Published in:
01-10-2012 | Original Scientific Paper
Assessment of columnar-lined esophagus in controls and patients with gastroesophageal reflux disease with and without proton-pump inhibitor therapy
Published in: European Surgery | Issue 5/2012
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Background
Gastroesophageal reflux disease (GERD) is associated with columnar-lined esophagus (CLE) without and with intestinal metaplasia (IM), i.e., nondysplastic Barrett’s esophagus (NDBE; 0.5 % annual cancer risk). We aimed to compare endoscopy and histopathology in controls and GERD patients with and without proton-pump inhibitor (PPI) therapy.
Methods
We conducted endoscopy with four-quadrant multi-level biopsy sampling of any endoscopically visible columnar-lined esophagus (CLEv) in 0.5 cm increments and at 0.5 and 1.0 cm distal to the level of the rise of the endoscopic gastric-type folds in controls (n = 76), GERD patients with (n = 177) and without (n = 38) PPI therapy. Squamous epithelium (Squ) of the esophagus and oxyntic mucosa (OM) of the proximal stomach defined normalcy. CLE included oxyntocardiac, cardiac mucosa (CM) ± IM.
Results
All persons had CLE interposed between Squ and OM. Frequency and distribution of endoscopic and histopathologic findings did not differ between the three groups (p > 0.05). Frequency of IM was 13.2, 26.3, and 20.9 % in controls, GERD patients with and without PPI therapy, respectively (p = 0.194). The frequency of IM increased with longer CLEv. In 50 % of the cases, CLE included more than the proximal 1.0 cm portion of the endoscopically visible gastric-type folds.
Conclusions
The frequency of IM is independent from the presence or absence of GERD symptoms and increases with increased length of CLEv. The proximal portion of the endoscopic gastric-type folds contains CLE and not OM. Thus, what is taken for proximal stomach during endoscopy represents gastric folds forming sac-like CLE.