Some cells with signs of intestinal metaplasia. Gastric metaplasia

Modern diagnostic methods make it possible to promptly identify dangerous changes in the structure of internal organs that can subsequently develop into a cancerous tumor.

One of these diseases that leads to serious complications without proper treatment is intestinal metaplasia of the stomach. In 100% of clinical cases, it accompanies stomach cancer and, in more than 80%, gastric ulceration; about half of the patients suffer from duodenitis. Most often, the disease affects older people, but can also occur in mature patients.

What kind of disease is this, described a hundred years ago, but still insufficiently studied? Experts tend to consider this condition to be transitional: from negative changes under the influence of unfavorable factors (lack of a competent nutrition system, alcohol abuse, long-term use of medications, stress) to more severe consequences.

It all starts with inflammation of the gastric mucosa, which becomes chronic without proper therapy. The cells of the gastric epithelium gradually atrophy, ceasing to fulfill their intended purpose. In their place, intestinal cells appear, which, naturally, realize their main function.

Thus, abnormal transformations gradually lead to the “switching off” of the stomach from the digestive system. Although initially benign, the changes become malignant over time.

The process is completely reversible in the early stages of the disease; in its advanced form, the condition is considered precancerous.

Typology of the disease

Depending on which cells replace the gastric epithelium, 2 types of pathology are distinguished:

1. complete, mature, or small intestine; most often accompanies gastritis. The stomach is filled with all types of cells of the small intestine and, in its functional and morphological properties, becomes extremely similar to this organ. This type is the most common, has the most favorable outcomes and is considered as the initial step on the way to the next stage;
2. incomplete, immature, or colonic. A precancerous condition that, without timely treatment, ends in the death of a person. Often, cells from both the small and large intestines are found in the stomach at the same time, in which case they speak of a transition process leading to the formation of malignant tumors.

In addition, there are weak, moderate and severe degrees of development of pathology. The first is characterized by damage to 5% of the organ area, the second - less than 20%, and the third - more than 20%.

The stages of glandular tissue atrophy can also vary: type A (minor), type B (intermediate), type C (complete).

Risk factors

The reasons that provoke the development of intestinal metaplasia can be:

• infection of the digestive organs with pylori, which causes ulcerative lesions of the mucous membrane and chronic gastritis;
• gastroesophageal reflux, or the passage of food from the stomach back into the esophagus and inflammation of the latter;
• reflux of the contents of the small intestine along with bile into the stomach due to sphincter weakness;
• long-term irritation of the gastric mucosa (exposure to chemicals, including medications, thermal burns);
• hormonal changes;
• stressful conditions, prolonged depression.

As a result of a decrease in the acidity of the internal gastric environment, prerequisites appear for the replacement of gastric microflora with intestinal microflora.

The reproduction of Helicobacter pylori is very dangerous (if a person is negligent about his treatment). It is these bacteria, producing a huge amount of toxins during their life, that most often provoke abnormal changes in the walls of internal organs, which ultimately ends in cancer. The consumption of alcoholic beverages and salty foods speeds up the process.

Symptoms

The pathology has no obvious signs. The symptomatic picture usually resembles other gastrointestinal diseases. The patient may be concerned about:

• decreased appetite and weight loss;
• nausea, in some cases - vomiting;
• belching with a sour taste;
• pain in the stomach area that occurs on an empty stomach or during the night;
• bitterness in the mouth;
• symptoms characteristic of peptic ulcer.

Methods for diagnosing pathology

Metaplasia is often discovered incidentally during endoscopy for other gastrointestinal diseases. The main method for confirming the diagnosis will be to conduct a test; during the study, the histologist will determine the presence of foreign cells in the mucosa that produce sulfamucin.

This secretion actively absorbs carcinogens, which subsequently provoke the development of a cancerous tumor. In addition, the content of carcinoembryonic antigen (CEA) increases in the patient’s blood.

To determine the extent of the lesion, the chromoendoscopy method is used. A special dye tints diseased cells so that they can be seen under a microscope. Thus, when making a diagnosis, the type, size and location of abnormal changes are also noted.

Treatment of intestinal metaplasia of the gastric mucosa

Therapy can be conservative, but surgical intervention is also possible, depending on the type and degree of progression of the disease.

1. The operation is indicated to prevent the development of a malignant tumor. It is performed by the abdominal or more modern laparoscopic method. However, if you consult a doctor in a timely manner and correctly diagnose the operation, you can avoid it by eliminating the unfavorable factors that led to the disease.
2. Drug treatment is based primarily on pylori, preventing stomach contents from refluxing into the esophagus and stopping the development of cancer cells. Pathogenic microorganisms are treated with antibiotics, which are known to have a negative effect on the state of the intestinal microflora. Therefore, in combination with them, such drugs as Linex, Duphalac and others are prescribed. In addition, it is necessary to use drugs that restore the strength of the immune system. For gastroesophageal reflux disease, the doctor will prescribe medications that prevent food from entering the stomach back into the esophagus; as a rule, they contain aluminum and magnesium salts.
3. Compliance with diet and daily routine. It is necessary to balance your schedule so that you have enough time for rest.

Basics of nutrition in pathology

As in the case of other diseases of the digestive tract, improvement and recovery is possible only by following the recommended diet:

• Food that irritates the gastric mucosa is excluded from the diet - spicy and salty dishes, smoked foods, fresh milk, yeast bread, pastries and flour sweets. Various types of sour, canned and pickled foods are also contraindicated;
• alcohol and salt are extremely dangerous!!!;
• Under no circumstances should you starve - this provokes the development of ulcers; eat small portions more often, forget about overeating;
• You will also have to give up the habit of eating at night: the damaged mucous membrane of the stomach, just like you, needs rest;
• It is best to cook dishes using steam or water, and do not eat the food immediately after it is ready while it is hot, but let it cool slightly until it is warm.

You should consult your doctor about folk remedies. Of course, they cannot eliminate the root cause of the disease, but herbal infusions can cope with some symptoms.

