What Are the Treatment Medications for Atrophic Gastritis with Intestinal Metaplasia?
Atrophic gastritis is a common and frequently occurring condition, particularly among older adults. According to data, more than half of individuals over the age of 55 show signs of atrophic gastritis during endoscopic examinations. Many people become anxious after being diagnosed with this condition, especially when intestinal metaplasia is involved. Concerns about its potential to develop into gastric cancer are understandable. So, what medications are available for treating atrophic gastritis with intestinal metaplasia?
Understanding Atrophic Gastritis with Intestinal Metaplasia
Atrophic gastritis is a type of chronic gastritis characterized by the gradual loss of gastric glandular cells due to long-term inflammation. This often leads to intestinal metaplasia, a process in which the normal stomach lining is replaced by cells that resemble those found in the intestines. There are two main types: small intestinal metaplasia and colonic-type metaplasia. The extent and severity of these changes are closely associated with an increased risk of developing gastric cancer.
Causes of Atrophic Gastritis with Intestinal Metaplasia
Research indicates that several factors contribute to the development of this condition, including age, gender, and family history of gastric cancer. Helicobacter pylori (H. pylori) infection is the primary cause. Other contributing factors include duodenal reflux, dysfunction of the sphincter muscle leading to bile and pancreatic juice regurgitation, consumption of coarse or spicy foods, high salt intake, alcohol abuse, and long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin and ibuprofen. Additionally, deficiencies in vitamin B12, folic acid, and vitamin C can impair the body's ability to neutralize harmful substances such as free radicals and nitrites, further worsening the condition.
Medications Used in the Treatment of Atrophic Gastritis with Intestinal Metaplasia
1. H. pylori Eradication Therapy
Since H. pylori infection plays a central role in the development of atrophic gastritis, eradicating the bacteria early can help prevent or slow the progression of intestinal metaplasia. Even after metaplasia has occurred, treatment can still reduce inflammation and delay disease progression.
The standard regimen is a four-drug combination known as quadruple therapy:
- Two antibiotics selected from amoxicillin, clarithromycin, metronidazole, quinolones, tetracycline, and furazolidone.
- A proton pump inhibitor (PPI), such as omeprazole, rabeprazole, esomeprazole, or lansoprazole, to suppress gastric acid secretion.
- A bismuth compound, such as colloidal bismuth subcitrate or bismuth pectin, to protect the stomach lining and enhance eradication rates.
Amoxicillin is typically preferred due to its low resistance rate. For patients allergic to amoxicillin, alternative combinations like tetracycline plus furazolidone may be used.
2. Gastroprokinetic and Digestive Enzyme Agents
Patients often experience symptoms such as bloating and poor appetite. While these medications do not reverse the underlying pathology, they can significantly improve digestive symptoms. Commonly used drugs include:
- Gastroprokinetic agents: metoclopramide, domperidone, mosapride.
- Digestive enzymes: lactase, dried yeast, pepsin, pancreatin, multienzyme complexes, and azintim.
3. Mucosal Protective Agents
Reduced mucosal defense contributes to gastric atrophy. Enhancing protection and promoting healing are key parts of management, especially in cases involving bile reflux. Common protective agents include:
- Sucralfate
- Hydrotalcite
- Aluminum hydroxide
- Alginate
- Teprenone
- Rebamipide
4. Nutritional Support for Gastric Mucosa
Certain vitamins and trace elements play a crucial role in supporting gastric mucosal health and regeneration:
- Folic Acid (Vitamin B9): Helps maintain DNA methylation and may reverse intestinal metaplasia and dysplasia, potentially reducing cancer risk.
- Vitamin B12: Essential for nerve function and gastric mucosal repair. Lamb extract containing vitamin B12 has shown promise in improving atrophic changes and reversing intestinal metaplasia.
- Selenium: An antioxidant that helps neutralize harmful free radicals and supports immune function, potentially lowering cancer risk. Selenium-rich foods include seafood, garlic, mushrooms, and nuts.
5. Traditional Chinese Medicine (TCM) Formulations
Several herbal remedies have demonstrated efficacy in managing symptoms and slowing disease progression:
- Moluo Dan: A multi-herb formula that improves gut motility, protects the mucosal barrier, and modulates immunity.
- Weifuchun: Contains ginseng and other herbs; clinical studies suggest it can reverse intestinal metaplasia and dysplasia by enhancing mucosal blood flow and promoting tissue regeneration.
Conclusion
Atrophic gastritis with intestinal metaplasia is a precancerous condition that requires careful monitoring. Although no single drug offers a complete cure, a comprehensive approach combining H. pylori eradication, mucosal protection, nutritional support, and traditional medicine can help manage the condition effectively. Lifestyle modifications and regular endoscopic surveillance remain essential components of care. Early detection of malignant changes allows for timely intervention and improved outcomes.