Skip to main content
SpringerLink
Log in

Significance of Intestinal Metaplasia in Different Areas of Esophagus Including Esophagogastric Junction

  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Over the past two decades, the incidence ofadenocarcinoma of the esophagus and gastric cardia hasincreased at a rate exceeding that of any other cancer.Barrett's esophagus is the only known risk factor for these malignancies. Recently, emphasis hasbeen placed on the significance of specializedintestinal metaplasia (SIM) on esophageal biopsies. Ouraim was to compare the prevalence of SIM at different esophageal locations in patients who are athigher risk of developing esophageal adenocarcinoma(Caucasians) and patients with lower risk of developingesophageal adenocarcinoma (African-Americans).Eighty-seven unselected patients (42 Caucasians and 45African-Americans) underwent routine upper endoscopywith biopsies from the proximal margin of columnarmucosa. We classified patients into those with acolumnar-lined esophagus with SIM (CLE with SIM); CLE withoutSIM; or SIM with a normal-appearing gastroesophagealjunction (SIM-GEJ). The prevalence of CLE with SIM, CLEwithout SIM, and SIM-GEJ was 28%, 10%, and 10% in Caucasians compared to 0%, 18% and 11% inAfrican-Americans (P = 0.0001, 0.26, and 0.81,respectively). We found CLE with SIM only in patientswith reflux symptoms at least twice a week. It isconcluded that CLE with SIM is seen most commonly inpatients thought to be at risk for esophagealadenocarcinoma (Caucasians with reflux symptoms). It israrely seen in other groups with lower risk for thismalignancy (African-Americans, nonrefluxers). Conversely,SIM-GEJ and CLE without SIM are common in all groups andare of questionable significance.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

REFERENCES

  1. Spechler SJ, Goyal RK: Barrett's esophagus. N Engl J Med 315:362–371, 1986

    Google Scholar 

  2. Hamilton SR: Pathogenesis of columnar cell lined (Barrett's) esophagus. In Barrett's Esophagus. Pathophysiology, Diagnosis and Management. SJ Spechler, RJ Goyal (eds). New York, Elsevier Science, 1985, pp 29–37

    Google Scholar 

  3. Bremner CG, Lynch VP, Ellis FH: Barrett's esophagus: Congenital or acquired? An experimental study of esophageal mucosal regeneration in dogs. Surgery 68:209–216, 1970

    Google Scholar 

  4. Spechler SJ, Goyal RK: The columnar-lined esophagus, intestinal metaplasia and Norman Barrett. Gastroenterology 110:614–621, 1996

    Google Scholar 

  5. Kim SL, Waring JP, Spechler SJ, Sampliner RE, Doos WG, Krol WF, Williford WO: Department of Veterans Affairs Gastroesophageal Reflux Study Group: Diagnostic inconsistencies in Barrett's esophagus. Gastroenterology 107:945–949, 1994

    Google Scholar 

  6. Haggitt RC, Tryzelaar J, Ellis FH, Colcher H: Adenocarcinoma complicating columnar epithelium-lined (Barrett's) esophagus. Am J Clin Pathol 70:1–5, 1978

    Google Scholar 

  7. Hameeteman W, Tytgat GNJ, Houthoff HJ, Van Den Tweel JG: Barrett's esophagus: Development of dysplasia and adenocarcinoma. Gastroenterology 96:1249–1256, 1989

    Google Scholar 

  8. Spechler SJ: The frequency of esophageal cancer in patients with Barrett's esophagus. Acta Endosc 22:541–544, 1992

    Google Scholar 

  9. Chow WH, Finkle WD, McLaughlin JK, Frankl H, Ziel HK, Fraumeni JF: The relation of gastroesophageal reflux disease and its treatment to adenocarcinomas of the esophagus and gastric cardia. JAMA 274:474–477, 1995

    Google Scholar 

  10. Blot WJ, Devesa SS, Kneller RW, Foramen JF: Rising incidence of adenocarcinoma of the esophagus and gastric cardia. JAMA 265:1287–1289, 1991

    Google Scholar 

  11. Duhaylongsod FG, Wolfe WG: Barrett's esophagus and adenocarcinoma of the esophagus and gastroesophageal junction. J Thorac Cardiovasc Surg 102:36–42, 1991

    Google Scholar 

  12. Rogers EL, Goldkind SF, Iseri OA, Bustin M, Goldkind L, Hamilton SR, Smith RRL: Adenocarcinoma of the lower esophagus: A disease primarily of white men with Barrett's esophagus. J Clin Gastroenterol 8:613–618, 1986

    Google Scholar 

  13. Sarr MG, Hamilton Sr, Marrone GC, Cameron JL: Barrett's esophagus: Its prevalence and association with adenocarcinoma in patients with symptoms of gastroesophageal reflux. Am J Surg 149:187–193, 1985

    Google Scholar 

  14. Skinner DB, Walther BC, Riddell RH, Schmidt H, Iascone C, DeMeester TR: Barrett's esophagus: Comparison of benign and malignant cases. Ann Surg 198:554–566, 1983

    Google Scholar 

  15. Cameron AJ, Zinsmeister AR, Ballard DJ, Carney JA: Prevalence of columnar-lined (Barrett's) esophagus: Comparison of population-based clinical and autopsy findings. Gastroenterol 99:918–922, 1990

    Google Scholar 

  16. Streitz JM, Andrews CW, Ellis FH: Endoscopic surveillance of Barrett's esophagus: Does it help? J Thorac Cardiovas Surg 105:383–388, 1993

