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Inflammation at the neo squamo- columnar junction in Barrett's oesophagus
  1. R C FITZGERALD
  1. Digestive Diseases Research Centre
  2. St Barts and the Royal London School of Medicine and Dentistry, Turner Street, London E1 2AD, UK
  3. r.c.fitzgerald{at}mds.qmw.ac.uk

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    Editor,—In the recent article entitled “Inflammation of the gastro-oesophageal junction (carditis) in patients with symptomatic gastro-oesophageal reflux disease: a prospective study” (Gut1999;45:484–488), the authors determined that mucosal injury at the gastric cardia is highly localised to the region adjacent to the squamo-columnar junction in patients with gastro-oesophageal reflux disease (GORD). This is of particular interest to us in view of our recent work on the inflammatory response in Barrett's oesophagus. We have shown that while the Barrett's segment may be relatively devoid of inflammation, the neo squamo-columnar junction continues to excite an inflammatory reaction.1 These results were independent of patient medication (n=50, p<0.05), similar to the study by Lemboet al.

    Lembo et al suggest that carditis may be due to “wear and tear” at the gastro-oesophageal junction as well as secondary to gastro-oesophageal reflux andHelicobacter pylori infection. Our similar findings in patients with Barrett's oesophagus suggest that the gastric and intestinal types of epithelium (either in normal stomach or in metaplastic oesophagus) may represent an adaptation to frequent exposure to refluxate. In contrast, the squamo-columnar junction is particularly susceptible to inflammation. It is interesting to speculate whether it is the proximal squamous oesophagus or the distal gastric/intestinal mucosa which excites the inflammatory response at the junction of these epithelia. In the study by Lemboet al, the biopsies containing squamous mucosa alone were not particularly inflamed; this suggests that it may be the interaction of cytokines generated from both the columnar and squamous epithelium in close proximity which are necessary to generate an inflammatory reaction. This may have implications for the strictures which occur in proximal Barrett's oesophagus.

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