Inflammation and intestinal metaplasia of the gastric cardia: The role of gastroesophageal reflux and H. pylori infection

Goldblum, John R.; Vicari, Joseph J.; Falk, Gary W.; Rice, Thomas W.; Peek, Richard M.; Easley, Kirk A.; Richter, Joel E.

doi:10.1016/s0016-5085(98)70576-1

Cited by 255 publications

(144 citation statements)

References 14 publications

Supporting

Mentioning

133

Contrasting

Unclassified

Order By: Relevance

“…Others suggest that CIM represents a response to stressful stimuli. The nature of these stimuli could be acid reflux or other etiologies such as H pylori infection (12,13). The relationship between BE and IM of the gastric cardia is still a matter of dispute (5).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Barrett’s Esophagus and Cardiac Intestinal Metaplasia: Two Conditions within the Same Spectrum

White

Gabril

Ejeckam

et al. 2008

Canadian Journal of Gastroenterology

View full text Add to dashboard Cite

BACKGROUND: Immunostaining for cytokeratin 7 (CK7) and cytokeratin 20 (CK20) has a characteristic pattern in Barrett's esophagus (BE), but reports regarding its sensitivity and specificity are inconsistent. Intestinal metaplasia of the gastric cardia (CIM) is histologically similar to BE, but with no abnormal endoscopic findings. OBJECTIVES: To evaluate the sensitivity and specificity of a semiquantitative CK7/CK20 immunostaining pattern for the diagnosis of BE, and to further elucidate the pathogenesis of CIM. METHODS: Tissues were examined by hematoxylin and eosin and periodic acid schiff/alcian blue stains, and then were immunostained with CK7 and CK20 antibodies. Correlations with other clinical parameters were statistically analyzed. RESULTS: When values were revised based on follow-up data and auxiliary testing, all BE cases (100%) displayed the characteristic BE CK7/CK20 immunostaining pattern, compared with 66% of CIM cases. In the subgroup of patients who were endoscopically and immunohistochemistry-positive but histologically negative, all patients except for one had documented BE when clinical history, auxiliary testing and follow-up were evaluated. There were no statistically significant differences between BE and CIM regarding Helicobacter pylori infection or the type of metaplasia (complete versus incomplete). The sensitivity of the CK7/CK20 pattern reached 100% in the subgroup of CIM patients with a history of acid reflux. Of 26 cases of CIM where follow-up was available, four cases (15%) progressed to BE, and one developed dysplasia. All four cases showed the BE pattern of CK7/CK20 staining and were negative for H pylori infection. CONCLUSIONS: A semiquantitative CK7/CK20 pattern can be used to confirm BE even in the absence of histological evidence. The subgroup of CIM with acid reflux may develop into BE and may need closer follow-up.

show abstract

Section: Discussionmentioning

confidence: 99%

“…Some suggest that it is linked to Helicobacter pylori infection (12,13), while others associate it with acid reflux (5,14,15). Another study suggests that patients with short segment BE have a higher risk for developing dysplasia than patients with CIM (16).…”

mentioning

confidence: 99%

Barrett’s Esophagus and Cardiac Intestinal Metaplasia: Two Conditions within the Same Spectrum

White

Gabril

Ejeckam

et al. 2008

Canadian Journal of Gastroenterology

View full text Add to dashboard Cite

show abstract

“…In contrast to H. pylori-associated carditis, GERD carditis is not associated with inflammation elsewhere in the stomach (121). Intestinal metaplasia of the cardia is detected in between 3 and 10% of patients with GERD (118,122), being present in patients with clinical symptoms of GERD, but without H. pylori infection. Furthermore, there is a close correlation between the severity of GERD, as measured by 24-hour pH monitoring and the intensity of carditis (128).…”

Section: Causation Of Carditismentioning

confidence: 95%

“…In situations where infection is present, the intensity of carditis parallels that of antritis (122). Active carditis is present in 89% of patients in whom H. pylori is present in the stomach (124).…”

