Primary Motility  Disorders of the  Esophagus
 The Esophageal
 Mucosa
 The
 Esophagogastric  Junction
 Barrett's
 Esophagus

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OESO©2015
 
Volume: Barrett's Esophagus
Chapter: Diagnosis
 

What is the relationship between the presence of intestinal metaplasia at the squamocolumnar junction and the extent of esophageal columnar lining?

D.A. Antonioli (Boston)

When the squamo-columnar junction coincides with the gastroesophageal junction (i.e., no columnar-lined esophagus), the prevalence of intestinal metaplasia (IM) at the squamocolumnar junction has varied from 6% to 25% in recent series [1-7]. Thus, IM in this situation is not rare; it is more common in men than women, increased in prevalence with increasing age, and its detection in a cohort of patients is related to the number of mucosal tissue samples obtained [1-7]. When the squamo-columnar junction is displaced into the distal esophagus (i.e., columnar-lined esophagus), the presence of intestinalized mucosa (goblet cells) is part of the new working definition of Barrett's esophagus, at least in adults. Thus, Barrett's esophagus is currently defined as any length of distal esophageal columnar-lined esophagus plus the detection of goblet cells in biopsy specimens [8]. Detection of the latter is related to the extent of sampling and the age of the patient. In children and adolescents developing a columnar-lined esophagus, the early phase of metaplasia is characterized by a disorganized cardiac and/or cardiofundic phenotype; only over time, in the presence presumably of a continued adverse acidic environment, does this mucosa undergo intestinalization with the acquisition of goblet cells [9]. Therefore, in young patients, IM does not correlate with the extent of the esophageal columnar lining, but in adults, goblet cells are present in virtually all patients regardless of the extent of the columnar esophageal mucosa.

References

1. Morales TG, Sampliner RE, Bhattacharyya A. Intestinal metaplasia of the gastric cardia. Am J Gastroenterol 1997;92:414-418.

2. Spechler SJ, Zeroogian JM, Antonioli DA, et al. Prevalence of metaplasia at the gastro-oesophageal junction. Lancet 1994;344:1533-1536.

3. Hackelsberger A, Gunther T, Schultze V, et al. Intestinal metaplasia at the gastro-oesophageal junction: Helicobacter pylori gastritis or gastro-oesophageal reflux disease? Gut 1998;43:17-21.

4. Hirota WK, Loughney TM, Lazas DJ, et al. Specialized intestinal metaplasia, dysplasia, and cancer of the esophagus and esophagogastric junction: prevalence and clinical data. Gastroenterology 1999;116:277-285.

5. Pereira AD, Suspiro A, Chaves P, et al. Short segments of Barrett's epithelium and intestinal metaplasia in normalappearing oesophagogastric junction: the same or two different entities? Gut 1998;42:659-662.

6. Goldblum JR, Vicari JJ, Falk GW, et al. Inflammation and intestinal metaplasia of the gastric cardia: the role of gastroesophageal reflux and H. pylori infection. Gastroenterology 1998;114:633-639.

7. El-Serag HB, Sonnenberg A, Jamal MM, et al. Characteristics of intestinal metaplasia in the gastric cardia. Am J Gastroenterol 1999;94:622-627.

8. Sampliner RE. Practice guidelines on the diagnosis, surveillance and therapy of Barrett's esophagus. Am J Gastroenterol 1998;93:1028-1032.

9. Qualman SJ, Murray RD, McClung J, Lucas M. Intestinal metaplasia is age related in Barrett's esophagus. Arch Pathol Lab Med 1990;114:1236-1240.


Publication date: August 2003 OESO©2015