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. 2000 Aug;53(8):619–625. doi: 10.1136/jcp.53.8.619

The gastric cardia in gastro-oesophageal disease

H El-Zimaity 1, V Verghese 1, J Ramchatesingh 1, D Graham 1
PMCID: PMC1762920  PMID: 11002767

Abstract

Background—There have been conflicting reports concerning the use of cardia biopsies in screening patients for gastro-oesophageal disease.

Aim—To define the histopathological changes in the gastric cardia of patients with and without gastro-oesophageal disease.

Methods—Topographically mapped gastric biopsy specimens were obtained from patients with gastro-oesophageal disease and from controls. Biopsies were scored on a visual analogue scale of 0 to 5 for Helicobacter pylori, intestinal metaplasia, pancreatic metaplasia, foveolar hyperplasia, and active inflammation. The presence or absence of cardiac glands was recorded.

Results—Sixty five patients with gastro-oesophageal disease and 71 controls were examined. Intestinal metaplasia was present in cardia biopsies of 10 patients with gastro-oesophageal disease and 11 controls. Only two patients with gastro-oesophageal disease and intestinal metaplasia in the cardia had no evidence of exposure to H pylori. Intestinal metaplasia was not found in the cardia of those with long segment Barrett's oesophagus. Carditis was strongly associated with active H pylori infection (p = 0.000) and resolved after treatment of the infection. A negative association was present between gastro-oesophageal disease and the presence of cardiac glands in cardiac biopsies (p = 0.003). Pancreatic metaplasia was found in 15 of 65 and foveolar hyperplasia in 19 of 65 cases but neither was related to gastro-oesophageal disease.

Conclusion—Intestinal metaplasia in the cardia is uncommon in gastro-oesophageal disease in the absence of H pylori infection. With chronic H pylori infection the junction between the cardia and corpus expands in a cardia–corpal direction.

Key Words: Barrett's oesophagus • gastro-oesophageal disease • cardia • Helicobacter pylori

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Figure 1 The cardia is a small structure varying from 0–10 mm in length. El-Zimaity triple stain. Original magnification, x4.

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