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Pathogenesis and potential reversibility of intestinal metaplasia − a milestone in gastric carcinogenesis

Jan Drnovsek

Jan Drnovsek

  • Department of Gastroenterology, University Medical Centre LjubljanaLjubljana, Slovenia
  • Faculty of Medicine, University of LjubljanaLjubljana, Slovenia
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Drnovsek, Jan
, 
Matjaz Homan

Matjaz Homan

  • Faculty of Medicine, University of LjubljanaLjubljana, Slovenia
  • Department of Gastroenterology, Hepatology and Nutrition, University Children’s HospitalLjubljana, Slovenia
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Homan, Matjaz
, 
Nina Zidar

Nina Zidar

  • Faculty of Medicine, University of LjubljanaLjubljana, Slovenia
  • Institute of Pathology, Faculty of Medicine, University of LjubljanaLjubljana, Slovenia
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Zidar, Nina
 und 
Lojze M Smid

Lojze M Smid

  • Department of Gastroenterology, University Medical Centre LjubljanaLjubljana, Slovenia
  • Faculty of Medicine, University of LjubljanaLjubljana, Slovenia
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Smid, Lojze M
  
21. Apr. 2024
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Artikel-Kategorie: Review
Online veröffentlicht: 21. Apr. 2024
Seitenbereich: 186 - 195
Eingereicht: 03. Nov. 2023
Akzeptiert: 19. März 2024
DOI: https://doi.org/10.2478/raon-2024-0028
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© 2024 Jan Drnovsek et al., published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.

Background

Non-cardia gastric cancer remains a major cause of cancer-related mortality worldwide, despite declining incidence rates in many industrialized countries. The development of intestinal-type gastric cancer occurs through a multistep process in which normal mucosa is sequentially transformed into hyperproliferative epithelium, followed by metaplastic processes leading to carcinogenesis. Chronic infection with Helicobacter pylori is the primary etiological agent that causes chronic inflammation of the gastric mucosa, induces atrophic gastritis, and can lead to intestinal metaplasia and dysplasia. Both intestinal metaplasia and dysplasia are precancerous lesions, in which gastric cancer is more likely to occur. Atrophic gastritis often improves after eradication of Helicobacter pylori; however, the occurrence of intestinal metaplasia has been traditionally regarded as “the point of no return” in the carcinogenesis sequence. Helicobacter pylori eradication heals non-atrophic chronic gastritis, may lead to regression of atrophic gastritis, and reduces the risk of gastric cancer in patients with these conditions. In this article, we discuss the pathogenesis, epigenomics, and reversibility of intestinal metaplasia and briefly touch upon potential treatment strategy.

Conclusions

Gastric intestinal metaplasia no longer appears to be an irreversible precancerous lesion. However, there are still many controversies regarding the improvement of intestinal metaplasia after Helicobacter pylori eradication.
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Englisch
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Medizin, Klinische Medizin, Allgemeinmedizin, Innere Medizin, Hämatologie, Onkologie, Radiologie
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