Barrett's Esophagus and Intestinal Metaplasia of Gastric Cardia: Prevalence, Clinical, Endoscopic and Histological Features

Abstract

Background & Aims: Over the past few decades, the incidence of adenocarcinomas of the gastroesophageal junction has rapidly increased. Barrett's esophagus is a risk factor for esophageal adenocarcinoma, but the role of intestinal metaplasia of the gastric cardia as a precursor in cardia-related cancer is controversial. The aims of the present study were to examine the prevalence of intestinal metaplasia in the gastroesophageal junction and to evaluate the clinical, endoscopical and histological features of patients with intestinal metaplasia in the gastric cardia and patients with Barrett's esophagus.

Methods: 286 consecutive patients undergoing gastroduodenoscopy were enrolled in a prospective study. Biopsy specimens were performed in the distal esophagus, squamocolumnar junction, gastric cardia, gastric corpus and antrum.

Results: We identified 44 patients (15.3%) with intestinal metaplasia in biopsies from gastric cardia and 24 patients (8.3%) with Barrett's esophagus. Cardia intestinal metaplasia was significantly associated with older age (p=0.03), with intestinal metaplasia in the antrum (p=0.017) and H. pylori infection (p<0.0001). Severe chronic cardia inflammation increased the presence of cardia intestinal metaplasia 6.2 fold (OR=6.288; p<0.0001). Patients with Barrett's esophagus were predominantly men. Barrett's esophagus presence significantly correlated with reflux symptoms(p<0.0001), endoscopic esophagitis (p<0.0001) and hiatal hernia >2 cm (p=0.002). No patient had dysplasia in the gastroesophageal region.

Conclusions: Presence of intestinal metaplasia at the gastroesophageal region correlated with reflux symptoms and endoscopic signs of reflux disease in patients with Barrett's esophagus and with H.pylori infection and distal intestinal metaplasia in patients with cardia intestinal metaplasia.

Abbreviations: BE- Barrett_s esophagus; CIM- cardia intestinal metaplasia; CLE- columnar lined esophagus; GEJ- gastroesophageal junction; GERD - gastroesophageal reflux disease; IM- intestinal metaplasia; LSBE- long segment Barrett's esophagus; SCJ - squamocolumnar junction; SSBE- short segment Barrett's esophagus; USSBE- ultrashort segment Barrett's esophagus.