Prevention methods

To avoid thinking about how to treat intestinal metaplasia of the stomach in the future, follow these measures:

• try to reduce the amount of stress in your life. As paradoxical as it sounds, the stomach responds extremely vividly to negative emotions. This is due to the fact that many nerve endings are concentrated in this organ;
• follow the rules of hygiene - it never hurts to protect yourself from infection;
• take care of a balanced diet: it is better to permanently exclude from your diet such harmful foods as canned food, smoked sausages and cheeses, carbonated drinks, fried foods that are too fatty, and excessively salty foods. Diversify your table with whole grain bread, cereals in the form of porridges and soups, consume a sufficient amount of herbs, fresh vegetables and fruits;
• do not poison your body deliberately: alcoholic drinks and tobacco irritate the mucous membrane of the digestive organs, causing not only discomfort, but also more serious consequences in the form of damage to the membrane, which ceases to cope with its functions;

• If you have already encountered gastrointestinal diseases, undergo examination regularly (at least once every two years).

If you follow these simple recommendations, as well as pay close attention to your body, you will be able to notice any deviation from the norm in time and prevent the progression of the disease towards more severe stages. Take care of yourself and be healthy!

The interaction of unfavorable factors, consisting of malnutrition, alcohol or drug abuse, causing frequent inflammatory processes, eventually lead to modification of the gastric mucosa with a gradual loss of function.
The pathology is called “gastric metaplasia”. The main group of patients with this diagnosis are middle-aged and elderly people.

What is gastric metaplasia

The basis of the disease is gradual atrophy, then the death of the epithelium of the gastric mucosa and replacement by cells of other digestive organs - the small or large intestine. Newly formed areas of tissue have the properties of the organs to which they belong. The stomach gradually ceases to perform its inherent functions.

In this case, the gastric epithelium is replaced by intestinal epithelium in certain areas of some glands, groups, pits or ridges.

The appearance of ciliated or pancreatic cells in areas of metaplasia signals the beginning of the transition from the benign stage of the process to a malignant form.

Metaplasia is a fairly rare but dangerous pathology and is not considered an independent disease. It occurs against the background of other long-term chronic processes and without timely treatment, serious complications and deaths are possible. With the right approach to treatment and following the recommendations, a complete recovery is possible.

Classification of metaplasia

There are 2 types of gastric metaplasia:

1. Full mature or small intestine. Has a benign course.
2. Incomplete immature or colonic. More dangerous than the previous form, it often develops into a malignant tumor.

But there may also be a mixed form, when cells of the small and large intestines are found in the epithelium of the stomach at the same time.

Based on the size of the area occupied by altered cells, metaplasia is divided into several forms:

• weak - 5% of the area of ​​the gastric mucosa is occupied by altered cells;
• moderate – 20% of the surface is affected;
• severe - more than 20% of the mucosal surface is affected.

According to the degree of atrophy of the glands, they are distinguished:

• minor degree - type A;
• intermediate degree - type B;
• full degree - type C.

Also, according to the nature of distribution, the following are distinguished:

• Focal metaplasia - characterized by partial, small-area cell replacement, most often found in the pyloric and antral zone, against the background of inflammatory changes in the mucous membrane and when cell renewal processes are disrupted.
• Diffuse form - intestinal metaplasia is found in the pyloric and antrum, can move further, occupy a large area and involve the mucous membrane of the fundus.

Complete small intestinal metaplasia

The mature form of metaplasia is characterized by the fact that all the cells characteristic of the small intestine appear in the structure of the gastric mucosa. But the most reliable sign is the appearance of Paneth cells with characteristic apical granulation. They are found in the pits along with borderless enterocytes.

The gastric mucosa resembles the small intestine in structure and functional and morphological properties.

The complete, mature form of metaplasia is found much more often than the incomplete one. It is considered a transitional form to the immature colonic type. But they can be combined within the same gland or found in different glands.

This type of disease often accompanies chronic gastritis.

Incomplete colonic metaplasia

In the case of colonic metaplasia, the altered areas are characterized by the presence of cells that normally line the inner surface of the large intestine. With this form, Paneth cells are not found in the stomach. With incomplete colonic metaplasia, cell maturation and differentiation are impaired; this is a sign of a precancerous condition.

With this form of metaplasia, the gastric mucosa, in structure and functional properties, acquires features characteristic of the large intestine.

This type of metaplasia is considered more dangerous and less predictable in predicting the outcome of the disease.

In benign diseases, signs of colonic metaplasia are found in 11% of patients, in stomach cancer - in 94%.

Causes

The reasons that cause intestinal metaplasia of the mucosal surface in the stomach have not been fully studied and there is no clear answer. But provoking factors have been identified, a combination of which or prolonged exposure to one of them can give impetus to the development of the disease. Among the common unfavorable factors, prolonged negative psycho-emotional stress, stress or depressive states have a negative impact.

Other causes of metaplasia:

• frequent consumption of alcohol, spicy, fatty, fried foods, which cause irritation of the inner surface of the stomach walls;
• chronic inflammation and ulceration of the epithelium;
• throwing intestinal contents into the stomach cavity;
• decreasing the acidity level of gastric juice;
• penetration of the bacterium Helicobacter pylori into the stomach.

During the examination, patients are found to have low acidity of gastric juice; in such an environment, the microflora necessary for normal gastric function dies. The bactericidal properties of the juice are reduced and favorable conditions are created for the development of pathogenic intestinal bacteria, including the dangerous microbe Helicobacter pylori. Its vital activity is accompanied by the release of enzymes, which, as a result of complex chemical transformations, form nitro compounds with carcinogenic properties.

Nitro compounds, together with other carcinogens coming from food, destroy the gastric mucosa, promoting the occurrence of metaplasia and creating the preconditions for the development of a cancerous tumor.

Symptoms

There are no characteristic signs indicating metaplasia. Complaints are made in accordance with the causal factors that caused the disease.

With gastritis with high acidity, the patient feels:

• frequent burning sensation in the epigastrium;
• hunger pains;
• hunger during night sleep.

