SHORT SEGMENT BARRETT'S ESOPHAGUS AND INTESTINAL METAPLASIA OF THE CARDIA—IT'S NOT ALL SYMANTICS!!!

ABSTRACTThis interesting report from Sheffield, UK, studied the prevalence of intestinal metaplasia at the squamocolumnar junction in patients undergoing routine diagnostic upper endoscopy. The patients' age, sex, reflux symptoms (heartburn and acid regurgitation), smoking, and alcohol history were recorded. Eight biopsies were obtained per the study protocol; one from 2 cm above the squamocolumnar junction, three from within the esophagus below the squamocolumnar junction, three from 2 cm within the gastric flare on retroflexion, and one from the antrum. The squamocolumnar junction was defined as “the level of at least 50% of the circumference of the junction between dark red gastric-like and pale pink esophageal mucosa,” and Barrett's esophagus was diagnosed “endoscopically when there was 3 cm or more between the squamocolumnar junction and the proximal margin of the gastric folds.” A total of 117 patients (49 men), with an age range of 22–90 yr, met the study criteria. The distance between the proximal margin of the gastric folds and the squamocolumnar junction was 0- <1 cm in 72 patients, 1- <2 cm in 35 and 2- <3 cm in 10 patients. Twenty-one patients (18%) were documented to have intestinal metaplasia below the squamocolumnar junction. Intestinal metaplasia at the squamocolumnar junction was not associated with reflux symptoms, endoscopic esophagitis, hiatal hernia, histological esophagitis, nonsteroidal antiinflammatory drug use, and Helicobacter pylori infection; by logistic regression analysis, age was the only associated factor. (Am J Gastroenterol 1998;93:2303-2304. © 1998 by Am. Coll. of Gastroenterology)