Intestinal Metaplasia Overview


Intestinal metaplasia is a change in the lining of the stomach, where the normal cells are replaced by cells similar to those found in the intestines. This change can increase the risk of developing stomach cancer over time, but for most people in the United States, the risk of cancer remains low.[1][2]

Causes: The most common cause of intestinal metaplasia is infection with a bacteria called Helicobacter pylori (H. pylori). Other factors that can increase risk include older age, being male, smoking, having diabetes, and being overweight. People with a family history of stomach cancer or who are from certain racial or ethnic backgrounds may also be at higher risk.[3][4][5][6][2]

What to avoid:

- Smoking: Smoking increases the risk of intestinal metaplasia and stomach cancer. Quitting smoking is strongly recommended. [5]

- High salt intake: Eating a lot of salty foods may increase risk, so try to limit salt in your diet. [1]

- Persistent H. pylori infection: If you have been diagnosed with H. pylori, it is important to complete treatment to get rid of the infection. [3][4][2]

- Obesity: Being overweight may increase risk, so maintaining a healthy weight is helpful.[4]

What to use or do instead:

- H. pylori eradication: If you have H. pylori infection, taking the prescribed antibiotics to clear the infection can help prevent progression and may even help the stomach lining heal. [3][4][2]

- Healthy diet: Eating a balanced diet with plenty of fruits and vegetables and less salt is recommended. Interestingly, some studies suggest that eating spicy foods may actually lower the risk of intestinal metaplasia, but more research is needed. [6]

- Regular follow-up: For some people at higher risk (such as those with extensive changes, incomplete types of metaplasia, or a family history of stomach cancer), regular check-ups and possibly endoscopy may be recommended to monitor for changes.[1][2][7]

If you have intestinal metaplasia, talk with your healthcare provider about your individual risk and the best plan for you. Most importantly, treating H. pylori infection and avoiding smoking are the most effective steps to lower your risk.[3][4][5][2]

References

  1. The Role of Endoscopy in the Management of Premalignant and Malignant Conditions of the Stomach. Evans JA, Chandrasekhara V, Chathadi KV, et al. Gastrointestinal Endoscopy. 2015;82(1):1-8. doi:10.1016/j.gie.2015.03.1967.

  2. AGA Clinical Practice Guidelines on Management of Gastric Intestinal Metaplasia. Gupta S, Li D, El Serag HB, et al. Gastroenterology. 2020;158(3):693-702. doi:10.1053/j.gastro.2019.12.003.

  3. Predictors for Regression and Progression of Intestinal Metaplasia (IM): A Large Population-Based Study From Low Prevalence Area of Gastric Cancer (IM-predictor Trial). Aumpan N, Vilaichone RK, Pornthisarn B, et al. PloS One. 2021;16(8):e0255601. doi:10.1371/journal.pone.0255601.

  4. Predictors for Development of Complete and Incomplete Intestinal Metaplasia (IM) Associated With H. Pylori Infection: A Large-Scale Study From Low Prevalence Area of Gastric Cancer (IM-HP Trial). Aumpan N, Vilaichone RK, Nunanan P, et al. PloS One. 2020;15(10):e0239434. doi:10.1371/journal.pone.0239434.

  5. Demographic and Lifestyle Risk Factors for Gastric Intestinal Metaplasia Among US Veterans. Tan MC, Mallepally N, Liu Y, El-Serag HB, Thrift AP. The American Journal of Gastroenterology. 2020;115(3):381-387. doi:10.14309/ajg.0000000000000498.

  6. Prevalence and Factors Associated With Atrophic Gastritis and Intestinal Metaplasia: A Multivariate, Hospital-Based, Statistical Analysis. Chitapanarux T, Kongkarnka S, Wannasai K, Sripan P. Cancer Epidemiology. 2023;82:102309. doi:10.1016/j.canep.2022.102309.

  7. AGA Clinical Practice Update on Screening and Surveillance in Individuals at Increased Risk for Gastric Cancer in the United States: Expert Review. Shah SC, Wang AY, Wallace MB, Hwang JH. Gastroenterology. 2025;168(2):405-416.e1. doi:10.1053/j.gastro.2024.11.001.