Anatomically vague (it was named after its proximity to the heart), histologically undistinguished (its mucosa is usually described as being “similar to the mucosa of the antrum”) and functionally considered a drab territory that connects two well characterised segments of the digestive system, the gastric cardia has long been ignored by gastroenterologists, pathologists, and physiologists alike.

Suddenly, in the past few years, this neglected Grenz zone has been catapulted to the centre of the gastroenterological stage. Another spin-off of Helicobacter pylori? In a sense, yes. But, whereas the wily bacterium is blamed for a long list of calamities occurring in the remainder of the stomach, duodenum, and other systems, in the cardia it is portrayed as a protector of mucosal integrity.1 An implausible defensor mucosae.

During the past few decades a dramatic rise in the incidence of adenocarcinoma of the cardia has been reported in the very populations in which the incidence of gastric cancer has been decreasing.2 The latter trend has been explained as a consequence of the declining prevalence of H pylori infection. However, the increased incidence of cancer of the cardia is paradoxical: why should this minuscule ill-defined portion of the proximal compartment of the stomach behave differently from its more distal areas? One possible explanation is that the lack of a consensus on what the cardia area is, the difficulty of establishing the precise site of origin of tumours of the gastro-oesophageal junction, and various inaccuracies in tumour coding in cancer registries may have unwittingly conspired to …