Gastric “intestinal epithelial hyperplasia” is a common concern, and many people are worried and can’t sleep at night when they get the gastroscopy biopsy report and see the word chronic gastritis with intestinal epithelial hyperplasia. So, they start to consult and check the information constantly, as if they are at risk, wondering whether their stomach will become cancerous. Does intestinal epithelial hyperplasia mean that stomach cancer will occur? First of all, what is intestinal epithelial hyperplasia? Intestinal epithelial metaplasia refers to the replacement of normal gastric mucosa epithelium by intestinal epithelium, i.e. epithelial cells similar to small intestine or large intestine mucosa appear in gastric mucosa. It is a relatively common phenomenon, especially in elderly patients, often combined with chronic atrophic gastritis, and the proportion increases with age. Pathologically, intestinal epithelial metaplasia is divided into 2 types: complete intestinal epithelial metaplasia and incomplete intestinal epithelial metaplasia according to the function of the metaplastic epithelial cells; intestinal metaplastic cells can be divided into 2 subtypes: large intestine metaplasia and small intestine metaplasia according to the different secreted substances; and 3 grades: mild, moderate and severe according to the degree of intestinal metaplasia. Intestinal metaplasia usually first appears in the gastric sinus, then gradually involves the gastric lesser curvature, and then expands to the anterior and posterior walls of the gastric body. What kind of intestinal epithelial metaplasia is carcinogenic? Atrophic gastritis combined with intestinal epithelial hyperplasia is indeed associated with the development of gastric cancer. It has been established that intestinal epithelial hyperplasia is a precancerous lesion of gastric cancer. However, it does not mean that the presence of intestinal epithelial hyperplasia will definitely lead to cancer, but only some types of intestinal epithelial hyperplasia have the possibility of cancer. Generally speaking, small intestine type chemosis or complete intestinal epithelial chemosis with good epithelial differentiation is seen in various benign gastric diseases, especially in chronic gastritis, and the chemosis worsens with the development of inflammation. It is believed that this type of metaplasia may be of inflammatory response nature and is not related to gastric cancer. In contrast, colorectal type chemosis or incomplete intestinal epithelial chemosis with poor epithelial differentiation has a lower detection rate in benign gastric diseases, but a higher detection rate in the mucosa adjacent to intestinal type gastric cancer, indicating that this type of chemosis is related to the occurrence of gastric cancer. At present, it is believed that incomplete and colorectal type intestinal epithelial metaplasia is closely related to gastric cancer. How does intestinal epithelial hyperplasia evolve into gastric cancer? Glandular neck stem cells of gastric mucosa have multifaceted secretory potential, and in normal time it can differentiate into various mature epithelial cells of gastric mucosa. When stem cells are not working properly, the transition from intestinal chemosis to gastric cancer is roughly as follows: normal gastric mucosa → chronic superficial gastritis → chronic atrophic gastritis → incomplete small intestine type intestinal chemosis → incomplete large intestine type intestinal chemosis → heterogeneous hyperplasia → early gastric cancer → progressive gastric cancer. It takes a long time to develop from the appearance of intestinal epithelial hyperplasia to gastric cancer, which may be years or decades. Thus, it can be seen that gastric mucosal epithelial cell carcinogenesis is not an overnight event; it is not a leap from normal cells to cancer cells, but a chronic and progressive process that will undergo years of continuous precancerous changes before developing into malignant tumors. Therefore, early recognition and intervention, if possible, is also an effective way to prevent gastric cancer. How to prevent intestinal epithelial metaplasia carcinoma? 1. Eradication of Helicobacter pylori: Current research has found that although eradication of Helicobacter pylori cannot reverse intestinal epithelial metaplasia, it can slow down or stop the development of atrophy to prevent its progression to gastric cancer. The incidence of gastric cancer in patients with early eradication of H. pylori is lower than that in patients with no eradication or failed eradication. 2.Antioxidant therapy: Folic acid and vitamin B group as antioxidants can reverse atypical hyperplasia of gastric mucosa, and the current study shows that the mechanism may be involved in maintaining DNA methylation status and inhibiting oncogene expression. Therefore, in the treatment of intestinal epithelial hyperplasia, appropriate supplementation of antioxidants such as folic acid and vitamin B can help improve the atypical hyperplasia of gastric mucosa. 3.Endoscopic intervention therapy: In order to prevent the occurrence of gastric cancer, endoscopy is advocated every 3 years for patients with wide range atrophic gastritis and Helicobacter pylori. For patients with moderate to severe H. pylori who may have early gastric cancer, there are mainly endoscopic mucosal resection, endoscopic high-frequency electrodesiccation, endoscopic argon knife treatment, endoscopic laser treatment, endoscopic microwave treatment, etc., which can be chosen according to the different conditions of patients to remove the cause of the disease and improve the prognosis by removing the diseased tissue.