What Does Chronic Inflammation of Mucosa with Intestinal Metaplasia Mean?
Chronic Mucosal Inflammation with Intestinal Metaplasia
Chronic mucosal inflammation accompanied by intestinal metaplasia frequently signifies the emergence of intestinal epithelial metaplasia-like alterations within gastric mucosal tissue or glandular cells. Extensive clinical research underscores the potential for intestinal metaplasia to evolve into cancer. Intestinal epithelial metaplasia refers to the presence of intestinal epithelial glands within the gastric mucosa, particularly in the vicinity of the pyloric gland region. These metaplastic intestinal epithelial glands, under general histopathological observation, exhibit morphological and functional similarities to small intestinal epithelium, albeit some instances mimic colonic epithelium.
The metaplastic intestinal epithelial cells encompass absorptive cells, goblet cells, Paneth cells, among others. Notably, the mucus secreted by these metaplastic cells differs significantly from that of the gastric mucosa, with the former primarily comprising acidic mucin and the latter, neutral mucin. Intestinal metaplasia can manifest across diverse gastric mucosal backgrounds, and through pathological investigations, distinctions between intestinal epithelial metaplasia surrounding cancer and that associated with chronic gastritis have led to its classification in various manners.
According to the functional classification of metaplastic epithelium, intestinal epithelial metaplasia is categorized into complete and incomplete forms. Furthermore, mucin histochemical staining enables a more nuanced classification into colonic-type epithelial metaplasia and small intestinal-type intestinal epithelial metaplasia. Small intestinal-type intestinal epithelial metaplasia tends to occur at younger ages and is less frequently observed in cancer-adjacent mucosa compared to colonic-type intestinal epithelial metaplasia.
Currently, incomplete and colonic-type intestinal epithelial metaplasia are considered closely linked to gastric cancer. Chronic mucosal inflammation accompanied by intestinal metaplasia should be regarded as a precancerous lesion, necessitating heightened vigilance in daily life. Regrettably, there exists no direct and highly effective medication for reversing or ameliorating intestinal metaplasia. Therefore, active symptomatic treatment is paramount to alleviate pain and other associated conditions. While this condition progresses gradually and typically does not warrant surgical intervention, it is advisable to screen for Helicobacter pylori infection. Confirmed infections should be eradicated, often employing a quadruple regimen that incorporates a proton pump inhibitor, a bismuth agent, and two antibiotics.
Proton pump inhibitors commonly include esomeprazole and omeprazole, while bismuth agents typically encompass bismuth potassium citrate and colloidal bismuth pectin. The choice of antibiotics can be tailored from combinations involving amoxicillin, furazolidone, or amoxicillin and tetracycline.