    Google Scholar 

  17. Hamilton SR, Smith RRL, Cameron JL: Prevalence and characteristics of Barrett's esophagus in patients with adenocarcinoma of the esophagus or esophagogastric junction. Hum Pathol 19:942–948, 1988

    Google Scholar 

  18. Yang PC, Davis S: Incidence of cancer of the esophagus in the US by histologic type. Cancer 61:612–617, 1988

    Google Scholar 

  19. Spechler SJ, Zeroogian JM, Antonioli DA, Wang HH, Goyal RK: Prevalence of metaplasia at the gastro-oesophageal junction. Lancet 344:1533–1536, 1994

    Google Scholar 

  20. Weston AP, Krmpotich P, Makdisi WF, Cherian R, Dixon A, McGregor DH, Banerjee SK: Short segment Barrett's esophagus: Clinical and histological features, associated endoscopic findings, and association with gastroc intestinal. Am J Gastroenterol 91:981–986, 1996

    Google Scholar 

  21. Johnston MH, Hammond AS, Laskin W, Jones DM: The prevalence and clinical characteristics short segments of specialized intestinal metaplasia in the distal esophagus on routine endoscopy. Am J Gastroenterol 91:1507–1511, 1996

    Google Scholar 

  22. Lazas D, Maydonovitch C, Tang D, Wong RKH: Short segment's Barrett's esophagus (SSBE): Prevalence and clinical characteristics. Am J Gastroenterol 90:A1563, 1995

    Google Scholar 

  23. Spechler SJ, Zeroogian JM, Wang HH, Antonoili DA, Goyal RK: The frequency of specialized intestinal metaplasia at the squamo-columnar junction varies with the extent of columnar epithelium lining the esophagus. Gastroenterology 108:A224, 1995

    Google Scholar 

  24. Naudurkar S, Ng T, Adams S, Brooks L, Keegan A, Cox M, Martin CJ, Talley NJ: Short segment Barrett's esophagus: Prevalence, diagnosis and associations. Gastroenterology 110:A207, 1996

    Google Scholar 

  25. Goldman MC, Beckman RC: Barrett syndrome: Case report with discussion about concepts of pathogenesis. Gastroenterology 39:104–110, 1960

    Google Scholar 

  26. Mossberg SM: The columnar-lined esophagus (Barrett syndrome): An acquired condition? Gastroenterology 50:671–676, 1966

    Google Scholar 

  27. Borrie J, Goldwater L: Columnar cell-lined esophagus: assessment of etiology and treatment: A 22 years experience. J Thorac Cardiovasc Surg 71:825–834, 1976

    Google Scholar 

  28. Winters C Jr, Spurling TJ, Chobanian SJ, Curtis DJ, Esposito RL, Hacker JF, Johnson DA, Cruess DF, Cotelingam TD, Gurney MS: Barrett's esophagus: A prevalent, occult complication of gastroesophageal reflux disease. Gastroenterology 92:118–124, 1987

    Google Scholar 

  29. Cameron AJ, Kamath PD, Carpenter HC: Barrett's esophagus. The prevalence of short and long segments in reflux patients. Gastroenterology 108:A65, 1995

    Google Scholar 

  30. Abo SR, Stevens PD, Abedi M, Green PHR, Lightdale CJ, Bezwada H, Rotterdam H, Garcia-Carrasquillo RJ, Siegel LM: Prevalence of short-segment Barrett's epithelium in patients with gastroesophageal reflux disease. Gastroenterology 108:A45, 1995

    Google Scholar 

  31. Schnell TG, Sontag SJ, Chejfec G: Adenocarcinomas arising in tongues or short segments of Barrett's esophagus. Dig Dis Sci 37:137–143, 1992

    Google Scholar 

  32. Loughney TM, Lazas DJ, Frishberg DP, Emory TS, Maydonovitch CL, Wong RKH: Short segment Barrett's esophagus: Serial endoscopic and histologic assessment. Gastroenterology 110:A181, 1996

    Google Scholar 

  33. Weston AP, Krmpotich PT, Makdisi W, Cherian R, Dixon A, Topalovski M, McGregor D: Cadria histology in Barrett's esophagus: Prospective evaluation. Gastroenterology 110:A613, 1996

    Google Scholar 

  34. Iftikhar SY, James PD, Steele RJC, Hardcastle JD, Atkinson M: Length of Barrett's oesophagus: An important factor in the development of dysplasia and adenocarcinom. Gut 33:1155–1158, 1992

    Google Scholar 

  35. Menke-Pluymers MBE, Hop WCJ, Dees J, Van Blankenstein M, Tilanus HW, the Rotterdam esophageal tumor study group. Cancer 72:1155–1158, 1993

    Google Scholar 

  36. Clark GWB, Smyrk TC, Burdiles P, Hoeft, SF, Peters JH, Kiyabu M, Hinder RA, Bremner CG, DeMeester TR: Is Barrett's metaplasia the source of adenocarcinoma of the cardia. Arch Surg 129:609–614, 1994

    Google Scholar 

Download references

Authors
  1. Naga Chalasani
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. John M. Wo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. John G. Hunter
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. Patrick Waring
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Chalasani, N., Wo, J.M., Hunter, J.G. et al. Significance of Intestinal Metaplasia in Different Areas of Esophagus Including Esophagogastric Junction. Dig Dis Sci 42, 603–607 (1997). https://doi.org/10.1023/A:1018863529777

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/A:1018863529777

Search

Navigation