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Relative risk of dysplasia for patients with intestinal metaplasia in the distal oesophagus and in the gastric cardia
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  1. P Sharmaa,
  2. A P Westona,
  3. T Moralesd,
  4. M Topalovskib,
  5. M S Mayoc,
  6. R E Samplinerd
  1. aDivision of Gastroenterology, University of Kansas, VA Medical Center, Kansas City, Missouri, USA, bDepartment of Pathology, VA Medical Center, Kansas, cDepartment of Preventive Medicine, University of Kansas, dDivision of Gastroenterology, University of Arizona, Tucson Arizona, USA
  1. Dr P Sharma, Assistant Professor of Medicine, University of Kansas, Gastroenterology Section (111), VA Medical Center, 4801 E Linwood Blvd, Kansas City, MO 64128, USA.

Abstract

BACKGROUND Biopsy specimens obtained from the gastro-oesophageal junction can reveal intestinal metaplasia in patients presenting for routine upper endoscopy. The site of biopsy may play a critical role in determining the dysplasia risk of a patient.

AIMS To evaluate prospectively the dysplasia risk in patients with intestinal metaplasia of the distal oesophagus or within the gastric cardia.

METHODS Patients with short segment Barrett's oesophagus (SSBO) and cardia intestinal metaplasia (CIM) were followed prospectively.

RESULTS 177 patients with SSBO were identified (mean age 62 years, range 38–82; 91% whites). Twenty prevalence cases of dysplasia in SSBO were detected: 17 low grade dysplasia (LGD), three high grade dysplasia (HGD). Seventy six patients with CIM were identified (mean age 67 years, range 37–81; 81% whites). A single prevalence case of LGD in CIM was detected. During follow up of 78 SSBO and 34 CIM patients, dysplasia developed in nine (seven LGD, two HGD) with SSBO and in one (LGD) with CIM. There were significant differences between the two groups with respect to age, ethnicity, dysplasia prevalence, and incidence. Time to dysplasia progression was significantly longer in CIM compared with SSBO patients. Of the five patients with SSBO and HGD, one developed adenocarcinoma of the oesophagus on follow up. No HGD or cancers have been detected over this time period in CIM patients.

CONCLUSIONS The dysplasia risk is significantly greater in SSBO than in CIM patients, indicating two potentially different clinical processes. Future studies should separate SSBO from CIM in order to enhance the understanding of the pathophysiology and malignant potential of each entity.

  • high grade dysplasia
  • low grade dysplasia
  • metaplasia
  • Barrett's oesophagus
  • gastro-oesophageal reflux disease

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Footnotes

  • Abbreviations used in this paper:
    CIM
    cardia intestinal metaplasia
    GOJ
    gastro-oesophageal junction
    GORD
    gastro-oesophageal reflux disease
    HGD
    high grade dysplasia
    LGD
    low grade dysplasia
    LSBO
    long segment Barrett's oesophagus
    OGD
    oesophagogastroduodenoscopy
    SSBO
    short segment Barrett's oesophagus

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