tooth[인터뷰] Gastroenterology Director Lee Sang-hwan
toothIntestinal metaplasia, a precancerous lesion that can lead to gastric cancer
toothOnce it happens, there is no going back… only to prevent further progress
Gastric cancer ranks third in the incidence of cancer worldwide. The situation in the country is not much different. Although the incidence of gastric cancer has declined over the past 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, there is a gastrointestinal disease that increases the risk of stomach cancer by about 10 times. It is ‘intestinal metaplasia’.
I asked director Lee Sang-hwan (Irum Internal Medicine Clinic), a gastroenterologist, about what kind of disease is intestinal metaplasia and how to follow-up and manage it if you have been diagnosed with intestinal metaplasia during a recent health checkup.
Director Lee Sang-hwan, a 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, in which the gastric wall thins, is left untreated. Intestinal metaplasia is one of the precancerous lesions that can cause gastric cancer. The stages in which gastritis progresses from intestinal epithelial metaplasia to gastric cancer are as follows: △Chronic atrophic gastritis, in which the gastric wall becomes thin due to excessive stimulation of gastric acid △Intestinal metaplasia, in which the surface of the gastric mucosa becomes rough and uneven △Adenoma, which is a pre-cancer, is known to gradually progress in the order of low-grade dysplasia △high-grade dysplasia △gastric cancer.
In general, intestinal metaplasia starts from the bottom right in front of the passage through which food passes into the duodenum and gradually spreads. However, the symptoms that appear at this time are not very different from mild gastritis, so it is often discovered incidentally through a health checkup. On gastroscopic examination, it appears as a bumpy mucosal lesion with a rough surface like an asphalt road.
Director Lee Sang-hwan said, “If intestinal metaplasia gets worse, 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 the secretion of gastric acid is reduced, it becomes an environment in which bacteria are easy to grow, and symptoms such as the smell of gas or persistent diarrhea may occur due to the overgrowth of bacteria in the intestine,” he added.
“Depending on the severity, it may be necessary to shorten the examination cycle”
Director Lee Sang-hwan said, “If intestinal metaplasia is observed on endoscopy, the follow-up examination is determined according to the degree of its progress.” Normally, gastroscopy is performed every two years, which is the national examination interval. However, it is recommended to undergo a gastroscopy every year in the case of a wide range of moderate or severe intestinal metaplasias, △ Helicobacter pylori infection, or △ a family history of gastric cancer. If it is observed that it has progressed to an adenoma, a precursor to gastric cancer, the interval can be advanced by up to 6 months. An endoscopy follow-up is performed and the treatment is judged to be successful only when the progress 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 repetitive food and stomach acid stimulation for a long time or erosive change in which the mucous membrane peels off. At this time, the probability that damaged gastric mucosal cells are 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 to eliminate these bacteria is recommended. In the case of chronic atrophic gastritis, which is a pre-intestinal metaplasia stage, it is known that the condition can be reversed with eradication treatment. Unfortunately, intestinal metaplasia once protruded does not re-enter. However, director Lee Sang-hwan emphasized the importance of eradication treatment, saying, “Treatment of Helicobacter pylori can slow down 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 consumed by each patient to determine which food may have caused intestinal metaplasia.
For early detection of gastrointestinal diseases, regular endoscopy should be performedㅣSource: Getty Image Bank
“Unexpected foods that help progress intestinal metaplasia”
Since intestinal metaplasia does not return once it occurs, it is important to suppress its progression so that the lesion does not protrude or expand. To do so, it is important to refrain from foods that stimulate the stomach. Director Lee Sang-hwan introduced 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 an excessively high ratio of barley, brown rice, beans, and red beans falls into this category. Nuts such as almonds, peanuts, walnuts, and pine nuts are also habitually eaten every day, and intestinal metaplasia can be aggravated by abnormal stimulation.
“Cabbage, which is said to be good for the stomach, can 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 during the cooking process, so it is not very helpful. 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 a 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 better to avoid drinking coffee before meals, as the stomach with intestinal metaplasia has lost its existing function. Drink coffee as a dessert after a meal.
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 observed with a special mode called narrow band 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 normal mucosa from damaged mucosa while looking at his or her own endoscope picture. all. Director Lee Sang-hwan advised, “It is safe to undergo a health checkup at a hospital equipped with a high-end endoscope capable of NBI mode.”
He said, “It is difficult to distinguish between intestinal metaplasia and adenoma, which is a precursor to cancer that may occur thereon, so there is a high probability of missing it if you receive an endoscopy at a factory-style health checkup center.” did.
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