GUT 1998;43:17-21 ( July )

Intestinal metaplasia at the gastro-oesophageal junction: Helicobacter pylori gastritis or gastro-oesophageal reflux disease?

A Hackelsberger,^a T Günther,^b V Schultze,^a G Manes,^a J-E Dominguez-Muñoz,^a A Roessner,^b P Malfertheiner^a

^a Department of Gastroenterology, Hepatology, and Infectious Diseases, ^b Department of Pathology, Otto-von-Guericke University, Magdeburg, Germany

Correspondence to: Professor P Malfertheiner, Department of Gastroenterology, Hepatology, and Infectious Diseases, Otto-von-Guericke-University, Magdeburg, Leipziger Strasse 44, 39120 Magdeburg, Germany.

Accepted for publication 4 February 1998

BackgroundIntestinal metaplasia, whether in the cardia or the distal oesophagus, has been uniformly defined as specialised columnar epithelium, suggesting a relation with Barrett's oesophagus. It is, however, not clear whether the risk factors associated with intestinal metaplasia are identical at both sites.
AimsTo investigate biopsy specimens obtained below the squamocolumnar junction (SCJ) in relation to endoscopic aspect, gastric histology, and clinical presentation.
Patients and methodsIn 423 patients investigated the endoscopic aspect of the SCJ was classified as unremarkable (group I, n=315) or suggestive of Barrett's oesophagus (group II, n=108). Standardised biopsy specimens from the antrum, corpus, and directly below the SCJ were investigated.
ResultsIntestinal metaplasia was detected at the SCJ in 13.4% of group I patients, where it was significantly associated with gastric intestinal metaplasia (odds ratio (OR) 6.96; confidence interval (CI) 2.48 to 19.54) and H pylori (OR 7.85; CI 2.82 to 21.85), and in 34.3% of group II patients where it was significantly associated with reflux symptoms (OR 19.98; CI 6.12 to 65.19), erosive oesophagitis (OR 12.16; CI 3.86 to 38.24), and male sex (OR 6.25, CI 2.16 to 18.14), but not with H pylori or gastric intestinal metaplasia.
ConclusionThis study suggests that the pathogenesis of intestinal metaplasia at the SCJ is not uniform: at an endoscopically unremarkable SCJ it is a sequela of H pylori gastritis, but coexisting with endoscopic features of Barrett's oesophagus it is associated with male sex and gastro-oesophageal reflux disease.
(GUT 1998;43:17-21)

Keywords: intestinal metaplasia;  Barrett's oesophagus;  gastric cardia; Helicobacter pylori gastritis;  gastro-oesophageal reflux disease

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© 1998 by Gut
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