Ascorbic acid and intestinal metaplasia in the stomach: a prospective, randomized study

Backgound: Intestinal type metaplasia plays a role in intestinal type gastr ic carcinoma development. Ascorbic acid demonstrates a protective effect ag ainst gastric carcinogenesis, due to its ability to inactivate oxygen free- radicals as well as its nitrite-scavenging effects. Aim: To assess whether long-term ascorbic acid administration following Hel icobacter pylori eradication could affect intestinal metaplasia regression in the stomach. Methods: Sixty-five patients were included in the study. The inclusion crit erion was the presence of intestinal metaplasia on the gastric mucosa after H. pylori eradication. An upper gastrointestinal endoscopy was performed a nd 3 biopsy specimens were taken in the antrum, 3 in the gastric body, and 2 in the incisura angularis. Patients were randomized to receive 500 mg of ascorbic acid o.d., after lunch (32 patients) for 6 months or no treatment (33 patients). All patients underwent to endoscopic control at the end of t he 6 months. Results: H. pylori infection recurrence was detected in 6 (9.4%) patients ( three from each group), and these patients were excluded from further analy sis. We were unable to find evidence of intestinal metaplasia in any biopsi ed site of the gastric mucosa in 9/29 (31%) patients from the ascorbic acid group and in 1/29 (3.4%) of the patients from the control group (P=0.006). Moreover, a further six (20.7%) patients from the ascorbic acid group pres enting chronic inactive pangastritis with widespread intestinal metaplasia at entry, showed less extensive antritis with intestinal metaplasia at cont rol, whilst a similar finding was only seen in one patient from the control group (P=0.051). Conclusion: The administration of ascorbic acid significantly helps to reso lve intestinal metaplasia of the gastric mucosa following H. pylori eradica tion, and its use as a chemoprevention treatment should be considered.