Intestinal metaplasia at the squamocolumnar junction in patients attending for diagnostic gastroscopy

Trudgill, Nigel; Suvarna, S. Kim; Kapur, Kapil; Riley, Stuart

doi:10.1136/gut.41.5.585

Cited by 122 publications

(55 citation statements)

References 20 publications

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“…Other studies, for example, have shown an association between the incomplete type of IM and clinical/pathologic features of GERD (47), such as white race, male sex, higher patient age, and active esophagitis. Not all studies, however, have detected these clear-cut associations (48,58). The type and pattern of IM at the GEJ may also help to explain the differences in dysplasia and cancer risk in patients with IM in the cardia related to H. pylori versus those with IM in metaplastic columnar epithelium in the distal esophagus related to GERD (see section below on "Natural History").…”

Section: Intestinal Metaplasia Of the Gastroesophageal Junction Regionmentioning

confidence: 99%

Unraveling the Mystery of the Gastroesophageal Junction: A Pathologist's Perspective

Odze

2005

Am J Gastroenterology

155

100

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The gastroesophageal junction (GEJ), which is defined as the point where the distal esophagus joins the proximal stomach (cardia), is a short anatomic area that is commonly exposed to the injurious effects of GERD and/or Helicobacter pylori infection. These disorders often lead to inflammation and intestinal metaplasia (IM) of this anatomic region. The true gastric cardia is an extremely short segment (<0.4 mm) of mucosa that is typically composed of pure mucous glands, or mixed mucous/oxyntic glands that are histologically indistinguishable from metaplastic mucinous columnar epithelium of the distal esophagus. In patients with GERD, whether physiologic or pathologic, the length of cardia-type epithelium increases and extends proximally above the level of the anatomic GEJ into the distal esophagus. Columnar metaplasia of the distal esophagus represents a squamous to columnar metaplastic reaction that develops from an esophageal stem cell and may pass through an intermediate phase characterized by the presence of a type of epithelium that possesses a mixture of squamous and columnar features, termed multilayered epithelium. In contrast, IM of the gastric cardia represents a columnar to columnar cell metaplastic reaction that develops from a gastric stem cell located in the deep foveolar compartment of the gastric mucosa. Intestinal metaplasia, particularly the incomplete type, is widely believed to represent the precursor lesion upon which dysplasia and cancer arises. The frequency of IM is probably greater in metaplastic columnar epithelium in the esophagus secondary to GERD, than in cases of true gastric carditis secondary to H. pylori, and may be a reason why there is a higher risk of carcinoma in the former compared to the latter. A variety of clinical, endoscopic, histologic, and histochemical methods can be used to distinguish GERD-induced columnar metaplasia of the distal esophagus from H. pylori-induced inflammation of true gastric cardia, and these are outlined in this review, but further controlled studies are needed to critically evaluate these techniques. Further prospective trials are needed to adequately evaluate the different etiologic and pathogenetic mechanisms and, most importantly, the risk of malignancy in these two conditions.

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Section: Intestinal Metaplasia Of the Gastroesophageal Junction Regionmentioning

confidence: 99%

Unraveling the Mystery of the Gastroesophageal Junction: A Pathologist's Perspective

Odze

2005

Am J Gastroenterology

155

100

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“…Chronic inflammation and intestinal metaplasia are often detected at the esophagogastric junction without classical Barrett’s esophagus [8, 9, 10, 11, 12]. These histopathologic lesions reportedly associate with GERD [13, 14].…”

Section: Introductionmentioning

confidence: 99%

Gastroesophageal Reflux Disease: Prevalence, Clinical, Endoscopic and Histopathological Findings in 1,128 Consecutive Patients Referred for Endoscopy due to Dyspeptic and Reflux Symptoms

