INFLAMMATION AND INTESTINAL METAPLASIA OF THE GASTRIC CARDIA - THE ROLE OF GASTROESOPHAGEAL REFLUX AND HELICOBACTER-PYLORI INFECTION

Background & Aims: Whether inflammation of the cardia indicates gastro esophageal reflux disease (GERD) and/or is a manifestation of pangastr itis caused by Helicobacter pylori infection is unknown. The aim of th is study was to evaluate the relationship between cardia inflammation, H. pylori infection, and cardia intestinal metaplasia in patients wit h and without GERD. Methods: Patients with GERD were compared with con trols undergoing endoscopy for a variety of other conditions. Endoscop ic biopsy specimens from the distal esophagus and cardia, fundus, and antrum were evaluated for inflammation, H. pylori infection, and intes tinal metaplasia. Results: Neither the prevalence of H. pylori infecti on (controls, 48%; GERD, 41%) nor cardia inflammation (controls, 41%; GERD, 40%) differed between groups. All 11 controls and 22 of 23 patie nts with GERD (96%) and cardia inflammation had H. pylori infection. E sophagitis was more common among GERD patients (33%) than controls (7% ; P = 0.01). Cardia intestinal metaplasia was more common among contro ls (22%) than GERD patients (3%; P = 0.01); all had cardia inflammatio n, 7 had H. pylori infection, and 6 had metaplasia elsewhere in the st omach. Conclusions: The prevalence of cardia inflammation is similar i n patients with and without GERD and is associated with H. pylori infe ction (P < 0.001). Cardia intestinal metaplasia is associated with H. pylori-related cardia inflammation (P = 0.01) and intestinal metaplasi a elsewhere in the stomach, indicating that it is distinct from Barret t's esophagus.