestinal endoscopy.

Reply Date: 2023/03/22

More Info

Intestinal metaplasia is a condition where the normal gastric epithelium is replaced by intestinal-type epithelium. This change is often considered a precancerous condition, particularly in the context of chronic gastritis and gastric ulcers. Your report indicates that you have intestinal metaplasia in the gastric antrum, which is a significant finding that warrants further attention.

The presence of intestinal metaplasia is associated with an increased risk of developing gastric cancer, particularly if it is extensive or associated with dysplasia (abnormal cell growth). It is crucial to monitor this condition closely, especially since you have a history of gastric issues, including superficial gastric ulcers and erosions. Regular endoscopic evaluations are recommended to assess the progression of intestinal metaplasia and to rule out any dysplastic changes.

Given your symptoms of discomfort and your history of alcohol consumption, which can exacerbate gastric issues, it would be prudent to seek further gastrointestinal evaluation. Alcohol can irritate the gastric mucosa and may contribute to the worsening of your symptoms. A repeat endoscopy could provide valuable information about the current state of your gastric mucosa and help determine if there are any new developments, such as dysplasia or malignancy.

In terms of management, lifestyle modifications are essential. Reducing or eliminating alcohol intake, adopting a balanced diet rich in fruits and vegetables, and avoiding irritants such as spicy foods can help improve your gastric health. Additionally, medications such as proton pump inhibitors (PPIs) may be beneficial in managing symptoms of gastroesophageal reflux disease (GERD) and promoting healing of the gastric mucosa.

If you experience worsening symptoms, such as persistent abdominal pain, nausea, vomiting, or changes in bowel habits, it is crucial to seek immediate medical attention. These could be signs of complications that require prompt evaluation.

In summary, given your history of intestinal metaplasia, gastric ulcers, and current symptoms, it is advisable to undergo a follow-up endoscopy. This will allow for a thorough evaluation of your gastric mucosa and enable your healthcare provider to tailor a management plan that addresses both your symptoms and the potential risks associated with intestinal metaplasia. Regular monitoring and proactive management are key to preventing progression to more serious conditions.

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