Primary Motility  Disorders of the  Esophagus
 The Esophageal
 Esophagogastric  Junction

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Volume: Barrett's Esophagus
Chapter: Short Barrett's esophagus

What extent of gastric-type columnar-lining of the esophagus should be considered normal?

H.W. Boyce (Tampa)

The esophagus is lined by squamous epithelium to the level of the proximal margin of the gastric folds, which marks the esophagogastric muscular junction. This level is accurately measured only when the lumen is deflated [1]. Nearly all patients with short or long segment Barrett or columnar-lined esophagus (CLE) have a hiatal hernia. When the lumen of the hernia pouch is distended, the proximal margins of the gastric folds move distally and the malposition creates an artificial separation from the normal squamocolumnar junction that suggests a short segment CLE.

Endoscopic observations in normal persons indicate that the squamocolumnar mucosal junction should be located within one or two millimeters of the proximal margin of the gastric folds [2]. Occasional short peninsulas of columnar epithelium produce irregularity of this junction and small columnar islands may be located near this junction in normals. Other than these slight mucosal defects, there should be no columnar epithelium proximal to the predominant circumference level of the squamous mucosa.

At this time, the question can only be answered by stating that any extension of columnar epithelium, other than the slight irregularities noted above, cephalad to the proximal margin gastric folds should not be considered normal. The presence of specialized intestinal metaplasia with Alcian blue pH 2 stained goblet cells above this level is diagnostic of CLE. Biopsies must be done to confirm specialized intestinal metaplasia since inspection at endoscopy and chromoendoscopy are not sufficiently accurate for this purpose [3, 4].


1. McClave SA, Boyce HW, Gottfried MR. Early diagnosis of columnar-lined esophagus: a new endoscopic diagnostic criterion. Gastrointest Endosc 1987;33:413-416.

2. Boyce HW. Endoscopic definitions of esophagogastric junction regional anatomy. Gastrointest Endosc 2000;51:586592.

3. Canto MI, Setrakian S, Petras RE, et al. Methylene blue selectively stains intestinal metaplasia in Barrett's esophagus. Gastrointest Endosc 1996;44:1-7.

4. Acosta MM, Boyce HW. Chromoendoscopy; where is it useful? J Clin Gastroenterol 1998;27:13-20.

Publication date: August 2003 OESO©2015