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