The extent of Barrett's esophagus depends on the status of the lower esophageal sphincter and the degree of esophageal acid exposure

Objective: The purpose of this study was to assess whether the extent of in testinal metaplasia is related to the severity of the gastroesophageal refl ux disease. Methods: A total of 556 consecutive patients with symptoms sugg estive of foregut disease had upper gastrointestinal endoscopy with extensi ve biopsies from the gastroesophageal junction and the esophagus, All patie nts had esophageal motility and 24-hour pH monitoring. In 411 patients, car diac-type mucosa was identified; in 147 patients, the cardiac-type mucosa s howed intestinal metaplasia. They were divided into 3 groups based on the e xtent of intestinal metaplasia commonly seen clinically: long segments (>3 cm), short segments (<3 cm), and limited to the gastroesophageal junction. The duration of symptoms, the status of the lower esophageal sphincter, the degree of esophageal acid exposure, and the time to clear a reflux episode were assessed in each group. Results: The presence of intestinal metaplasi a in cardiac-type mucosa was associated with the hallmarks of gastroesophag eal reflux disease. The extent of intestinal metaplasia correlated strongly with the degree of esophageal acid exposure (r = 0.711; P <.001) and inver sely with the lower esophageal sphincter pressure (r = 0.351; P <.001) and length (r = 0.259; P =.002). Patients with a long segment of intestinal met aplasia (>3 cm) had longer duration of symptoms (16 years) than those patie nts with a segment of intestinal metaplasia less than 3 cm (10 years; P =.0 48) or those patients with intestinal metaplasia limited to the gastroesoph ageal junction (10 years; P =.01). Conclusion: The extent of intestinal met aplasia, that is, Barrett's esophagus, is related to the status of the lowe r esophageal sphincter and the degree of esophageal acid exposure.