IS BARRETTS-ESOPHAGUS ASSOCIATED WITH INTESTINAL METAPLASIA OF THE GASTRIC CARDIA

Objective: Barrett's esophagus has been associated with adenocarcinoma of the esophagogastric junction and gastric cardia, The purpose of th is study was to determine whether patients with Barrett's esophagus ha ve a higher prevalence of intestinal metaplasia involving the gastric cardia than those without Barrett's esophagus, Methods: Two groups of patients were compared for the prevalence of intestinal metaplasia of the gastric cardia, Group 1 included 50 patients with well-defined Bar rett's esophagus who were being followed in an endoscopic surveillance program, Group 2 consisted of 104 individuals participating in a sepa rate study identifying the prevalence of cardia intestinal metaplasia in patients undergoing elective upper endoscopy, Both groups had biops y specimens taken from the gastric cardia, Eleven patients in group 2 were found to have Barrett's esophagus and were excluded from the anal ysis, Histological evidence of intestinal metaplasia was defined as sp ecialized columnar epithelium containing goblet cells staining with Al cian blue at pH 2.5, Results: The prevalence of cardia intestinal meta plasia in the 50 patients in group 1 (Barrett's esophagus) was 22%, wh ereas the prevalence in the 93 patients in group 2 (no Barrett's esoph agus) was 24%, which was not a statistically significant difference, A significant difference between groups still could not be identified w hen the results were examined with regard to equal number of biopsy sp ecimens taken, None of the patients in either group had dysplasia iden tified within the cardia intestinal metaplasia. Conclusions: Patients with Barrett's esophagus do not have a higher prevalence of intestinal metaplasia of the gastric cardia than those presenting for routine en doscopy, Although intestinal metaplasia of the gastric cardia is a rel atively common finding, dysplasia is uncommon, Therefore, we suggest t hat screening biopsy specimens of the gastric cardia in patients with Barrett's esophagus be limited to study protocols at this time, In add ition, we believe that these data raise the question of whether a true association exists between Barrett's esophagus and gastric cardia can cer.