The main complaints with reflux disease with frequent reflux of bile into the stomach:

• for diffuse pain;
• bitterness in the mouth;
• vomiting

Diagnostics reveals an imbalance in the motility of the antral zone of the stomach and reverse peristalsis.

Histology will indicate focal metaplasia of the antrum of the organ.

If the process is provoked by a peptic ulcer:

• intense, local pain;
• hunger pains that subside after eating.

Regular periods of spring-autumn exacerbations.

Endoscopy shows changes in the mucous membrane characteristic of an ulcer - erosions, scars.

Helibacteriosis has symptoms similar to chronic gastritis. The diagnosis is confirmed by examination of biomaterial taken from the mucosa, in which waste products of the microorganism are detected, and a respiratory test, that is, examination of the air exhaled by the patient, and stool analysis.

General symptoms common to all patients with metaplasia:

• belching with a bitter or sour taste;
• the appearance of periodic pain in the upper abdomen;
• frequent attacks of nausea, sometimes vomiting;
• decreased appetite.

Diagnostics

The stage, localization, degree, form and type of pathology can only be determined through instrumental examination.

The most reliable examination method that allows you to accurately identify gastric metaplasia is fibrogastroduodenoscopy. The device has a built-in backlight and a video camera, with its help you can examine in detail the inner surface of the walls of the esophagus, stomach and duodenum, at the same time take a small part of the mucous membrane of organs for histological examination and, in laboratory conditions, identify tissue changes at the cellular level.

For a more accurate diagnosis, the method of chromogastroscopy is used. In this case, a dye, methylene blue, is applied to the gastric mucosa through a gastroscope. If there are intestinal cells, they absorb the dye and acquire a blue color, which is clearly visible on the screen and makes it possible to specifically take the material for a biopsy.

Treatment

Therapy includes medication and surgery, diet, and traditional medicine.

The treatment regimen is developed by the doctor, taking into account the clinical picture, the diagnostic results obtained, the individual characteristics of the patient’s body and his age.

Drug treatment

Usually doctors prescribe:

• antibiotics to destroy pathogenic microflora;
• at the same time, probiotics are prescribed to restore the normal bacterial flora of the stomach - Linex, Bifiform;
• for increased acidity of gastric juice - Omeprazole;
• for heartburn - Phosphalugel, Maalox;
• to reduce secretory activity - Ranitidine;
• gastroprotectors - to protect the mucous membrane from destruction.

If no positive dynamics are observed during repeated examinations, surgical intervention is recommended.

Surgery

Abdominal surgery – used for extensive lesions. In this case, the areas of the stomach affected by metaplasia are completely removed.

Laparoscopy is a gentle method. In practice it is used more often.

Diet

The key to successful treatment is diet. Meals should be fractional. It is ideal if the food is fresh and prepared in a home kitchen from good quality ingredients. You should exclude all fast foods and semi-finished products from your diet. Food is served warm; hot and cold dishes are prohibited.

The following should be excluded or limited:

• all fried, fatty, salted, smoked, marinated, peppered, spicy foods and dishes made from them;
• from drinks, a complete abstinence from alcohol, soda, strong black tea and coffee, and store-bought juices is required;
• Smoking is prohibited - tobacco smoke, entering the stomach, is irritating to the mucous membrane.

Authorized products:

• dietary meats (chicken fillet, turkey, rabbit) or fish prepared by boiling, steaming or baking - can be consumed as independent dishes or together with broth;
• porridge from any cereal;
• nuts, herbs, fruits, vegetables, fresh and thermally processed;
• mineral water, green tea, jelly, compote, decoctions.

The daily menu should be prepared in accordance with the doctor's recommendations. After consuming foods and drinks, the patient should analyze his internal feelings and give preference to those that do not cause discomfort.

ethnoscience

Among traditional medicine there are time-tested recipes that are effective for gastritis, peptic ulcers and other pathologies:

• Herbs infused for half an hour in boiling water (1 teaspoon per 200 ml of water) - yarrow, chamomile, St. John's wort. Take 30 ml half an hour before meals. You can brew the herbs separately or mix them and make a collection.
• If there are no contraindications to the use of honey, you can prepare a mixture of honey and aloe leaves. To do this, cut aloe leaves are kept in the refrigerator, then the thorns are removed from them and crushed in a blender or meat grinder, combined in equal proportions with honey. The mixture is kept in a cool, dark place for 2 weeks, then taken on an empty stomach, one tablespoon at a time.
• Instead of decoctions, you can use alcoholic tinctures of herbs or propolis. They are dosed in drops and diluted in water.

You need to know that treatment with herbs and other folk remedies should also be carried out after consultation with a doctor. Lack of knowledge about their action can aggravate the situation, for example, increase the secretion of hydrochloric acid when it is already high or increase/decrease blood pressure.

Intestinal metaplasia of the stomach is a common gastroenterological disease, manifested in the form of degeneration of gastric epithelial tissue into intestinal tissue. The pathology is accompanied by a violation of the basic functions of parietal cells, the task of which is to synthesize hydrochloric acid. Patients with intestinal metaplasia suffer not only from damage to the digestive organ, but also from metabolic disorders in general. Intestinal metaplasia of the stomach - what is it and how is it treated? All this will be discussed in this article.

Intestinal metaplasia of the stomach - what is it?

In medicine, there are two types of disease - these are mature metaplasia(small intestine) and immature(colon). The main difference between them is that in the mature form of the pathology, the epithelium consists predominantly of cells of the small intestine (goblet, bordered enterocytes, and Paneth cells). The fact is that the functional properties and structure of stomach tissue are similar to the small intestine.

The immature form is accompanied by a disturbance in the development of the gastric glands, in which the lower and upper layers have practically no differences. In this case, the epithelium consists only of colon cells.

