THE PREVALENCE AND CLINICAL CHARACTERISTICS OF SHORT SEGMENTS OF SPECIALIZED INTESTINAL METAPLASIA IN THE DISTAL ESOPHAGUS ON ROUTINE ENDOSCOPY

Objective: To prospectively determine the prevalence and clinical char acteristics of short segments of specialized intestinal metaplasia in the distal esophagus. Short segment is defined as extending less than 2 cm proximal to the esophagogastric junction. This has been referred to by some investigators as ''short segment Barrett's esophagus.'' Met hods: One hundred and seventy two patients undergoing elective esophag ogastroduodenoscopy were consecutively enrolled. Patients with known B arrett's esophagus were excluded. All study patients completed a sympt om questionnaire. At endoscopy, the presence of esophagitis and locati ons of the diaphragmatic hiatus, esophagogastric junction, and the squ amocolumnar junction were recorded. Biopsy specimens were obtained at the squamocolumnar junction to identify specialized intestinal metapla sia and 2 cm above the squamocolumnar junction to evaluate for histolo gical esophagitis. Results: Two patients (1.2%) had at least 2 cm of c olumnar-lined esophagus. Of the 170 patients without 2 cm of columnar- lined esophagus, 16 (9.4%) patients had short segments of specialized intestinal metaplasia. Twelve (7.0%) of these patients had specialized intestinal metaplasia limited to the esophagogastric junction. All pa tients with specialized intestinal metaplasia were Caucasian, and ther e was a slight male predominance. Patients without specialized intesti nal metaplasia (n = 154, 90.6%) did not differ statistically with resp ect to age, gender, use of acid-suppressing drugs, alcohol, or smoking history. Pyrosis and regurgitation were significantly more common in patients with specialized intestinal metaplasia involving the distal 2 cm of the esophagus or the esophagogastric junction. Cough was more c ommon in the group with specialized intestinal metaplasia limited to t he esophagogastric junction. The groups were similar in frequency of d ysphagia, globus sensation, nocturnal pyrosis, eructation, early satie ty, nausea, and abdominal pain. Conclusions: Specialized intestinal me taplasia less than 2 cm proximal to the esophagogastric junction is co mmon in Caucasian patients undergoing routine esophagogastroduodenosco py. Pyrosis and regurgitation are significantly more common in patient s with short segments of specialized intestinal metaplasia, whether in volving the distal 2 cm of the esophagus or the esophagogastric juncti on alone. Alcohol and tobacco use are no more common in patients with specialized intestinal metaplasia than in those without metaplasia. Th e presence of specialized intestinal metaplasia did not correlate with either endoscopic or histological esophagitis.