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Digestive Diseases and Sciences
Published in: Digestive Diseases and Sciences 8/2018

01-08-2018 | Review

Are Gastric and Esophageal Metaplasia Relatives? The Case for Barrett’s Stemming from SPEM

Authors: Ramon U. Jin, Jason C. Mills

Published in: Digestive Diseases and Sciences | Issue 8/2018

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Abstract

Chronic injury and inflammation in the esophagus can cause a change in cellular differentiation known as metaplasia. Most commonly, the differentiation changes manifest as Barrett’s esophagus (BE), characterized by the normal stratified squamous epithelium converting into a cuboidal–columnar, glandular morphology. BE cells can phenotypically resemble specific normal cell types of the stomach or intestine, or they can have overlapping phenotypes in disorganized admixtures. The stomach can also undergo metaplasia characterized by aberrant gastric or intestinal differentiation patterns. In both organs, it has been argued that metaplasia may represent a recapitulation of the embryonic or juvenile gastrointestinal tract, as cells access a developmental progenitor genetic program that can help repair damaged tissue. Here, we review the normal development of esophagus and stomach, and describe how BE represents an intermixing of cells resembling gastric pseudopyloric (SPEM) and intestinal metaplasia. We discuss a cellular process recently termed “paligenosis” that governs how mature, differentiated cells can revert to a proliferating progenitor state in metaplasia. We discuss the “Cyclical Hit” theory in which paligenosis might be involved in the increased risk of metaplasia for progression to cancer. However, somatic mutations might occur in proliferative phases and then be warehoused upon redifferentiation. Through years of chronic injury and many rounds of paligenosis and dedifferentiation, eventually a cell with a mutation that prevents dedifferentiation may arise and clonally expand fueling stable metaplasia and potentially thereafter acquiring additional mutations and progressing to dysplasia and cancer.
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Metadata
Title
Are Gastric and Esophageal Metaplasia Relatives? The Case for Barrett’s Stemming from SPEM
Authors
Ramon U. Jin
Jason C. Mills
Publication date
01-08-2018
Publisher
Springer US
Published in
Digestive Diseases and Sciences / Issue 8/2018
Print ISSN: 0163-2116
Electronic ISSN: 1573-2568
DOI
https://doi.org/10.1007/s10620-018-5150-0

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