Causes

Various factors can provoke the development of pathology. The most common ones include:

• development of inflammatory processes affecting the walls of the stomach;
• inflammation of the tissues of the esophagus, as well as the possible spread of the process to other organs of the digestive system;
• hormonal imbalance;
• severe stress, overwork of the body;
• development of chronic gastritis or stomach ulcers;
• improper or unbalanced diet, excessive consumption of junk food that irritates the digestive system;
• stagnation of bile.

Doctors believe that the root cause of gastric metaplasia is Helicobacter pylori– a pathogenic microorganism that can cause the development of stomach ulcers or gastritis, which will ultimately lead to various disturbances in the activity of stomach cells. Infection with a pathogenic microorganism is very dangerous for the patient’s health, as it is often accompanied by the development of dangerous pathologies, including stomach cancer.

The process of development of cancer in this case occurs in several stages:

• infection of the body;
• the development of an inflammatory process, which over time becomes chronic;
• atrophy of cells of the gastric mucosa or their death;
• metaplasia of mucosal cells;
• problems with the synthesis of new cells;
• development of malignant formation.

On a note! In order to recognize the pathology in time, you need to know what signs of intestinal metaplasia are manifested. This will allow you to start timely therapy, thereby avoiding serious complications.

Characteristic symptoms

The danger of the pathology, first of all, lies in the fact that it can be practically asymptomatic. At an early stage of development, with successful treatment, the disease can manifest itself only as mild discomfort, to which patients, as a rule, do not pay any attention. If metaplasia occurs due to the development of a chronic form of gastritis or gastric ulcer, then in addition to the symptoms of existing pathologies, new ones arise.

The most common symptoms of gastric metaplasia include:

• sudden weight loss;
• deterioration of appetite or complete loss of it;
• painful sensations in the right or left side;
• a feeling of bitterness in the mouth, an attack of heartburn;
• frequent attacks of hunger;
• severe burning sensation in the stomach area;
• attacks of nausea and vomiting.

According to statistics, the symptoms of the disease appear mildly and irregularly, which significantly complicates the diagnostic process. Incorrect diagnosis of pathology ultimately leads to its serious progress. Therefore, at the first suspicious symptoms, you should immediately seek help from a doctor.

Diagnostic features

As noted earlier, unfortunately, it is not always possible to detect intestinal metaplasia at an early stage of development, because it often develops against the background of other pathologies. But, despite this, making an accurate diagnosis at an early stage and, of course, timely treatment of the disease are the main conditions for a successful and rapid recovery.

The first thing a doctor does to make a diagnosis is a biopsy of the patient’s gastric mucosa. This procedure will reveal altered cells in the tissue, as well as sulfamucin (a substance that attracts carcinogens). The patient is also prescribed a laboratory blood test. If doctors detect the presence of CEA in the patient’s blood (CEA is a carcinoembryonic antigen), this may indicate the development of metaplasia.

On a note! Carrying out diagnostic procedures allows not only to identify pathology, but also to determine its location or size. This greatly simplifies the treatment process.

Possible complications

Improper treatment or its complete absence can lead to the development of serious complications, including the development of neoplasia and dysplasia of the patient’s stomach, dysfunction of the epithelium and atrophy of the glands. When microorganisms settle, a necrotic focus of inflammation develops, which is chronic in nature. It leads to the gradual degeneration of tissues, which are eventually replaced by diseased cells.

The presence of other pathogenic microorganisms that can synthesize carcinogenic substances can also provoke an acceleration of the development of neoplasms. To avoid serious complications of the pathology, it is necessary to carry out timely diagnosis and, accordingly, treatment.

Treatment methods

Depending on the degree of damage to the mucous membrane and the patient’s health condition, the doctor prescribes a course of treatment. As a rule, metaplasia therapy requires an integrated approach. It includes taking pharmaceutical medications, following a special diet and using proven traditional medicine. In rare cases, doctors resort to surgery. Let's consider each of these methods separately.

Medicines

Once a diagnosis is made, the patient is prescribed a course of drug treatment, the main objective of which is to:

• normalization of gastric juice secretion;
• destruction of pathogenic microorganisms, including Helicobacter pylori;
• prevention of the development of malignant formation;
• preventing damage to the mucous membrane of the esophagus as a result of stomach acid entering it.

As an addition to basic medications, doctors may prescribe some types of first-line antibacterial drugs. The most effective of them include Clarithromycin and Amoxicillin. The duration of the antibacterial course is 1-1.5 weeks, but if this does not give the desired result, the doctor will prescribe the use of second-line antibacterial agents. As a rule, second-line antibiotics are prescribed when the patient’s body exhibits low sensitivity to drugs.

Diet

Treatment of all gastroenterological diseases must be accompanied by adherence to a special diet prescribed by a doctor. This will not only speed up the recovery process, but also prevent possible relapses of the pathology. In this case, the diet consists of eliminating from the patient’s diet all harmful foods that have an irritating effect on the digestive system. First of all, this applies to sour, smoked, salty, spicy or fatty foods. It is also recommended to limit the amount of pickled and canned foods, white bread and dairy products.

It is recommended to eat small portions, but often. This is called fractional nutrition. It is also advisable to avoid night or late snacks, as this overloads the digestive system - at night, the affected mucous membrane should be restored, and not fully functioning. All dishes must be steamed or boiled. Make sure that food is sufficiently cooked during cooking, especially fish and meat.

Important! If you have diseases of the gastrointestinal tract, it is not recommended to eat too hot or cold food. This leads to irritation of the mucous membrane of the internal organs, which only intensifies the symptoms of the pathology. The temperature of all dishes should be moderate.

Folk remedies

Traditional therapy can be supplemented with proven traditional medicine. But we must not forget that the use of even the most effective and proven folk remedies is not a reason to refuse drug treatment. Traditional therapy serves only as a supplement. Otherwise, you risk triggering the disease, provoking the development of additional symptoms or intensification of old ones.

Table. Traditional medicine for intestinal metaplasia.

