Intestinal epithelial metaplasia refers to the transformation of intestinal epithelial tissue of gastric mucosa, which is a kind of precancerous lesion of gastric cancer, but it does not mean that intestinal metaplasia will definitely have cancer, and only some types of intestinal metaplasia have the possibility of cancer. We often encounter such a group of patients in outpatient clinic. After taking biopsy by gastroscopy, the pathology report shows: moderate chronic atrophic gastritis (sinus) and moderate intestinal epithelial metaplasia. Subsequently, the patients started to consult and check the information, some said it was precancerous, some said to pay attention to the review, etc. However, the patients and/or their family members were not satisfied. However, the patient and/or family members will keep on tangling, and after a long time, the patient will become anxious, like an enemy, as if cancer is coming, and undoubtedly sentenced to “life imprisonment”. Patients will seek medical advice everywhere, repeat examinations many times, and become anxious and nervous, inexplicably fearful. Intestinal epithelial metaplasia means that the normal epithelium of gastric mucosa is replaced by intestinal epithelium, and in mild cases, only a few intestinal epithelial cells are present, while in severe cases, intestinal villi can be seen. The intestinal epithelial cells are mainly composed of absorptive cells interspersed with cup-shaped cells, and Pan’s cells can be seen at the bottom. Their morphology, mucus characteristics, enzyme histochemistry and ultrastructure are similar to those of the small or large intestine, which are obviously different from those of the gastric epithelium. According to the mucus secretion of intestinal epithelial metaplasia and the nature of its mucus secretion, intestinal epithelial metaplasia can be divided into four types: complete small intestinal metaplasia; incomplete small intestinal metaplasia; complete colonic metaplasia; and incomplete colonic metaplasia. Gastric mucosal epithelial cell carcinogenesis is not an overnight event, not a leap from normal cells to cancer cells, but a chronic and progressive process in which the intestine undergoes years of continuous precancerous changes before developing into a malignant tumor. Early recognition and early intervention can be an effective way to prevent gastric cancer. Endoscopic recognition of intestinal epithelial metaplasia: 1. Yellowish nodular type: single or multiple 2-3 mm yellowish nodules, slightly flattened and protruding from the gastric mucosa, with a villi-like or fine-granular surface. In the yellowish nodular type intestinal epithelial metaplasia. It is mildly irregular, finely granular, or villi-like. 2, porcelain white nodule type: isolated or multiple small nodules, porcelain white translucent, smooth surface, soft, microscopic reflection stronger than normal gastric mucosa. Porcelain white nodules are unstable and can disappear or transform to diffuse type. 3, fish scale skin-like appearance: the gastric cell is enlarged in strips, arranged like fish scale, generally in strips or diffuse distribution. 4, diffuse type: the mucosa is diffusely irregularly granular and uneven, slightly grayish white. Endoscopic manifestation is nodular or diffuse; diffuse type mainly has two morphological manifestations, one is granular diffuse unevenness, the other gastric scattered rice-like. The degree of intestinal epithelial metaplasia of gastric mucosa is different, then the accuracy of gastroscopic diagnosis is different, the heavier the degree of intestinal metaplasia, the higher the rate of compliance, that is, moderate and severe intestinal metaplasia carnal-specific changes are more prominent than light, the rate of endoscopic diagnosis and the rate of compliance between endoscopic and pathological diagnosis is also high. Therefore, endoscopy requires careful observation and careful identification so that accurate biopsy can be performed and the diagnostic rate can be improved. Degree and grading of intestinal epithelial metaplasia Regardless of large intestine type metaplasia or small intestine type metaplasia, the degree of metaplasia can be classified as mild, moderate and severe. When looking at 3-5 fields of view under 400x light microscope, if the intestinal chemosis cells occupy less than 1/3 of the glandular ducts, it is mild (+), if it occupies 1/3-2/3, it is moderate (++), and if the intestinal chemosis cells occupy more than 2/3 of the glandular ducts, it is severe. Some scholars also classify the area of intestinalization into 0-3 grades: grade 0 mucosa contains no intestinal lesions; grade 1 intestinalization accounts for 30% of the mucosal area; grade 2 intestinalization has an area between 30% and 70%; grade 3 intestinalization has an area greater than 70%. The degree of intussusception tends to increase with age. 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 is aggravated with the development of inflammation, and it is believed that this type of chemosis may belong to the nature of inflammatory reaction and has little relationship with gastric cancer. In contrast, colorectal type chemosis or incomplete intestinal epithelial chemosis, with poor epithelial differentiation, has a low detection rate in benign gastric diseases, but a high detection rate in the mucosa adjacent to intestinal gastric cancer, indicating that this type of chemosis has a certain relationship with the occurrence of gastric cancer. Therefore, for complete intestinal epithelial metaplasia or small intestine type metaplasia, there is no need to be overly alarmed, but for moderate or severe incomplete intestinal epithelial metaplasia or large intestine type metaplasia, great attention should be paid to close follow-up, and it is recommended to follow up gastroscopy once every 6-12 months to monitor the changes of the disease, and at the same time, accurate sampling by endoscopists and accurate description by pathologists to give accurate corresponding staging is only beneficial for clinicians to make a comprehensive assessment. It is only by guiding the patient’s follow-up and can reduce the patient’s mental pressure. In conclusion, the transition from intestinalization to gastric cancer is roughly as follows: normal gastric mucosa → chronic superficial gastritis → chronic atrophic gastritis → incomplete small intestine intestinalization → incomplete large intestine intestinalization → heterogeneous hyperplasia → early gastric cancer → progressive gastric cancer, which shows that it takes a long time to develop from intestinalization to gastric cancer. In addition to the necessary medication and regular review, the most important thing is to pay attention to the regulation of diet, avoiding the stimulation of gastric mucosa by stimulating foods such as tobacco, alcohol, acid, spicy, cold, greasy, etc., so as to slow down the progress of intestinalization.