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Gastritis/Focal Intestinal Metaplasia and Colon Polyps

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November 12th, 2010
I am a female, 43, and two years ago I had a hysterectomy. Before and after the surgery I had to apply pressure in the rectum area to help stools to pass. My OB/GYN said that the constipation and need to apply pressure could have been caused by my prolapsed uterus.
Over the last several years, I have had some symptoms of feeling full, lots of gas (both ends), pencil like stools, diarrhea and constipation with some noticeable mucous in the stool sometimes... I have had vomited 3 or 4 times (two times I made myself to get relief) in the last year - that was not attributed to a virus - more that my stomach hurt and I felt sick. I was put on thyroid medication due to hyperthyroidism in June, .05 mcg, then .075 mcg since September. When I went in for my thyroid medication change my physician's assistant, I spoke to her about my gas, stomach and stool sypmtoms. She referred me to a GI. I went through an evaluation. Due to the fact that my dad's brother had colon cancer and died in his 50's and my mom's brother had stomach cancer 6 years ago, he recommended that I get an endoscopy and colonoscopy.
Results
Colonoscopy - came back with internal hemorrhoids (no surprise there) and two colon polyps - 1. Ascending colon polyp - tubular adenoma. 2. Sigmoid polyp - tubular adenoma. He said it was a good thing I had the procedure because by the time I turned 50 those would have probably become colon cancer. Shocked Recommendation to come back in two years for another colonoscopy.

Endoscopy - came back with a Gastric Antrum Biopys - 1. Mild Reactive Gastritis 2. Focal Intestinal Metaplasia 3. No Heliobacter identified I had no idea what this meant til I looked it up and got more detail. Rolling Eyes Recommendation to come back in two years for another endoscopy.

My questions are:
Do you think I should get checked annually?
Should I be concerned about the polyps? One was like cauliflower and one was flat.
Is intestinal metaplasia curable?
Is it treatable? What are the treatment options - meds, surgery, radiation, chemo?
What are the different levels of metaplasia?
Is there a way to tell how long I have had this?
How many patients with metaplasia develop stomach cancer?
What other tests can I have to see if I have cancer genes?
What diet and lifestyle changes can I make and medicines can I take?
What should I avoid?
Would the triple antibiotic therapy work?

Thank you for your input.
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First Helper msv047
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replied November 27th, 2010
Approximately 25% of the population will have colorectal polyps identified during colonoscopy. The polyps that you had removed have a rather low malignant potential, although your GI doctor is correctin stating that these polyps could have progressed to cancer, in time, had they not been removed.

Intestinal metaplasia of the stomach has been linked to H. pylori, but may also occur in the absence of infection with this bacteria. It is a known risk factor for stomach cancer, although only a minority of patients with this abnormality will actually go on to develop gastric cancer. (In many cases, it will spontaneously resolve.)

I would agree with your GI doctor's advice to re-scope you in 2 years. Unless you test positive for either current or prior H. pylori infection, it is unlikely that an H. pylori antibiotic regimen will be of benefit to you.

I have extensively included a discussion of diet and lifestyle as they relate to GI tract cancer prevention in my new book, "A Cancer Prevention Guide for the Human Race."


Sincerely,


Robert A. Wascher, MD, FACS

www.doctorwascher.com

Author, "A Cancer Prevention Guide for the Human Race"



A landmark, evidence-based guide to a healthy cancer-prevention lifestyle, based on cutting-edge cancer research.
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cmkalm
replied December 27th, 2010
Dr. Wascher:

Thank you for the response.

I am concerned because of cancer on my dad's side(my dad's brother) died a few years ago in his 50s of colon cancer. My mom's side has cancer too (my mom's brother 6 years ago at around 52 - stomach cancer - duodenum - had the whipple procedure and is cancer free so far her other brother diagnosed with prostate cancer at 68 two years ago, great aunt had lung cancer in 60s died in the 80s, and great grandmother had breast cancer at 83 and died in 1983.

Now around 11/15 or so I had an odd growth "pop" up on my right external middle ear, my doctor thought it was a bug bite, gave me antibiotics, a week later I went back because it had gotten bigger, it looked like a volcano and had a shave biopsy done on 11/30 - came back as squamous cell carcinoma! It grew to 1 cm in two weeks! Went to M.D. Anderson Cancer Center on 12/15 and got it removed via Mohs Surgery - got all of it in first procedure and pathology came back with clear margins. My doctor is very confident she got all of it with no spreading to lymph nodes. My skin has been very oily, lots of breaking out and I had a sebaceous cyst recently too. I have totally changed my diet in the last 8 weeks since all this has been going on. I have had huge anxiety since the IM diagnosis and then the Squamous Cell Carcinoma...I am in complete shock. I am overall in fairly good shape - weight and health wise. I just ran my first 5K last June and my life has changed so much since the summer...

I will get the book.

Please advise me on what else you know about Intestinal Metaplasia and are you familiar with radiofreqency ablation?

God bless,
CK
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cmkalm
replied December 28th, 2010
Question on Soy & Cancer
Also what is your take on soy? I have heard that because soy has estrogen if you are at risk for cancer that you should avoid soy? Please advise because I want to avoid any foods that could be triggers for cancer.
P.S. I did order your book, thank you.
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msv047
replied January 3rd, 2011
Dr... Thank you for your responses and great work.. I read your post above about Intestinal Metaplasia. Re: your statement ( It is a known risk factor for stomach cancer, although only a minority of patients with this abnormality will actually go on to develop gastric cancer. (In many cases, it will spontaneously resolve.)
Would that also be true of Focal Metaplasia of the antrum?
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Hasim
replied December 4th, 2011
Hi doctor my biopsy says I have IM and astral gastritis. I read ur comment that only minority of IM patients develop cancer. I want to know in what time do IM progress to cancer? Pls help it's making me crazy.
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cmkalm
replied May 22nd, 2012
I do not know of any studies that show the incidence of gastric cancer that had IM. The only studies I have seen are ones that involved military personnel or alcoholics. It would be nice to get a physician's answer on this!
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