Product name, photo	Application
	To prepare a medicinal decoction, you need to pour 300 ml of boiling water into 1 tbsp. l. crushed dried plant and leave in a tightly closed thermos for 10-12 hours. Strain the finished product through several layers of gauze and take 50 ml 3 times a day. It is advisable to do this before each meal, more precisely, 30 minutes before. The duration of the therapeutic course is 2 weeks, after which it is necessary to take a short break.
	To prepare the herbal mixture, you need to mix 10 g of marshmallow, yarrow and chamomile in one bowl. Then pour 500 ml of boiling water 3 tbsp. l. prepared collection and leave for 30-40 minutes. Take the finished medication orally before each meal.
	To prepare the decoction, you need to pour 400 ml of boiling water with 2 tbsp. l. seeds and cook over low heat for 5-7 minutes. The product should be infused for another 2 hours, after which it should be filtered through gauze. Take the finished decoction 30 ml 3-4 times a day.
	Pour 200 ml of boiling water over 1 tbsp. l. crushed medicinal plant and drink throughout the day as a replacement for regular tea. It is advisable to use the product immediately before meals. This will enhance the therapeutic effect. The duration of the treatment course is until the symptoms are completely eliminated.
	You need to pour 1 tbsp boiling water. l. medicinal plant and leave in a closed thermos for 40 minutes. Take the finished decoction 3-4 times a day, 50 ml, approximately 30 minutes before meals. To avoid unpleasant consequences, before using marshmallow decoction, you should consult your doctor.

Even though all folk remedies consist exclusively of natural ingredients, all actions must be coordinated with a doctor. Self-medication in this case can lead to the fact that you will not only not get rid of the symptoms of intestinal metaplasia, but also provoke the emergence of other health problems. And if you ignore drug therapy in favor of using folk remedies, the risk of serious consequences increases, even death.

Surgical intervention

If conservative treatment is ineffective, doctors often resort to surgery. The peculiarity of the surgical operation is that the intervention in the patient’s body should be minimal. For this purpose, special endoscopic equipment is used. This method of surgery in medicine is called minimally invasive.

As a rule, doctors resort to surgical removal of the affected area of ​​tissue only in rare cases when it is absolutely necessary. After the operation, the patient faces a long recovery period, during which he must follow all the doctor’s instructions, including taking vitamin supplements, following a daily routine or a special diet.

Prevention measures

There are some preventive measures, following which, the patient will be able to prevent the development of this dangerous pathology:

By following all of the above recommendations, you can improve your health, thereby preventing the development of many diseases. The key stage of effective treatment is the timely identification of symptoms of the disease and the timely initiation of a therapeutic course. Therefore, if you suspect that you have intestinal metaplasia of the stomach or other problems with the digestive system, you should immediately seek help from a doctor. , you can find out by following the link.

Video - Intestinal metaplasia of the gastric mucosa

Intestinal metaplasia, its types and the risks of developing benign neoplasms have not been fully studied. In their work, doctors base their work on disorders of cellular metabolism that provoke intestinal-type development.

Intestinal metaplasia - what is it?

Intestinal metaplasia is a disease in which tissue from the stomach lining is replaced by intestinal cells. The disease was first described by Professor Kupfer more than 100 years ago.

Elderly people are most often affected. According to statistics, 80% of those infected are diagnosed with chronic gastritis, as well as duodenal ulcer.

In a healthy state, the tissues that cover the walls of the stomach are constantly renewed. When damaged, cell division increases, which leads to increased migration and restoration of cellular renewal. In patients diagnosed with chronic gastritis, this process is disrupted, resulting in the inability of the gastric glands to perform their functions, which leads to metaplasia.

Features for different parts of the stomach: antrum, pyloric region

Metaplastic changes can occur in any part of the stomach, occupying only part of the mucosa or the entire thickness.

The lesions are located in the membrane of the body, fundus or pyloric region, less often in the antrum.

Important! Pathological changes in the gastric mucosa are considered a precancerous condition, so the disease is classified as dangerous. Studies conducted by many scientists have confirmed the presence of metaplasia in 94% of patients suffering from stomach cancer.

Observations over the past two decades have confirmed that tissue changes in intestinal metaplasia and intestinal type gastric cancer (Lauren classification) are completely identical.

Doctors believe that intestinal cancer occurs under the influence of external carcinogenic factors (substances that cause cancer). Most often occurs in the body of the stomach. Studies have shown that the disease develops in complex epidemiological areas.

Types of metaplasia of the gastric mucosa

There are two types of disease:

• complete (small intestine, mature);
• incomplete (colon, immature).

Mature metaplasia is characterized by the presence of cells that are found only in the small intestine: bordered, sulfamucines, goblet enterocytes. But the main sign confirming this type of disease is Paneth cells. The tissues of the stomach resemble the small intestine not only in structure, but also in functional properties.

With immature metaplasia, there is a disturbance in the maturation and development of the gastric glands: the upper layers are practically no different from the lower ones. The epithelium mainly consists of cells of the large intestine.

The complete type of intestinal metaplasia is more common, and in most cases is detected in patients with chronic gastritis.

It is believed that this is a transitional stage to colonic metaplasia.

Important! According to statistics, an incomplete form of stomach cancer is detected in 94% of cases. Therefore, the disease is considered a precancerous condition, which, if not treated promptly, can lead to death.

• According to the type of prevalence of the lesion, they are distinguished:
• weak – localization on 5% of the mucosal surface;
• moderate – up to 20%;

pronounced – more than 20%.

• Doctors distinguish intestinal metaplasia according to the type of pathology:
• pyloric - the tubular glands in the body of the stomach are replaced by mucous. They are called "Sterck's pyloric glands." Found, as a rule, in atrophic;
• pancreatic – quite rare. It is classified by the appearance of fine-grained texture cells in the mucosal tissues.

Focal and diffuse forms

Additionally, focal and diffuse forms of development of the anomaly are distinguished in pyloric metaplasia.

With the focal type, replacement of some tubular glands occurs against the background of inflammation and damage to the cellular renewal of the gastrointestinal tract. Diffuse pathology is characterized by damage to the gastric mucosa without disruption of the structure and death of cells.

