Relative risk of dysplasia for patients with intestinal metaplasia in the distal oesophagus and in the gastric cardia

Abstract

Background-Biopsy specimens obtained from the gastro-oesophageal junction can reveal intestinal metaplasia in patients presenting for routine upper endoscopy. The site of biopsy may play a critical role in determining the dysplasia risk of a patient. Aims-To evaluate prospectively the dysplasia risk in patients with intestinal metaplasia of the distal oesophagus or within the gastric cardia. Methods-Patients with short segment Barrett's oesophagus (SSBO) and cardia intestinal metaplasia (CIM) were followed prospectively. Results-177 patients with SSBO were identified (mean age 62 years, range 38-82; 91% whites). Twenty prevalence cases of dysplasia in SSBO were detected: 17 low grade dysplasia (LGD), three high grade dysplasia (HGD). Seventy six patients with CIM were identified (mean age 67 years, range 37-81; 81% whites). A single prevalence case of LGD in CIM was detected. During follow up of 78 SSBO and 34 CIM patients, dysplasia developed in nine (seven LGD, two HGD) with SSBO and in one (LGD) with CIM. There were significant diVerences between the two groups with respect to age, ethnicity, dysplasia prevalence, and incidence. Time to dysplasia progression was significantly longer in CIM compared with SSBO patients. Of the five patients with SSBO and HGD, one developed adenocarcinoma of the oesophagus on follow up. No HGD or cancers have been detected over this time period in CIM patients. Conclusions-The dysplasia risk is significantly greater in SSBO than in CIM patients, indicating two potentially diVerent clinical processes. Future studies should separate SSBO from CIM in order to enhance the understanding of the pathophysiology and malignant potential of each entity. (Gut 2000;46:9-13)

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

“…On the other hand, Oberg et al (35) reported the development of cardiac mucosa (with some proceeding to IM) in the proximal esophagus after esophagectomy, suggesting that this is an acquired condition related to acid exposure. Interestingly, Sharma et al (16) found that there was a higher prevalence and incidence of dysplasia in their short segment BE group than in their CIM group (11.3% versus 4.6%, respectively). These data support our hypothesis that the development of BE is a progression from CIM to BE, then to dysplasia.…”

“…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).…”

Inactivation of p16, RUNX3, and HPP1 occurs early in Barrett's-associated neoplastic progression and predicts progression risk

“…For example, the length of the BE segment has been considered as a major risk factor for progression to EAC (Hameeteman et al, 1989;Miros et al, 1991;Williamson et al, 1991;Iftikhar et al, 1992;Menke-Pluymers et al, 1993;van der Burgh et al, 1996;Avidan et al, 2002) and dysplasia (Gopal et al, 2003). However, several studies have also shown that EAC occurs in short-segment BE (Hamilton et al, 1988;Schnell et al, 1992;Cameron et al, 1995;Sharma et al, 2000).…”

Utilization of Cytokeratins 7 and 20 Does Not Differentiate between Barrett's Esophagus and Gastric Cardiac Intestinal Metaplasia

“…Similar to SSBE, the risk of development of dysplasia and adenocarcinoma in CIM is unknown. However, clinical studies suggest that the tendency for developing dysplasia or carcinoma in patients with intestinal metaplasia of the cardia is considerably lower than in BE (16,22). Consequently, patients with CIM are not usually enrolled in screening programs.…”