The Pathology of Reflux Disease at a Cellular Level: Part 2—Evolution of Cardiac Mucosa to Oxyntocardiac Mucosa and Intestinal Metaplasia

BACKGROUND: Short segment Barrett's esophagus is defined 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 reflux 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 difficult 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 reflux 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 significantly higher in the group with esophageal intestinal metaplasia. The two groups were similar in terms of gender (male: female), gastroesophageal reflux 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 finding 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 reflux disease symptoms and H. pylori infection did not differ among the two groups studied.

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Specialized intestinal metaplasia in patients with gastro-oesophageal reflux disease

British Journal of Surgery ◽

10.1046/j.1365-2168.2000.01481-10.x ◽

2000 ◽

Vol 87 (7) ◽

pp. 968-969

Author(s):

I. L. P. Beales

Keyword(s):

Intestinal Metaplasia ◽

Reflux Disease ◽

Oesophageal Reflux ◽

Oesophageal Reflux Disease ◽

Specialized Intestinal Metaplasia

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The cardia: Esophageal or gastric? Critical reviewing the anatomy and histopathology of the esophagogastric junction

Acta chirurgica iugoslavica ◽

10.2298/aci1203015l ◽

2012 ◽

Vol 59 (3) ◽

pp. 15-26 ◽

Cited By ~ 2

Author(s):

Johannes Lenglinger ◽

Stephanie See ◽

Lukas Beller ◽

Enrico Cosentini ◽

Reza Asari ◽

...

Keyword(s):

Esophagogastric Junction ◽

Distal Portion ◽

The Body ◽

Distal Esophagus ◽

Gastric Cardia ◽

Cardiac Mucosa ◽

Oxyntic Mucosa ◽

Columnar Lined Esophagus ◽

Oxyntocardiac Mucosa ◽

Multi Level

Background: Discrepancy exists regarding the anatomical allocation of the cardia: esophageal or gastric. With this review we aimed to clarify this issue. Methods: Using PUB MED, Scopus and Google we analyzed the recent literature (1889-2012) regarding the "esophageal" vs. the "gastric" cardia. Results: The synonymous use of the term cardia to describe the anti reflux mechanism within the distal portion of the esophagus and the proximal segment of the stomach nourished the misunderstanding, that the cardia represents a normal anatomical structure interposed between the tubular esophagus and the body of the stomach. Anatomical, histopathological and physiological studies revealed that what has been taken for gastric cardia in fact represents reflux damaged dilated distal esophagus (DDE). Since DDE is covered by columnar lined esophagus (CLE) it cannot be differentiated from the proximal stomach during regular endoscopy. However, the histopathology of multi level biopsies obtained from the endoscopically suspected esophagogastric junction (EGJ) serves to allocate the origin of the columnar lined foregut, esophageal (cardiac, oxyntocardiac mucosa, intestinal metaplasia) vs. gastric (oxyntic mucosa). Conclusions: Neither the esophagus nor the stomach contains a "cardia". The recent misconceptions regarding the foregut anatomy explain, why the innermost coverage of the reflux damaged esophagus is termed "cardiac mucosa". Thus the term should be reserved to name the histopathology of cardiac and oxyntocardiac mucosa, which develop due to gastroesophageal reflux within the distal esophagus.

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