The Gastric Cardia

Abstract

The origin and biologic significance of cardiac gastric mucosa are controversial. Traditionally, it has been considered native mucosa and part of normal foregut development. It has been recently suggested that cardiac mucosa is present only as a metaplastic response to gastroesophageal reflux disease and therefore always abnormal. We evaluated the esophagogastric junction in 100 pediatric autopsy samples to determine the existence, characteristics, and length of pure cardiac mucosa at different ages. No patient had a history of gastroesophageal reflux disease. Cardiac mucosa immediately distal and contiguous to the esophageal squamous mucosa was identified in all 100 samples, varying in length from 0.1 to 3 mm; the mean length was 1 mm. There was an inverse correlation between patient age and length of cardiac mucosa; gender had no influence on measured length. Three patients had mild to moderate histologic esophagitis; two had gastritis. No metaplastic features or Helicobacter pylori were identified. These findings support the concept that there is a normal, variably narrow developmental zone at the esophagogastric junction covered by cardiac mucosa and is present at birth. When cardiac type mucosa is found in biopsy material, it does not necessarily represent evidence of a mucosal metaplastic response to gastroesophageal reflux disease.

Kyoto international consensus report on anatomy, pathophysiology and clinical significance of the gastro-oesophageal junction

“…As already described in the explanation for CQ7 and 8, several investigators have noted the association of longer cardiac-type mucosa with age, and inflammation at the GOJ,77–83 though not confirmed by others 74 75 87. However, these studies were retrospective observations and, thus, inadequate for establishing the cause–consequence relationship.…”

“…However, Chandrasoma, a representative researcher from USC, acknowledged the presence of the cardiac mucosa (mostly oxyntocardiac type) in four out of seven autopsy specimens of infants 79. In contrast, other groups demonstrated the existence of the cardiac mucosa in autopsy studies of fetuses and infants, though its extent was very limited 72 74–77 86 87. For instance, De Hertogh et al 74 identified the cardiac mucosa as containing only mucous glands with a mean length of 1.0 mm (range 0.1–3 mm) and present distal to the squamous epithelium in all autopsy cases of fetuses, neonates and an infant (up to 7 month), but it spanned only 0.3–0.6 mm after birth.…”

“…The same group confirmed their previous findings that the cardiac mucosa with pure mucous glands (mean length: 0.612 mm, range 0.160–1.308 mm) was present in fetuses, neonates and may grow in length with age, which showed similar cytokeratin staining with the Barrett’s epithelium. 86 Derdoy et al 87 reported that cardiac mucosa with pure mucous glands was present in all paediatric autopsy cases including premature babies (mean age: 2.2 years, range: 1 day to 18 years). Zhou et al 72 also showed the presence of a very short stretch of transitional epithelium composed of simple columnar epithelium, pure mucous glands or mixed (oxyntocardiac) glands (mean length: 0.226 mm in foetuses, 0.167 mm in postnatal infants) between the oesophageal squamous epithelium and the gastric oxyntic mucosa in 78% of their series.…”

Acid and the basis for cellular plasticity and reprogramming in gastric repair and cancer

“…A parallel argument could be made for cancers at the gastro-esophageal junction, where a similar transition zone between squamous mucosa of the esophagus and glandular mucosa of the stomach may represent an area of increased metaplastic (and oncogenic) potential 226–228 . Indeed, gastro-esophageal cancers are increasingly common 229 and appear to be more similar to gastric cancer at the molecular level 230 .…”

Follow the Metaplasia: Characteristics and Oncogenic Implications of Metaplasia’s Pattern of Spread Throughout the Stomach

“…Histologically, the gastric cardia is defined as the mucosa that is distal to the anatomic gastroesophageal junction and proximal to the characteristic oxyntic glands of the gastric corpus ( Odze, 2005 ). There exists a debate on the origin and development of the gastric cardia, and it relies in part on whether the presence of mixed mucous/oxyntic glands is a result of a metaplastic conversion of pure corpus glands from chronic injury, such as gastroesophageal reflux disease (GERD) ( Chandrasoma et al, 2000 ; Chandrasoma et al, 2003 ), or whether these mixed glands are normally present from birth ( Kilgore et al, 2000 ; Glickman et al, 2002 ; Derdoy et al, 2003 ). While the intent of this review is not to engage in this debate, the correlation between the mixed glands that characterize this transition zone and the presence of cardia gastric tumors may not be coincidental.…”