Intestinal metaplasia, which increases the risk of gastric cancer 10-fold, must be managed ‘this way’ [인터뷰]

a tooth[인터뷰] Director of Gastroenterology Lee Sang-hwan
a toothIntestinal metaplasia, a precancerous lesion that can lead to gastric cancer
a toothOnce it happens, there is no going back…only to prevent further progress

Gastric cancer is the third most common cancer worldwide. The situation in the country is not much different. Although the incidence of gastric cancer has decreased over the last decade, it is still considered one of the most common cancers. Risk factors that increase the risk of gastric cancer include smoking, drinking, stress and bacterial infection. Among these, although somewhat unfamiliar, is gastrointestinal disease which increases the risk of stomach cancer approximately 10 times. It is ‘intestinal metaplasia’.

I asked director Lee Sang-hwan (Irum Internal Medicine Clinic), a gastroenterologist, what kind of disease intestinal metaplasia is and how to follow and manage it if you have been diagnosed with intestinal metaplasia during a recent health examination.

Director Lee Sang-hwan, specialist in gastroenterologyㅣSource: Erum Internal Medicine Clinic
“Intestinal metaplasia, if left untreated, can lead to gastric cancer”
Intestinal metaplasia is a disease that can occur if chronic atrophic gastritis, where the gastric wall thins, is not treated. Intestinal metaplasia is one of the precancerous lesions that can cause stomach cancer. The stages by which gastritis progresses from intestinal epithelial metaplasia to gastric cancer are as follows: △ Chronic atrophic gastritis, where the gastric wall becomes thin due to excessive stimulation of gastric acid △ Intestinal metaplasia, where the surface of the gastric mucosa becomes rough and uneven △ Adenoma, which is a pre-cancer, is known to progress gradually. in the order of low-grade dysplasia △high-grade dysplasia △ gastric cancer.

Intestinal metaplasia generally starts from the bottom right in front of the passage where food enters the duodenum and gradually spreads. However, the symptoms that appear at this time are not very different from mild gastritis, so it is occasionally discovered through a health examination. On gastroscopic examination, it appears as an uneven mucosal lesion with a rough surface like an asphalt road.

Director Lee Sang-hwan said, “If intestinal metaplasia worsens, normal gastric acid secretion function declines, so digestion is not good, and symptoms such as heavy bloating, abdominal distension, lack of appetite, and anorexia may appear secondary .” “In addition, when gastric acid secretion is reduced, it becomes an environment where bacteria can easily grow, and symptoms such as gas smell or persistent diarrhea can occur due to bacterial overgrowth in the intestine,” he said. added up

“Depending on severity, the exam cycle may need to be shortened”
Director Lee Sang-hwan said, “If intestinal metaplasia is seen on endoscopy, the follow-up examination is determined according to the degree of its progress.” Gastroscopy is usually performed every two years, which is the national examination interval. However, yearly gastroscopy is recommended in the case of a wide range of moderate or severe intestinal metaplasias, △ Helicobacter pylori infection, or △ family history of gastric cancer. If it is seen to have progressed to an adenoma, a precursor to stomach cancer, the interval can be extended up to 6 months. A follow-up endoscopy is carried out and the treatment is deemed successful only when the progression has stopped.

“Helicobacter pylori infection, an important risk factor for intestinal metaplasia”
Risk factors for intestinal metaplasia identified so far include △Helicobacter pylori infection △age (61 years or older) △smoking △lineal family history of gastric cancer △stimulating eating habits. As we age, the stomach wall is damaged due to thinning of the stomach wall due to repeated food and long time stomach acid stimulation or an erosive change in which the mucous membrane peels away. At this stage, the likelihood of gastric mucosal cells being replaced by intestinal mucosal cells increases.

Helicobacter pylori (Helicobacter pylori) infection is considered an important risk factor. Therefore, when infected with Helicobacter pylori, eradication treatment is recommended to eliminate these bacteria. In the case of chronic atrophic gastritis, which is a stage of pre-intestinal metaplasia, the condition is known to be reversible with eradication treatment. Unfortunately, intestinal metaplasia once prolapsed does not return. However, director Lee Sang-hwan emphasized the importance of eradication treatment, saying, “Treating Helicobacter pylori can slow the progression of intestinal metaplasia to gastric cancer.”

It is not possible to conclude whether a particular food is good or bad, but it is also important to review the food that each patient eats to determine which food may have caused intestinal metaplasia.

For early detection of gastrointestinal diseases, regular endoscopy should be performedㅣSource: Getty Image BankFor early detection of gastrointestinal diseases, regular endoscopy should be performedㅣSource: Getty Image Bank
“Unexpected foods that help develop intestinal metaplasia”
Since intestinal metaplasia does not return once it occurs, it is important to stop its progression so that the lesion does not protrude or enlarge. To do that, it is important to refrain from foods that stimulate the stomach. Director Lee Sang-hwan presented unexpected foods corresponding to this.

Powdered health supplements or irritating foods such as onions, garlic, ginger and hemp should be avoided. The same goes for harsh foods that can damage the gastric mucosa. Mixed grain rice with too high a ratio of barley, brown rice, beans and red beans belong to this category. If nuts such as almonds, peanuts, walnuts, and pine nuts are also eaten regularly every day, intestinal metaplasia can be aggravated by abnormal stimulation.

“Cabbage, said to be good for the stomach, may act as a poison for intestinal metaplasia”
Cabbage is known to be good for the stomach. Vitamin U, which is abundant in cabbage, has the effect of protecting the mucous membrane of the stomach, and vitamin K has a blood clotting effect, preventing stomach bleeding. However, when consumed in the form of boiled cabbage, steamed cabbage, cabbage powder, cabbage juice, etc., the vitamins contained in raw cabbage are destroyed or transformed into during the cooking process, so it is not very useful. In addition, dietary fiber, which is abundant in cabbage, can cause gas in the small and large intestine, and when it is refluxed up to the stomach, it stimulates the gastric mucosa, so cabbage often acts as poison for intestinal metaplasia.

“Intestinal metaplasia patients can drink coffee and alcohol”
Just because you have intestinal metaplasia doesn’t mean you can’t drink coffee or alcohol. However, it is best to avoid drinking coffee before meals, as the stomach with intestinal metaplasia has lost its current function. Drink coffee as a dessert after a meal.

The same goes for alcohol. Although not contraindicated, there are several types of alcohol that should be avoided. Beer and makgeolli are rich in enzymes and yeast that stimulate the stomach, so it is best to avoid them. From the perspective of intestinal metaplasia patients, soju is better.

One tip for early detection of intestinal metaplasia?
When intestinal metaplasia is seen with a special method called narrowband endoscopy (NBI) rather than with a general endoscope screen, the color of the mucous membrane becomes clearer, which is enough for the patient to distinguish between normal mucosa and mucosa with ‘to damage when looking at his or her own endoscope picture. Director Lee Sang-hwan said, “It is safe to have a health examination at a hospital that has a high-end endoscope that can use NBI mode.”

He said, “Because intestinal metaplasia is difficult to distinguish from adenoma, which is the precursor stage of cancer that can occur on it, there is a high chance of missing it if you have an endoscopy in a factory-style health screening centre. ” he did.


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