From the Guidelines
Gastric metaplasia is potentially reversible in some cases, particularly when the underlying cause is addressed, as evidenced by the goal of endoscopic eradication therapy to permanently eliminate all intestinal metaplasia and achieve a complete reversion to squamous epithelium 1. When gastric metaplasia occurs in the intestine or esophagus due to chronic inflammation or acid exposure, removing the triggering factor can allow the tissue to return to its normal state.
Key Considerations
- The reversibility of gastric metaplasia depends on the duration and severity of the metaplasia, with long-standing changes being less likely to regress completely.
- Achieving complete eradication of intestinal metaplasia (CE-IM) is protective, with an odds ratio of 0.4 (95% CI, 0.3–0.6) for reduced risk of esophageal adenocarcinoma (EAC) 1.
- Endoscopic eradication therapy, such as radiofrequency ablation (RFA), can be a therapeutic option for select individuals with nondysplastic Barrett’s esophagus who are judged to be at increased risk for progression to high-grade dysplasia or cancer 1.
Management Options
- Aggressive acid suppression with proton pump inhibitors like omeprazole (20-40mg daily) or pantoprazole (40mg daily) for extended periods may lead to regression in some patients.
- Treating H. pylori infection with standard triple therapy (amoxicillin 1g twice daily, clarithromycin 500mg twice daily, and a proton pump inhibitor twice daily for 14 days) can sometimes reverse gastric metaplasia in the duodenum.
- RFA should be used in individuals undergoing ablative therapy, particularly for those with confirmed low-grade dysplasia in Barrett’s esophagus 1.
From the Research
Gastric Metaplasia Reversibility
- The reversibility of gastric metaplasia is a topic of ongoing research and debate 2, 3.
- Some studies suggest that eradication of Helicobacter pylori can lead to improvement or regression of atrophic gastritis, but the effect on intestinal metaplasia is less clear 4, 2.
- A study published in 2024 found that gastric intestinal metaplasia is no longer considered an irreversible precancerous lesion, and that Helicobacter pylori eradication may lead to regression of atrophic gastritis and reduce the risk of gastric cancer 3.
- However, another study published in 2021 found that proton pump inhibitor use was associated with a dose-dependent increased likelihood of gastric intestinal metaplasia among Helicobacter pylori-positive patients 5.
- The mechanisms of metaplasia in the stomach involve complex cellular reprogramming and regeneration processes, and the potential for reversibility may depend on various factors, including the extent of injury and the presence of Helicobacter pylori infection 6.
Key Findings
- Eradication of Helicobacter pylori can lead to improvement or regression of atrophic gastritis 4, 2, 3.
- Intestinal metaplasia may be reversible, but the evidence is not yet conclusive 2, 3.
- Proton pump inhibitor use may be associated with an increased likelihood of gastric intestinal metaplasia among Helicobacter pylori-positive patients 5.
- Cellular reprogramming and regeneration processes are involved in the development of metaplasia in the stomach 6.