Causes

The main reasons for the development of the disease include:

• inflammation of the gastric mucosa caused by various factors;
• gastrointestinal irritation;
• chronic esophagitis - inflammation of the tissues of the esophagus;
• long-term gastritis - especially with increased stomach acidity. In most cases, the development of metaplasia is associated with the bacterium Helicobacter pylori. The microorganism affects the immune system and adapts to its changes, causing damage to the gastric epithelium of varying severity;
• frequent stressful situations;
• chronic reflux - esophagitis - exposure to irritating factors on the mucous membrane of the esophageal walls for more than six months. Inflammation occurs when gastric juice leaks or leaks into the esophagus;
• hormonal disorders.

Symptoms of the disease

Intestinal metaplasia itself does not manifest itself. All symptoms relate to ailments that preceded its development. Doctors identify the main signs of the disease:

• nausea;
• aching pain in the epigastric region;
• loss of appetite.

The epigastric region is the part of the abdomen in the upper, middle area just below the ribs

With increased acidity of the stomach, “hunger” pains are observed, which intensify at night. If the disease is accompanied by reflux of gastric contents into the esophagus, vomiting and a feeling of bitterness in the mouth may occur.

Diagnosis of the problem

The diagnostic standard is considered to be histological examination, which reveals the form of the disease. During the procedure, small pieces of tissue taken from the human body are examined.

To determine the extent of damage, an additional examination of the gastrointestinal tract is carried out using endoscopic equipment with cell staining. Suspected pathological tissues are tinted with a special paint - methylene blue, which is absolutely safe for human health. Damaged cells acquire a special color and become visible under a microscope.

A combination of methods allows you to diagnose the disease more accurately. In addition, the degree of identification of the bacterium that causes chronic gastritis is increasing, and the need to identify it in intestinal metaplasia in order to prevent a precancerous condition is increasing.

Features of treatment

Therapy depends entirely on the degree of damage to the mucosa. If metaplasia is detected, the patient is registered with a gastroenterologist.

Drug therapy

Treatment with medications is primarily aimed at:

• elimination of gastroesophageal reflux disease - a disease in which the acidic contents of the stomach are regularly thrown into the esophagus. Under the influence of acid, damage to the mucous membrane occurs;
• suppression of gastric secretion;
• destruction of the bacteria H. pylori;
• prevention of benign neoplasms.

The treatment regimen is developed only by the attending physician, taking into account the results of the examinations. Therapy begins with the appointment:

• Proton pump inhibitors are modern medications that reduce the acidity of gastric juice. These include: rabeprozole, omeprozole, pantoprazole;
• antacids (Maalox, phosphalugel) - agents that neutralize hydrochloric acid;
• H2 – histamine blockers (cimetidine, ranitidine) – antisecretory drugs;
• gastroprotectors - in case of increased acidity of the stomach, they prevent the destruction of the mucous membrane.

Pregnancy and childhood are restrictions for taking certain medications.

To enhance the effect, first-line antibacterial agents (amoxicillin, clarithromycin) are additionally prescribed. The course of treatment is 7–10 days. In case of ineffectiveness of therapy, as well as low sensitivity of the infection to these drugs, second-line antibiotics (tetracycline, metronidazole) are prescribed.

The use of inhibitors increases the pH of the stomach, reduces the viscosity of gastric mucus, and prevents the destructive effect of antibacterial drugs. It is necessary to take into account that at the same time you should take medications that strengthen the immune system and prevent the development of dysbacteriosis.

Surgical intervention

Surgery is recommended if there is no positive effect on conservative treatment. In order to minimize the area of ​​intervention in the body and the degree of injury, operations are performed using special endoscopic equipment. This type of surgery is called minimally invasive surgery. It is characterized by a limited depth of damage to the mucous membrane. If necessary, the damaged area is completely removed. As a result of the procedure, the risk of carcinogenic formations is significantly reduced.

Diet

Treatment will not be complete without proper nutrition. Patients are recommended:

• exclude dairy products from the menu, as well as those that irritate the gastric mucosa (fried, spicy, salty);
• do not drink alcohol, coffee, carbonated drinks;
• meals should be fractional, at least 5–6 rubles/day;
• last meal – 2–3 hours before bedtime;
• The diet must include fresh vegetables and fruits.

Nutritionists advise introducing a variety of cereals into your diet. It is recommended to eat food only warm.

Too hot food irritates the gastric mucosa, while cold food takes a long time to digest and provokes the release of hydrochloric acid.

Photo gallery: foods you can eat

You can eat steamed meat. It retains many beneficial substances for the body, which are so necessary during illness.
The absorbent properties of rice porridge are successfully used to effectively remove toxins and waste. Fresh fruits are a source of fiber and vitamins Fresh and steamed vegetables will not harm the stomach and will be an excellent addition to the diet

The use of folk remedies

Traditional medicine offers no less effective methods of combating the disease. Decoctions and infusions of medicinal herbs and herbs reduce signs of inflammation and relieve pain.

1. Herbal mixture of chamomile, calendula, yarrow and marshmallow root. Take 1 tsp. each herb, mix and steam 0.5 liters of boiling water. Leave in a thermal container for about an hour. Filter and take 3-4 times a day for 30 minutes. before meals, 20 ml.
2. Pour boiling water over flax seeds (1 tbsp) and boil for 5 minutes. Leave for 1-2 hours, take 30 ml before each meal.
3. St. John's wort. Grind 15 gr. dried herbs, steam 200–250 ml of boiling water. Leave to infuse in a thermos for 12 hours, preferably overnight. Filter the mixture and bring the volume to 250 ml. Take 30 minutes before. before meals, 50 ml of infusion. The course of treatment is 14 days, then take a week break.

Photo gallery: popular folk remedies in the treatment of gastric metaplasia

St. John's wort has astringent properties, prevents the appearance of malignant neoplasms A decoction of flax seeds protects the mucous membrane from the harmful effects of gastric juice Chamomile, yarrow, calendula, calamus root have an anti-inflammatory and wound-healing effect

Complications

In a healthy person, epithelial cells are constantly renewed. Under the influence of harmful factors (alcohol, long-term use of medications, poor diet), the mucous membrane gradually changes. If treatment is not started in time, the inflammatory process becomes chronic.