Section: Causation Of Carditismentioning

confidence: 99%

See 1 more Smart Citation

Gastritis and Carditis

Owen

2003

Modern Pathology

View full text Add to dashboard Cite

Dyspepsia is a common clinical problem. Its causes include peptic ulcer disease, gastroesophageal reflux, and functional (nonulcer) dyspepsia. A detailed clinical description of pain does not reliably differentiate the cause. Approximately 80% of gastroscopies are performed for the investigation of dyspepsia. "Gastritis" is diagnosed endoscopically in 59% of all stomachs, although in only 3% are the changes severe. Pathologic examination of unselected gastric biopsy specimens reveals that abnormalities are present in 62-73%, but there is only a weak correlation between endoscopic and histologic findings. For these reasons, it is recommended that endoscopic examination should always be accompanied by biopsy. Ideally, biopsies should be taken in a systematic fashion to include sampling of antrum and corpus. Recent evidence suggests that gastric infection by Helicobacter pylori initially presents as a superficial gastritis. Later it may become atrophic with development of intestinal metaplasia. The onset of atrophic changes may be related to the duration of infection, the strain of the infecting organism, associated dietary factors, or as-yet undefined host factors related to immunity. Persistent superficial gastritis predisposes to duodenal ulcer and gastric mucosa-associated lymphoid tissue lymphoma. Atrophic gastritis predisposes to gastric ulcer and adenocarcinoma. Evidence is accumulating that in some patients, pernicious anemia may be an end result of H. pylori-induced atrophic gastritis. Reactive gastropathy is a relatively common finding in gastric biopsies; in most instances it is associated with either reflux of duodenal contents or therapy with nonsteroidal anti-inflammatory drugs. Lymphocytic gastritis, eosinophilic gastritis, and the gastritis associated with Crohn's disease are distinct morphologic entities. Most gastroscopies are performed for the investigation of dyspepsia (1-7). This is a common clinical problem but is rarely life-threatening. The causes of dyspepsia include peptic ulcer disease (30%), gastroesophageal reflux (29%), and nonulcer (functional) dyspepsia (40%). The cause of functional dyspepsia is unclear at the present time, although in many instances it may be related to abnormalities of gut motility. In Ͻ1% of cases is gastric cancer a cause of dyspepsia. A detailed description of the symptoms of dyspepsia does not reliably differentiate the cause, although the presence of heartburn strongly suggests a component of gastroesophageal reflux. Correlations among patient symptoms, endoscopic appearances, and biopsy findings of gastritis are imperfect (4 -6). Agreement is best in cases where peptic ulcer or another focal lesion is identified. A study by Khakoo et al. (7) from the United Kingdom illustrates the problems encountered. Endoscopic and histologic findings were reviewed in 167 patients who underwent gastroscopy for dyspeptic symptoms. Of these, 98 patients (57%) had endoscopic evidence of gastritis. In 42% of patients, gastritis involved the antrum alone, in 7% it involved the...

show abstract

Barrett's Esophagus

Morales¹,

Sampliner²

1999

Arch Intern Med

View full text Add to dashboard Cite

The last 2 decades have seen dramatic advances in Barrett's esophagus. The definition has evolved; the rising incidence of adenocarcinoma has been recognized; and effective therapy to control gastroesophageal reflux disease has been developed. Both proton pump inhibitor therapy and laparoscopic fundoplication represent major developments. Studies of patients with dysplasia have helped to clarify appropriate surveillance intervals and treatment strategies for these patients, although controversy still exists. The possibility of reversing Barrett's esophagus in selected high-risk patients offers major hope for the future prevention of adenocarcinoma of the esophagus.

show abstract

Inflammation and intestinal metaplasia of the gastric cardia: The role of gastroesophageal reflux and H. pylori infection

Cited by 255 publications

References 14 publications

Barrett’s Esophagus and Cardiac Intestinal Metaplasia: Two Conditions within the Same Spectrum

Barrett’s Esophagus and Cardiac Intestinal Metaplasia: Two Conditions within the Same Spectrum

Gastritis and Carditis

Barrett's Esophagus

Contact Info

Product

Resources

About