Letter: cancer risk among persons with columnar‐lined oesophagus – authors’ reply

Abstract

SIRS, We thank Lenglinger and co-workers for their comments regarding our study.1 Our data clearly show that columnar-lined oesophagus (CLE) with only cardiac (CM) and oxintocardiac mucosa (OCM) cannot be considered free from cancer risk, as the majority of patients will develop intestinal metaplasia (IM) over time. 2However, the magnitude of this risk remains unknown. Bhat et al.3 reported a five-fold reduction (0.07 vs. 0.36) in the combined annual incidence of cancer or high-grade dysplasia in CLE without IM in comparison to CLE with IM in the index endoscopy, but Kelty et al. found no difference. 4 We agree with the need for larger multi-centric studies, but strict inclusion criteria are needed to minimise the problem of sampling error in IM assessment. From our data, we cannot either support or deny the hypothesis of Chandrasoma 5 that both OCM and IM develop from CM, but we can hypothesise that OCM is an early event, when compared with IM. Lenglinger suggests that biopsies from the squamocolumnar junction (SCJ) have the highest yield for the detection of IM. There is evidence that goblet cells preferentially appear near the neo-SCJ 5 and their density is higher in the proximal third of CLE. 6 However, as far as we know, there are no data supporting differences between biopsies from the SCJ or from just below the Zline, as we have systematically performed, 2 in the assessment of IM. It is clear from our study that proton pump inhibitors used in the clinical setting do not prevent IM development.2 Oberg reported a 10.3-fold decrease in the risk of developing IM in patients with an efficient anti-reflux surgical procedure, 7 but 20% of them developed IM during follow-up. We have no data on the efficiency of surgical procedures performed in our cohort. 2 ACKNOWLEDGEMENTThe authors' declarations of personal and financial interests remain unchanged from those in the original article.