ENDOSCOPIC ASSESSMENT OF THE PREVALENCE O F GASTRO ESOPHAGEAL JUNCTION INTESTINAL METAPLASIA IN GASTROESOPHAGEAL REFLUX

Background: The classic diagnosis of Barret esophagus is based on the finding of three of more cm of distal esophagus covered by specialized columnar epithelium. However, at the present time, it is based on the presence of intestinal metaplasia in the junction of squamous-columna r mucosae. Aim: To assess the prevalence of Barret esophagus using end oscopic and pathological criteria in healthy subjects and in individua ls with gastroesophageal reflux. Patients and methods: One hundred thi rty nine controls and 372 patients with symptoms of gastroesophageal r eflux subjected to an upper gastrointestinal endoscopy were studied. P atients with Barret esophagus were classified as having a ''mini Barre t: when the pathological presence of intestinal metaplasia was the onl y finding. A ''short Barret esophagus'' was diagnosed when less than 3 cm were covered with fingerings of mucosal substitutions and ''extens ive Barret esophagus'' when more than 3 cm of esophageal mucosa were s ubstituted. Results: Two percent of controls, 12.4% of patients with g astroesophageal reflux without esophagitis and 11.7% of such patients with esophagitis had intestinal metaplasia in the gastroesophageal jun ction. Patients with Barret esophagus were older than the rest of pati ents. ''Short Barret esophagus'' is six times more frequent than ''ext ensive Barret esophagus''. Esophageal erosions, peptic ulcers and sten osis were more frequent in patients with extensive Barret esophagus. T he prevalence of dysplasia was similar in all types of Barret esophagu s. Conclusions: Intestinal metaplasia was very infrequent in control p atients. In subjects with gastroesophageal reflux, classic endoscopic diagnosis may miss up to 80% of patients with Barret esophagus. Thus, gastroesophageal junction biopsies must be obtained in all patients wi th symptoms of gastroesophageal reflux.