Gastric metaplasia develops against the background of concomitant diseases and successive changes.

Chronic gastritis caused by the Helicobacter bacteria leads to complications such as:

• glandular atrophy – pathological changes in the mucous membrane;
• dysplasia – a violation of the epithelium and its functional properties;
• Neoplasia of the gastric mucosa is the first sign of cancer.

Some scientists have scientifically proven that chronic gastritis, the bacterium Helicobacter pylori, intestinal metaplasia, atrophy and stomach cancer are links in one chain in which a microorganism becomes a provocateur. As a result of infection, chronic inflammation is formed in the mucous membrane, and tissue degeneration occurs, provoking the development of intestinal-type stomach cancer.

Against the background of atrophic chronic gastritis, in which the irreversible disappearance of the gastric glands occurs with their replacement by altered tissues, gastrointestinal cancer develops in 75% of cases.

In addition to the bacterium H. pylori, other types of microorganisms appear that produce carcinogenic and mutagenic substances that accelerate the risk of tumors.

In addition, atrophic hCG leads to impaired secretion of internal factor and a decrease in the production of hydrochloric acid. As a result, the normal absorption of vitamin B12 is disrupted, which leads to anemia and neurological disorders.

The gastric mucosa is replaced by metaplastic epithelium, which leads to irreversible processes and the development of cancer

Preventive measures

Primary prevention measures include:

• change in diet;
• giving up bad habits, in particular alcohol and smoking;
• taking vitamin preparations;
• the ability to avoid stressful situations;
• maintaining an optimal balance between rest and work.

If concomitant diseases are identified, it is necessary to take measures to cure them. Otherwise, this can lead to a number of complications and cause irreversible processes in the body. Patients with gastrointestinal diseases are recommended to undergo FGDS with biopsy at least once every 2 years.

Intestinal metaplasia is a dangerous disease that provokes the development of stomach cancer. However, recent studies have revealed that timely consultation with a doctor and compliance with all recommendations slow down or regress destructive processes.

A disease in which cells from different organs of the gastrointestinal tract, such as the small or large intestine, gradually form in the gastric epithelium is called gastric metaplasia. The problem occurs against the background of another disease in which healthy epithelial cells die. As a result, the newly formed tissues perform the physiological function of the intestines with the loss of basic gastric properties.

Failure in the formation of stomach cells is a transitional disease.

Description

Gastric metaplasia characterizes a transitional state and not an independent disease. Gradual modification of stomach tissue occurs with constant exposure to unfavorable factors, such as nutritional disruptions, drug or alcohol abuse.

The gastric mucosa reacts to the irritant with an inflammatory process, which without treatment becomes chronic. An atrophic change occurs in cells that gradually lose their functional ability. At this stage, gastric metaplasia begins in most cases. If appropriate measures are not taken, transformation into dysplasia occurs, characterized by changes in cell nuclei and cytoplasm, and this leads to cancer. Metaplasia is also called the benign course of tissue atrophy. This process is considered reversible if proper therapy is prescribed and all recommendations are followed.

Features and risks

Intestinal metaplasia occurs:

• complete small intestine;
• incomplete colon.

The forms differ from each other in their tendency to malignancy. The first focal type is not precancer, since the altered cells retain their functions. The second type tends to become malignant due to impaired cellular differentiation, which is similar to dysplasia.

The danger of metaplasia lies in the difficulty of differentiating the disease due to the lack of specific signs.

• In the chronic stage of gastritis with high acidity, “hunger” pains, increased heartburn, and “night hunger” appear.
• With an ulcer - clearly localized pain on an empty stomach. Symptoms will worsen in spring and autumn.
• With reflux syndrome with the reflux of intestinal contents into the stomach, there is a bitter taste in the mouth, widespread pain, and vomiting.
• When a bolus of food is expelled from the stomach back into the esophagus, there is a strong burning sensation in the digestive tract and sour belching.

The only reliable method for diagnosing focal disease is fibroesogastroduodenoscopy, performed simultaneously with a biopsy. With its help, the stomach and intestines are carefully examined and the type of irritant, the localization of the tumor, the prevalence of the focal form are determined, and the malignancy of the process is confirmed or refuted.

Kinds

General typical classification of metaplasia:

• I - complete, small intestine, mature;
• II - incomplete, colonic, immature.

Based on the degree of distribution and area of ​​areas with modified epithelium, they are distinguished:

• mild - damage to 5% of the organ surface;
• moderate -20%;
• pronounced - over 20%.

Based on the severity of the atrophic process in the gland, the following types are distinguished:

• A - insignificant;
• B - intermediate;
• S - complete.

By the nature of the lesion:

1. Pyloric or antral form of development, which can be: focal with the replacement of part of the glands of the fundus against the background of inflammation and disruption of the process of cell renewal; diffuse with the distribution of atrophy from the pyloric to the fundus of the stomach, the antrum can be captured; the process takes place without destruction or death of cells.
2. Ciliated shape. The appearance of cells of this type in the stomach indicates development.
3. Pancreatic form with the appearance of small-grained cells with acidophilic and basophilic endings.

Complete metaplasia

Foci of mature metaplasia are formed from all cellular structures of the intestine, which contain sialomucins, sulfamucins, enterocytes (goblet, borderless, bordered). When filling the epithelium of the stomach lining, goblet nuclei alternate with bordered ones. A special feature of this type is the presence of Paneth nuclei with apical granulation in the deep pits of the wall. In most cases, small intestinal metaplasia occurs with underlying chronic gastritis. Another name for the problem is enterolization.

Small intestinal is sometimes combined with incomplete metaplasia. They can be located in the same gland or in different parts of the gastric wall. Enterolization is considered to progress to colonic metaplasia. In chronic inflammation, the focus of complete metaplasia turns into incomplete metaplasia in 11% of cases.

