Metaplasia and Dysplasia MCQ — NEET PG Practice Question | NEETPGAI
Metaplasia and Dysplasia
medium
microscope Pathology
During a routine endoscopy for reflux symptoms, a 52-year-old man is found to have columnar epithelium with goblet cells replacing the normal squamous epithelium of the distal esophagus. Which is the most common site of intestinal metaplasia in the gastrointestinal tract?
A. Proximal jejunum
B. Gastric cardia
C. Distal esophagus (Barrett's esophagus)
D. Gastric antrum
Explanation
Most Common Site of Intestinal Metaplasia in the GI Tract
Definition and Pathogenesis
Intestinal metaplasia (IM) is the replacement of native epithelium with intestinal-type columnar epithelium containing goblet cells. It can occur at multiple sites in the GI tract, driven by chronic inflammation, infection, or chemical injury.
Most Common Site: Gastric Antrum
Key Point
The gastric antrum is the most common site of intestinal metaplasia in the entire gastrointestinal tract. This is driven by Helicobacter pylori infection, which is one of the most prevalent chronic bacterial infections worldwide (affecting ~50% of the global population). Chronic H. pylori gastritis leads to a well-defined sequence: normal mucosa → chronic active gastritis → atrophic gastritis → intestinal metaplasia → dysplasia → gastric adenocarcinoma (Correa cascade). Because H. pylori preferentially colonizes the antrum, antral IM is far more prevalent globally than any other site.
High-YieldNEET PG
Barrett's esophagus (distal esophageal IM) is clinically important and well-recognized, but it occurs in only 5–15% of patients with chronic GERD. In contrast, gastric antral IM secondary to H. pylori affects hundreds of millions of people worldwide, making it the most common site overall.
Comparative Sites of Intestinal Metaplasia
Table
Site
Frequency
Primary Cause
Malignant Risk
Gastric antrum
Most common
H. pylori, chronic gastritis
Gastric adenocarcinoma
Gastric cardia
Common
GERD, H. pylori
Moderate
Distal esophagus (Barrett's)
Less common overall
Chronic GERD
Esophageal adenocarcinoma (0.2–0.5%/year)
Proximal jejunum
Rare
Not a typical site
Very low
Clinical Pearl
The Correa cascade describes the stepwise progression from H. pylori–induced chronic gastritis → atrophic gastritis → intestinal metaplasia → dysplasia → gastric carcinoma. Eradication of H. pylori can halt or partially reverse early stages but may not reverse established IM (Harrison's Principles of Internal Medicine, 21st ed.).
High-YieldNEET PG
While Barrett's esophagus is the classic teaching example of IM in the esophagus and carries significant adenocarcinoma risk, the question of the most common site in the GI tract refers to the gastric antrum due to the global burden of H. pylori infection (Robbins & Cotran Pathologic Basis of Disease, 10th ed.).
Mnemonic
H. pylori → Antrum → IM — H. pylori's home is the antrum, making antral intestinal metaplasia the most prevalent form worldwide.
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