From the Guidelines
The treatment for incomplete intestinal metaplasia primarily involves addressing the underlying cause, most commonly Helicobacter pylori infection, and eradication of H. pylori is recommended to reduce the risk of gastric cancer, as supported by the AGA clinical practice guidelines 1.
Key Considerations
- The goal of treatment is to prevent progression by eliminating the chronic inflammation that drives the metaplastic process.
- For H. pylori eradication, a standard triple therapy is recommended, consisting of a proton pump inhibitor (PPI) such as omeprazole 20mg twice daily, amoxicillin 1g twice daily, and clarithromycin 500mg twice daily for 14 days, as per the guidelines 1.
- Alternative regimens include quadruple therapy with bismuth or sequential therapy in areas with high clarithromycin resistance.
- Regular endoscopic surveillance is necessary, typically every 3-5 years, to monitor for progression to dysplasia or early cancer, as incomplete intestinal metaplasia carries a higher risk for malignant transformation compared to complete intestinal metaplasia.
Surveillance and Follow-up
- Patients with incomplete intestinal metaplasia who are at higher risk for gastric cancer, such as those with a family history of gastric cancer or extensive intestinal metaplasia, may require more frequent surveillance 1.
- The method of testing for H. pylori and strategies for confirming eradication are crucial, but the specific approach may vary depending on individual patient factors and local guidelines.
Lifestyle Modifications
- Lifestyle modifications, including weight loss if overweight, avoiding late meals, elevating the head of the bed, and eliminating trigger foods and alcohol, are also important in managing incomplete intestinal metaplasia.
- These modifications can help reduce symptoms and prevent progression of the disease.
High-Risk Features
- Patients with incomplete intestinal metaplasia and high-risk features, such as a family history of gastric cancer or extensive intestinal metaplasia, should be closely monitored and considered for more frequent surveillance or other interventions as needed 1.
From the Research
Treatment Options for Incomplete Intestinal Metaplasia
- The treatment for incomplete intestinal metaplasia is not universally defined, but several studies suggest that eradication of Helicobacter pylori can reduce the risk of dysplasia and cancer 2, 3.
- Endoscopic resection is appropriate for visible dysplasia and early-stage gastric adenocarcinoma without high-risk features that persists despite H. pylori eradication therapy 2.
- Endoscopic ablation therapies have shown promise for invisible or extensive dysplasia 2.
- A two-endoscope technique of endoscopic mucosal resection (EMR) has been designed for extensive lesions such as gastric intestinal metaplasia, and has been shown to be essentially safe and effective, with no recurrence at 6 months 4.
Role of Proton Pump Inhibitors
- The use of proton pump inhibitors (PPIs) has been associated with an increased likelihood of gastric intestinal metaplasia, particularly among Helicobacter pylori-positive patients 5.
- However, another study found no significant difference in the resolution of intestinal metaplasia by using different PPIs between the groups of eradicated and noneradicated patients 3.
Surveillance and Diagnosis
- Gastric intestinal metaplasia is usually diagnosed by upper endoscopy with biopsy, and histologic scoring systems have been developed to risk-stratify patients at highest risk for progression to gastric cancer 6.
- Appropriate surveillance of gastric intestinal metaplasia may be cost-effective and represents an opportunity for the early diagnosis and therapy of gastric cancer 6.