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. 1997 Nov;41(5):585–589. doi: 10.1136/gut.41.5.585

Intestinal metaplasia at the squamocolumnar junction in patients attending for diagnostic gastroscopy

N Trudgill 1, S Suvarna 1, K Kapur 1, S Riley 1
PMCID: PMC1891581  PMID: 9414961

Abstract

Background—The incidence of adenocarcinoma of the oesophagus and gastric cardia is increasing rapidly. Barrett's oesophagus is the major risk factor. Intestinal metaplasia at the squamocolumnar junction in the absence of Barrett's oesophagus is common but its relation to adenocarcinoma and gastro-oesophageal reflux disease is unclear. 
Aims—To study the prevalence and clinical, endoscopic, and histological associations of intestinal metaplasia at the squamocolumnar junction. 
Methods—Biopsy specimens were taken from 120 randomly selected patients undergoing routine diagnostic endoscopy. Eight biopsy specimens, taken from above and below the squamocolumnar junction, gastric fundus, and gastric antrum, were stained with haematoxylin/eosin, alcian blue/periodic acid-Schiff, and Gimenez, and graded independently by one pathologist. 
Results—Intestinal metaplasia at the squamocolumnar junction was found in 21 patients (18%). Metaplasia was associated with increasing age (p<0.01) and antral intestinal metaplasia (p=0.04). Logistic regression analysis revealed that age was the only independent predictor (p<0.01). There was no association with symptomatic, endoscopic, or histological markers of gastro-oesophageal reflux disease. 
Conclusions—Intestinal metaplasia at the squamocolumnar junction is a common finding. It is associated with increasing age but not gastro-oesophageal reflux disease. 



Keywords: intestinal metaplasia; Barrett's oesophagus; gastro-oesophageal reflux disease; oesophagus; gastric cardia; adenocarcinoma

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Figure 1 .

Figure 1

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: Mucosal biopsy sites. 


Figure 2 .

Figure 2

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: Columnar lined mucosa in biopsy specimens from the oesophagus immediately below the squamocolumnar junction showing goblet cells with alcian blue positive mucin (intestinal metaplasia). Alcian blue/periodic acid-Schiff; original magnification × 100. 


Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Adami B., Eckardt V. F., Paulini K. Sampling error and observer variation in the interpretation of esophageal biopsies. Digestion. 1979;19(6):404–410. doi: 10.1159/000198401. [DOI] [PubMed] [Google Scholar]
  2. Blot W. J., Devesa S. S., Kneller R. W., Fraumeni J. F., Jr Rising incidence of adenocarcinoma of the esophagus and gastric cardia. JAMA. 1991 Mar 13;265(10):1287–1289. [PubMed] [Google Scholar]
  3. Burgess J. N., Payne W. S., Andersen H. A., Weiland L. H., Carlson H. C. Barrett esophagus: the columnar-epithelial-lined lower esophagus. Mayo Clin Proc. 1971 Nov;46(11):728–734. [PubMed] [Google Scholar]
  4. Cameron A. J., Lomboy C. T. Barrett's esophagus: age, prevalence, and extent of columnar epithelium. Gastroenterology. 1992 Oct;103(4):1241–1245. doi: 10.1016/0016-5085(92)91510-b. [DOI] [PubMed] [Google Scholar]
  5. Champion G., Richter J. E., Vaezi M. F., Singh S., Alexander R. Duodenogastroesophageal reflux: relationship to pH and importance in Barrett's esophagus. Gastroenterology. 1994 Sep;107(3):747–754. doi: 10.1016/0016-5085(94)90123-6. [DOI] [PubMed] [Google Scholar]
  6. Craanen M. E., Dekker W., Blok P., Ferwerda J., Tytgat G. N. Intestinal metaplasia and Helicobacter pylori: an endoscopic bioptic study of the gastric antrum. Gut. 1992 Jan;33(1):16–20. doi: 10.1136/gut.33.1.16. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Goldman H., Antonioli D. A. Mucosal biopsy of the esophagus, stomach, and proximal duodenum. Hum Pathol. 1982 May;13(5):423–448. doi: 10.1016/s0046-8177(82)80026-9. [DOI] [PubMed] [Google Scholar]
  8. HAYWARD J. The lower end of the oesophagus. Thorax. 1961 Mar;16:36–41. doi: 10.1136/thx.16.1.36. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Haggitt R. C., Tryzelaar J., Ellis F. H., Colcher H. Adenocarcinoma complicating columnar epithelium-lined (Barrett's) esophagus. Am J Clin Pathol. 1978 Jul;70(1):1–5. doi: 10.1093/ajcp/70.1.1. [DOI] [PubMed] [Google Scholar]
  10. Hamilton S. R., Smith R. R., Cameron J. L. Prevalence and characteristics of Barrett esophagus in patients with adenocarcinoma of the esophagus or esophagogastric junction. Hum Pathol. 1988 Aug;19(8):942–948. doi: 10.1016/s0046-8177(88)80010-8. [DOI] [PubMed] [Google Scholar]
  11. Johnston M. H., Hammond A. S., Laskin W., Jones D. M. The prevalence and clinical characteristics of short segments of specialized intestinal metaplasia in the distal esophagus on routine endoscopy. Am J Gastroenterol. 1996 Aug;91(8):1507–1511. [PubMed] [Google Scholar]
  12. Klauser A. G., Schindlbeck N. E., Müller-Lissner S. A. Symptoms in gastro-oesophageal reflux disease. Lancet. 1990 Jan 27;335(8683):205–208. doi: 10.1016/0140-6736(90)90287-f. [DOI] [PubMed] [Google Scholar]
  13. Kobayashi S., Kasugai T. Endoscopic and biopsy criteria for the diagnosis of esophagitis with a fiberoptic esophagoscope. Am J Dig Dis. 1974 Apr;19(4):345–352. doi: 10.1007/BF01072525. [DOI] [PubMed] [Google Scholar]
  14. Paull A., Trier J. S., Dalton M. D., Camp R. C., Loeb P., Goyal R. K. The histologic spectrum of Barrett's esophagus. N Engl J Med. 1976 Aug 26;295(9):476–480. doi: 10.1056/NEJM197608262950904. [DOI] [PubMed] [Google Scholar]
  15. Powell J., McConkey C. C. Increasing incidence of adenocarcinoma of the gastric cardia and adjacent sites. Br J Cancer. 1990 Sep;62(3):440–443. doi: 10.1038/bjc.1990.314. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Quinn C. M., Bjarnason I., Price A. B. Gastritis in patients on non-steroidal anti-inflammatory drugs. Histopathology. 1993 Oct;23(4):341–348. doi: 10.1111/j.1365-2559.1993.tb01217.x. [DOI] [PubMed] [Google Scholar]
  17. Schnell T. G., Sontag S. J., Chejfec G. Adenocarcinomas arising in tongues or short segments of Barrett's esophagus. Dig Dis Sci. 1992 Jan;37(1):137–143. doi: 10.1007/BF01308357. [DOI] [PubMed] [Google Scholar]
  18. Sobala G. M., O'Connor H. J., Dewar E. P., King R. F., Axon A. T., Dixon M. F. Bile reflux and intestinal metaplasia in gastric mucosa. J Clin Pathol. 1993 Mar;46(3):235–240. doi: 10.1136/jcp.46.3.235. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Spechler S. J., Goyal R. K. The columnar-lined esophagus, intestinal metaplasia, and Norman Barrett. Gastroenterology. 1996 Feb;110(2):614–621. doi: 10.1053/gast.1996.v110.agast960614. [DOI] [PubMed] [Google Scholar]
  20. Spechler S. J., Zeroogian J. M., Antonioli D. A., Wang H. H., Goyal R. K. Prevalence of metaplasia at the gastro-oesophageal junction. Lancet. 1994 Dec 3;344(8936):1533–1536. doi: 10.1016/s0140-6736(94)90349-2. [DOI] [PubMed] [Google Scholar]
  21. Weston A. P., Krmpotich P., Makdisi W. F., Cherian R., Dixon A., McGregor D. H., Banerjee S. K. Short segment Barrett's esophagus: clinical and histological features, associated endoscopic findings, and association with gastric intestinal metaplasia. Am J Gastroenterol. 1996 May;91(5):981–986. [PubMed] [Google Scholar]
  22. Wright T. A., Gray M. R., Morris A. I., Gilmore I. T., Ellis A., Smart H. L., Myskow M., Nash J., Donnelly R. J., Kingsnorth A. N. Cost effectiveness of detecting Barrett's cancer. Gut. 1996 Oct;39(4):574–579. doi: 10.1136/gut.39.4.574. [DOI] [PMC free article] [PubMed] [Google Scholar]

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