Short segment Barrett's esophagus and distal gastric intestinal metaplasia

Abstract

-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.

Helicobacter pylori infection is associated with reduced risk of Barrett’s esophagus: a meta-analysis and systematic review

“…We found that the risk of Hp infection in patients with LSBE was significantly lower than that in the controls (OR = 0.47; 95% CI, 0.25–0.90; P = 0.02; I 2 = 82%). In contrast, we extracted data from 12 studies to explore the correlation between Hp and short-segment BE (SSBE), and obtained a t otal of 7886 BE patients and 31,173 controls [ 35 , 36 , 42 , 45 , 58 , 62 , 67 , 73 , 70 , 74 – 76 ]. There was no significant difference in the prevalence of Hp between the SSBE and controls (OR = 1.11; 95% CI, 0.78–1.56; P = 0.57; I 2 = 68%).…”