Therapeutic effect of metformin on reversing gastric intestinal metaplasia
Abstract
BACKGROUND: Currently, standard therapeutic agents are not available for treating gastric intestinal metaplasia (IM). However, emerging evidence suggests the potential efficacy of metformin in addressing this issue. Our aim was to assess the efficacy and safety of metformin in reversing IM.
METHODS: We initially investigated the impact of metformin on reversing gastric IM in mice. An open-label, prospective, randomized controlled trial was subsequently conducted at a tertiary hospital in China from April 2022 to May 2023. A total of 140 nondiabetic patients with pathologically confirmed IM and negative Helicobacter pylori tests were recruited. Patients were randomly assigned at a 1:1 ratio to receive either 500 mg of metformin daily for six months or 5 mg of folate three times daily as a control. The primary outcome was defined as the regression rate of IM in different groups at the end of the treatment.
RESULTS: Metformin improved gastric mucosal pathology in mice. A total of 158 patients were screened, 140 of whom were randomized to the two groups. Among these, 85/140 (60.7%) were male, and the mean age was 55.9 ± 8.3 years. Six-month follow-up data were available for 129 patients. Compared with folate users (control group), metformin users had a greater rate of regression of IM (48.6% [34/70] vs. 31.4% [22/70]; relative risk [RR] = 1.55, 95% confidence interval [CI] 1.01-2.36; P = 0.04) in the intention-to-treat population. Furthermore, in the per-protocol population,…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 158 participants or records.
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