INTESTINAL METAPLASIA OF THE GASTRIC CARDIA

Objective: Although the incidence of gastric adenocarcinoma in the U. S. is declining, the incidence of cancer localized to the gastric card ia has risen dramatically, It is not yet clear whether cancer of the g astric cardia arises from a premalignant lesion such as intestinal met aplasia (IM), The purpose of this study was to determine the prevalenc e of IM involving the cardia in patients presenting for elective EGD, and evaluate potential associated factors. Methods: During a 7 month p eriod patients referred for elective EGD at the Tucson VA Medical Cent er were invited to participate in the study. Prior to EGD each patient was surveyed with regard to GERD symptoms and smoking and alcohol his tory. During EGD note was made of the presence of esophagitis, hiatus hernia, and Barrett's-appearing mucosa, The esophagogastric junction ( EGJ) was defined as the end of the tubular esophagus coinciding with t he proximal heads of the gastric folds, Seven biopsies were taken from specific sites in the antrum, angularis, cardia, and EGJ, Biopsy spec imens were stained with a combination of H&E and Alcian blue at a pH o f 2.5. Histologic evidence of IM was defined as columnar-type epitheli um including goblet cells staining with Alcian blue, Patients were als o evaluated for H. pylori infection by histologic and serologic examin ations, Results: There were 104 patients (99 male, 5 female) with a me an age of 61.6 years. Twenty-four (23%) were found to have IM involvin g the gastric cardia, although none of these had dysplasia, Eleven pat ients (11%) had Barrett's esophagus; however, only 2 of these had conc omitant IM of the cardia. On the other hand, 9 of the 24 with IM of th e cardia had concomitant IM elsewhere in the stomach. Forty-nine patie nts (47%) were found to be positive for H. pylori infection and there was a significant association between H. pylori infection and IM of th e gastric cardia (p = 0.03). Conclusions: These data show that IM of t he gastric cardia is a relatively common finding and is associated wit h H. pylori infection, Although dysplasia was not identified, long-ter m follow-up studies will be necessary to determine the incidence of dy splasia or adenocarcinoma developing from IM of the cardia.