Medications for Treating Atrophic Gastritis with Intestinal Metaplasia

Atrophic gastritis is a prevalent and often chronic condition. Research indicates that over half of individuals above the age of 55 show signs of atrophic gastritis during endoscopic examinations. Many people feel anxious upon diagnosis, especially when intestinal metaplasia is involved, due to concerns about its potential to progress into cancer. So, what treatment options exist for those diagnosed with atrophic gastritis accompanied by intestinal metaplasia?

Understanding Atrophic Gastritis with Intestinal Metaplasia

Atrophic gastritis is a form of chronic inflammation in which the stomach lining's glandular cells are gradually replaced by fibrous tissue. This process often leads to intestinal metaplasia — a condition where the normal gastric mucosa transforms into intestinal-like mucosa. There are two main types: complete (small intestine-type) and incomplete (large intestine-type) metaplasia. The severity and extent of this transformation have been linked to an increased risk of gastric cancer.

Causes of Atrophic Gastritis with Intestinal Metaplasia

Scientific studies suggest that several factors contribute to the development of this condition, including age, gender, and family history of gastric cancer. Helicobacter pylori infection is the primary cause, but other contributors include duodenal reflux, bile and pancreatic juice regurgitation, long-term consumption of spicy or high-salt foods, alcohol abuse, and prolonged use of nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin and ibuprofen. Nutritional deficiencies such as low levels of vitamin B12, folate, and vitamin C can also impair mucosal repair and increase oxidative stress, worsening the condition.

Treatment Options for Atrophic Gastritis with Intestinal Metaplasia

While reversing intestinal metaplasia is challenging, certain medications can help manage symptoms and slow disease progression. Here are the major drug categories used in treatment:

1. Helicobacter pylori Eradication Therapy

Since H. pylori plays a central role in the development of atrophic gastritis and intestinal metaplasia, eradicating the bacteria early can prevent further damage. Even after metaplasia occurs, eradication may halt disease progression.

The standard approach is a four-drug regimen known as quadruple therapy:

- Two antibiotics: Common combinations include amoxicillin plus clarithromycin, amoxicillin plus furazolidone, or tetracycline plus metronidazole. Amoxicillin is preferred due to its low resistance rate.
- Proton pump inhibitor (PPI): Examples include omeprazole, rabeprazole, esomeprazole, and lansoprazole. These reduce gastric acid secretion, enhancing antibiotic effectiveness.
- Bismuth compound: Such as bismuth subsalicylate or colloidal bismuth pectin. These protect the gastric lining and improve eradication rates by reducing bacterial resistance.

2. Prokinetics and Digestive Enzymes

Patients often experience bloating and indigestion. While these medications don't reverse metaplasia, they can significantly relieve symptoms. Common prokinetic agents include:

- Metoclopramide
- Domperidone
- Mosapride

Digestive enzymes such as lactase, pepsin, pancreatin, and multi-enzyme complexes can aid digestion and alleviate discomfort.

3. Mucosal Protective Agents

Strengthening the gastric barrier is crucial in managing atrophic changes. Protective agents include:

- Sucralfate
- Aluminum hydroxide
- Magnesium aluminum silicate
- Teprenone
- Rebamipide

These drugs form a protective layer on the mucosa and promote healing, especially in cases involving bile reflux.

4. Mucosal Nutrition Supplements

Nutritional support plays a vital role in restoring gastric health. Key supplements include:

Folic Acid (Vitamin B9): Essential for DNA methylation and cellular repair, folic acid has shown potential in reversing mild to moderate intestinal metaplasia by inhibiting abnormal gene expression and tumor activation.

Vitamin B12: Particularly beneficial in patients with pernicious anemia or malabsorption. Lamb extract containing vitamin B12 has demonstrated clinical efficacy in improving mucosal regeneration and reversing atrophy and metaplasia.

Selenium: A powerful antioxidant that neutralizes free radicals and boosts immune function. Selenium-rich foods like seafood, liver, garlic, and mushrooms can support gastric health and potentially lower cancer risk.

5. Traditional Chinese Medicine Formulations

Certain herbal remedies have shown promise in treating atrophic gastritis and intestinal metaplasia:

Moluo Dan: A multi-herb formula that improves gastrointestinal motility, protects the mucosal barrier, and modulates immunity. It contains ingredients like Ophiopogon root, Poria, and Rehmannia, which collectively support mucosal healing.

Weifuchun: Composed of ginseng, Rabdosia rubescens, and Citrus aurantium, this formulation enhances microcirculation, accelerates epithelial cell renewal, and may reverse intestinal metaplasia while preventing malignant transformation.

Conclusion

Atrophic gastritis with intestinal metaplasia poses a significant health concern due to its association with gastric cancer. While no single medication guarantees reversal, a combination of H. pylori eradication, mucosal protection, nutritional supplementation, and targeted symptom management can effectively control the condition. In addition to medical treatment, lifestyle modifications and regular endoscopic surveillance remain critical for early detection and intervention. Always consult a gastroenterologist for personalized care and optimal outcomes.