Intestinal Metaplasia

Intestinal metaplasia occurs in about 10-15% of individuals with long-term reflux. Know all about the causes, symptoms, diagnosis and treatment of this disease.

What is Intestinal metaplasia?

It is the alteration of the epithelium, particularly of the stomach or esophagus, to a type identical to the intestine. The term “metaplasia” refers to the reversible transformation of one group of mature differentiated cell type to another mature differentiated cell type, in response to an injury.

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Intestinal metaplasia Types

As discussed earlier, the condition is normally of two types:

Intestinal metaplasia of the stomach

The first form is associated with the transformation of the stomach lining. In the earlier stages, the replaced epithelium resembles the small intestine. In the course of time however, it grows into the tissues of the colon, the last segment of the digestive system. The ailment, also known as “focal intestinal metaplasia,” could possibly be a precursor to a malignant tumor arising from the epithelium of the stomach.

Intestinal metaplasia of the esophagus

In this type, the esophageal cells undergo a metaplastic change. It is also called Barrett’s esophagus, a condition attributed to the back flow of stomach acids into the esophagus. Acid reflux damages the lining of the esophagus and gives rise to a mismatched cell type, as a part of the repair mechanism of the body.

Intestinal metaplasia Symptoms

Changes in the lining of the esophagus or stomach usually do not produce any significant symptoms. In certain cases, however, patients may experience some gastrointestinal symptoms.

Heartburn

Affected individuals are subjected to a burning sensation in the upper abdomen or chest due to backward flow of stomach contents, particularly acids. The condition is also marked by extreme discomfort in the chest. The burning pain aggravates when a patient lies down to sleep or bends after the intake of food.

Difficulty swallowing

There is always a feeling of food getting stuck in the esophagus that results in impaired swallowing.

Acid indigestion

Patients may often get a weird or bad taste in the mouth as a consequence of regurgitation of food or fluids.

Vomiting

The erosion of esophageal lining, owing to the reflux of stomach acids causes vomiting. In some instances, patients may vomit blood due to bleeding in the esophagus. The color of the vomit varies from bright red to light brown.

Blood-laden stools

Patients often pass bloody stools due to wearing out of the esophageal lining. The feces are normally filled with bright red or black blood.

Intestinal metaplasia Causes

No precise information on the causes of the disorder has been obtained so far. However, medical experts believe that gastroesophageal reflux disease (GERD), a condition in which the acid and noisome contents of stomach backwashes into the esophagus, could lead to metaplasia of the epithelium. Gastroesophageal sphincter is a small valve situated at the junction of the esophagus and stomach. It allows the swallowed food into the stomach from the esophagus and closes in order to prevent the backflow of the abdominal contents. In the case of GERD, the sphincter does not close properly, allowing the acid contents to leak back into the esophagus.

Chronic gastritis, a disorder characterized by stomach ulcers, could also be responsible for deterioration of the mucosal layer. Once the lining is damaged, metaplasia occurs. In the later stages, dysplasia may give rise to a differentiated immature cell type. The stomach lining is often prone to infection and subsequent damage by Helicobacter pylori bacteria. Contaminated food or water could be attributed to this problem, especially in poor sanitation places.

Intestinal metaplasia Diagnosis

Some of the methods used for detecting the condition include:

Endoscopy

A thin tube with a small camera fixed at the end, called endoscope, is inserted into the gastrointestinal tract to examine the esophagus and stomach for any kind of histological changes.

Biopsy

During endoscopy, physicians may remove a small sample of esophageal or gastric mucosal tissue for further examination.

Blood test

Increased levels of white blood cells indicate the presence of Helicobacter pylori bacteria. Low red blood cell count signifies pernicious anemia caused due to excessive bleeding in the stomach.

X-ray

An X-ray of the upper gastrointestinal tract may help in finding out any pathological changes in the esophagus or stomach.

Intestinal metaplasia Treatment

The severity of the condition determines the exact type of treatment. Acid regurgitation can be decreased by using antacids, H-2 receptor blockers and proton pump inhibitors. Reliability on drugs reduces for extensively damaged epithelium. In such cases, surgery is the only option for the patients. In most operative procedures, the damaged sections of the esophagus or stomach are removed.

In medically-advanced health centers, endoscopic mucosal resection is performed. In this technique, the Barrett’s lining is lifted away from the rest of the esophagus with suction or by injecting a solution with the help of an endoscope. The Barrett’s tissue is then excised and removed to allow growth of new, healthy tissues. However, patients may experience post-surgical complications like bleeding or tearing of the esophagus.

Sometimes, this procedure is combined with photodynamic therapy in which a light-sensitive drug is intravenously administered to the sufferers. This is followed by focusing a laser beam on the damaged tissues that activates the drug and destroys the precancerous cells. Chest pain, nausea, light sensitivity and scarring are some of the common side effects of the treatment procedure.

Intestinal metaplasia Diet

Post endoscopy, healthcare givers usually advise the patients to stick to a liquid diet, mainly comprising of water, clear juices or ice cream, for the next 24 hours. Once the discomfort in the chest reduces, semi-solid food and thick liquids can be included in the diet. Typical gastric irritants such as spicy foods, acid-containing fruits and vegetables as well as chocolates should be avoided. Beverages like tea, coffee, and soda must be replaced with water and herbal tea in order to alleviate heartburn.

A low calorie diet consisting of vegetables, fruits, lean meat and whole grains aids in maintaining weight and avoids acid reflux. Fat-free fillers help in controlling hunger and prevent acidic stomach juices from flowing back into the esophagus.

Intestinal metaplasia has a high chance of developing into gastric cancer. Therefore, it is advisable to quickly consult an experienced physician in case a patient exhibits gastrointestinal disturbances like stomach pain or heartburn.