Incomplete metaplasia

The immature form of the pathology is characterized by the replacement of gastric nuclei with alternating goblet-shaped and prismatic ones. No other names are found. The epithelium becomes polymorphic with a tendency to increase nuclear-cytoplasmic influences. There is a disruption in the process of maturation and differentiation of the glands, which is characterized by the uniformity of the upper and lower layers.

The incidence of detection of this type of metaplasia is increased in benign diseases of the stomach. Almost all cases of cancer developed precisely because of metaplasic tissue damage. Therefore, the immature form is a precancerous condition, characterized by a high mortality rate when detected late.

In gastric cancer, colonic metaplasia is found in 94% of cases. Due to the high frequency of coincidences of malignant transformations, pathology of this type requires a differentiated assessment when diagnosing intestinal metaplasia.

Causes

The causal factors influencing the development of gastric pathological processes have not been fully studied. To date, a group of the most significant provoking criteria has been identified, which in 100% of cases lead to the onset of intestinal metaplasia. The group includes:

• constant irritation of the stomach walls;
• chronic inflammation of the epithelial membrane;
• prolonged depression or constant psycho-emotional overload;
• inflammatory processes in the esophagus;
• ulceration of the epithelial membrane;
• intestinal dysfunctions, manifested by frequent reflux of gastric and duodenal contents into the esophagus.

Foci of metaplasia are often diagnosed with low acidity of digestive juice in the stomach. Lack of acid leads to selective changes in healthy microflora in the digestive organ. The process is accompanied by the destruction of gastric bacteria with abundant contamination of intestinal microorganisms.

Infection of the mucous membrane with Helicobacter is considered a dangerous phenomenon that provokes many pathologies in the gastrointestinal tract, including metaplasia. The microbe secretes proenzymes that add salts of nitric and nitrous acids to form carcinogenic products - nitrous substances. These substances combine with other carcinogens from ingested foods. Serious damage to gastric tissue occurs, which rapidly progresses, provoking the development of a malignant tumor. The pathological process intensifies when the rules of a healthy diet are not followed, for example, due to the abuse of salted food and strong alcohol.

Symptoms

Intestinal metaplasia, which affects the gastric mucosa, does not have specific symptoms. The clinical picture of the problem corresponds to the causative factors that provoked the atrophy of the glands. In pathologies with an imbalance in the acidity of the digestive juice, the patient will complain of the following sensations:

• constant burning in the gastrointestinal tract;
• "hunger" pains;
• severe hunger during sleep.

With persistent reflux pathology, the patient will complain of symptoms such as:

• diffuse pain;
• vomiting;
• bitter taste in the mouth.

During diagnosis, a disorder in the muscular activity of the sphincter in the antral zone of the stomach will be detected, and reverse peristalsis will appear. Histological analysis will reveal focal metaplasia located in the antrum of the organ. If the provoking factor is an ulcer, the following are noted:

• local pain with high intensity;
• “hunger” pains that subside after eating;
• periodic exacerbation of pain, mainly in spring and autumn.

During an endoscopic examination, characteristic complications such as scars, perforations, and bleeding will be revealed.

If the provocateur is a hormonal imbalance, the course of the pathology will be asymptomatic. The problem is discovered accidentally during a blood test for another reason.

With helicobacteriosis, the symptoms will be typical of chronic gastritis. Along with general symptoms, when examining a biopsy taken from the mucous membrane, waste products of Helicobacter will be detected. The data will be confirmed by a respiratory test, which involves analyzing the patient’s exhaled air, as well as by examining stool. General symptoms of metaplasia, characteristic of all patients:

• the appearance of constant or periodic pain in the epigastric region;
• belching sour or bitter;
• periodic attacks of nausea and vomiting;
• loss of appetite.

Diagnostics

Detection of the problem is possible with fibrogastroduodenoscopy, an endoscopic method for examining the internal cavity of the stomach. The procedure is carried out using an endoscope with a camera and a probe for collecting biological material for histological analysis.

With metaplasia, the biopsy specimen reveals characteristic tissue changes at the cellular level. The presence of sulfamucin, a substance capable of absorbing carcinogens, is detected. The formed compound is the main provocateur of the development of oncology.

At the same time, changes in the composition of self-antigens in cells are detected. A carcinoembryonic antigen appears due to decreased differentiation of cell nuclei. This can be confirmed by blood test results. An additional method for detecting pathology is the method of chromatic endoscopy. During the procedure, the condition of the affected tissues stained with methylene blue is assessed. Changed tissues as a result of exposure to the dye acquire a specific color. The method determines the degree of metaplasia. When conducting a comprehensive diagnosis, the size and location of metaplasia is clarified.

With metaplasia, timely detection and initiation of treatment in compliance with all doctor’s recommendations is extremely important. The therapeutic course includes:

• drug treatment;
• diet therapy;
• carrying out preventive measures;
• correction of the daily routine;
• treatment with folk remedies.

Medicines

Directions of drug therapy:

1. Preventing the return of a bolus of food from the stomach into the esophagus. This will prevent focal or diffuse inflammation in the lower esophagus, causing gastroesophageal reflux disease.
2. Destruction of infection that has developed due to the contamination of the gastric and intestinal mucosa with Helicobacter.
3. Prevention of cancer development.

The treatment regimen is developed by the attending physician based on the diagnostic results obtained. In order to restore beneficial gastric microflora, drugs like Linex are prescribed. It is recommended to take synthetic and natural immunomodulators and herbal medicine recipes. Appointed:

• proton inhibitors to stabilize the acidity of the digestive tract in conditions of its increase: “Rabeprozole”, “Omeprozole”, “Pantoprazole”;
• antacids to neutralize hydrochloric acid: Maalox, Phosphalugel;
• H2-blockers of histamines to suppress secretory activity: Cimetidine, Ranitidine;
• gastroprotectors to regulate gastric acidity and prevent mucosal destruction.

Drug therapy is carried out with dynamic monitoring of the patient’s condition and recovery processes in the stomach.