Voutilainen

Sipponen

Mecklin∥³

et al. 2000

Digestion

157

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Background and Aims: Gastroesophageal reflux disease (GERD) reportedly has increased in prevalence while Helicobacter pylori infection and peptic ulcer disease have been on the decrease. The aim of the present study was to examine the prevalence of GERD as well as the clinical, endoscopic and histologic variables that associate with GERD in patients referred for endoscopy. Patients and Methods: The study population was drawn from 1,562 consecutive patients referred for endoscopy. The exclusion criteria were previous H. pylori eradication, gastric surgery, anemia and weight loss. Thus 1,128 patients were enrolled in the present study. Results: Of the 1,128 patients, 199 (18%) were referred for endoscopy due to heartburn and/or regurgitation. GERD, defined as chronic (>6 months) heartburn and/or regurgitation with or without erosive esophagitis, Barrett’s esophagus, esophageal ulcer or stricture, was detected in 248 (22%) patients. Of the 248 GERD patients, 81 (33%) had endoscopy-negative GERD, but of those aged <50 years (n = 67), 57 (85%) were endoscopy-negative. The overall incidence of GERD was 307 per 100,000 population/year and that of endoscopy-positive GERD 207/100,000/year. The positive and negative predictive values of heartburn and regurgitation for endoscopy-positive GERD were 0.37 (95% CI 0.31–0.44) and 0.90 (95% CI 0.88–0.92), respectively. Independent risk factors for GERD were male sex (OR 1.9, 95% CI 1.3–2.7), previous medication for upper gastrointestinal symptoms (OR 2.7, 95% CI 1.7–4.1), the use of nonsteroidal anti-inflammatory drugs (NSAIDs; OR 2.0, 95% CI 1.3–3.0), histologic esophagitis (OR 2.2, 95% CI 1.5–3.2) and incomplete intestinal metaplasia at the gastroesophageal junction (OR 1.7, 95% CI 1.0–3.1). Chronic gastritis was protective against GERD (OR 0.7, 95% CI 0.5–0.9). No association was observed between GERD and H. pylori infection. The risk of patients aged <50 years (n = 407) of having major lesion (Barrett’s esophagus, esophageal stricture, peptic ulcer, esophageal/gastric carcinoma) was significantly lower than that of patients aged >50 years (n = 721; OR 0.5, 95% CI 0.3–0.9, p = 0.01). Conclusions: The correlation between reflux symptoms and endoscopy-positive GERD is poor and most GERD patients aged <50 years have endoscopy-negative GERD. The use of NSAIDs is a risk factor for GERD, whereas chronic gastritis, but not H. pylori infection, may protect against GERD. Incomplete intestinal metaplasia at the gastroesophageal junction is associated with GERD.

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“…Cardia intestinal metaplasia is associated with gastric distal intestinal metaplasia and with Helicobacter pylori infection (8,10,18) . Association of esophageal intestinal metaplasia (short segment), with gastric distal intestinal metaplasia was reported in the literature (32,35) . Cytokeratins CK7 and CK20 expression pattern analysis discriminates correctly between intestinal metaplasia in Barrett's esophagus and intestinal metaplasia of the cardia in the majority of cases (19,20,24) .…”

Section: Discussionmentioning

confidence: 92%

Short segment Barrett's esophagus and distal gastric intestinal metaplasia

Dietz

Chaves-e-Silva

Meurer

et al. 2006

Arq. Gastroenterol.

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-Background -Short segment Barrett's esophagus is defi ned by the presence of <3 cm of columnar-appearing mucosa in the distal esophagus with intestinal metaplasia on histophatological examination. Barrett's esophagus is a risk factor to develop adenocarcinoma of the esophagus. While Barrett's esophagus develops as a result of chronic gastroesophageal refl ux disease, intestinal metaplasia in the gastric cardia is a consequence of chronic Helicobacter pylori infection and is associated with distal gastric intestinal metaplasia. It can be diffi cult to determine whether short-segment columnar epithelium with intestinal metaplasia are lining the esophagus (a condition called short segment Barrett's esophagus) or the proximal stomach (a condition called intestinal metaplasia of the gastric cardia). Aims -To study the association of short segment Barrett's esophagus (length <3 cm) with gastric intestinal metaplasia (antrum or body) and infection by H. pylori. Patients and methods -Eight-nine patients with short segment columnar-appearing mucosa in the esophagus, length <3 cm, were studied. Symptoms of gastroesophageal refl ux disease were recorded. Biopsies were obtained immediately below the squamous-columnar lining, from gastric antrum and gastric corpus for investigation of intestinal metaplasia and H. pylori. Results -Forty-two from 89 (47.2%) patients were diagnosed with esophageal intestinal metaplasia by histopathology. The mean-age was signifi cantly higher in the group with esophageal intestinal metaplasia. The two groups were similar in terms of gender (male: female), gastroesophageal refl ux disease symptoms and H. pylori infection. Gastric intestinal metaplasia (antrum or body) was diagnosed in 21 from 42 (50.0%) patients in the group with esophageal intestinal metaplasia and 7 from 47 (14.9%) patients in the group with esophageal columnar appearing mucosa but without intestinal metaplasia. Conclusion -Intestinal metaplasia is a frequent fi nding in patients with <3 cm of columnar-appearing mucosa in the distal esophagus. In the present study, short segment intestinal metaplasia in the esophagus is associated with distal gastric intestinal metaplasia. Gastroesophageal refl ux disease symptoms and H. pylori infection did not differ among the two groups studied. HEADINGS -Barrett esophagus. Metaplasia. Helicobacter infections.

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Intestinal metaplasia at the squamocolumnar junction in patients attending for diagnostic gastroscopy

Cited by 122 publications

References 20 publications

Unraveling the Mystery of the Gastroesophageal Junction: A Pathologist's Perspective

Unraveling the Mystery of the Gastroesophageal Junction: A Pathologist's Perspective

Gastroesophageal Reflux Disease: Prevalence, Clinical, Endoscopic and Histopathological Findings in 1,128 Consecutive Patients Referred for Endoscopy due to Dyspeptic and Reflux Symptoms

Short segment Barrett's esophagus and distal gastric intestinal metaplasia

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