Specialized columnar epithelium of the esophagogastric junction: Prevalence and associations

OBJECTIVES: In Barrett's esophagus (BE) normal squamous esophageal epitheli um is replaced by specialized columnar epithelium (SCE). BE is related to g astroesophageal reflux disease (GERD) and is a risk factor for esophageal a denocarcinoma. SCE is detected also at normal-appearing esophagogastric jun ction without BE (junctional SCE). The relationships between junctional SCE , GERD, and cardia adenocarcinoma are obscure and controversial. The aims o f the present study were to investigate the prevalence and demographics of junctional SCE and to compare these figures with those reported for BE, and esophageal and cardia adenocarcinoma. A further aim was to examine the ass ociation between junctional SCE and GERD, Helicobacter pylori infection, an d gastritis. METHODS: One thousand one hundred-nineteen consecutive dyspeptic patients u nderwent gastroscopy and were enrolled into the study. RESULTS: Junctional SCE was detected in 110 patients (10%). The age-specifi c prevalence of junctional SCE increased with age. The male:female ratio wa s 1:1.1. In multivariate analysis, junctional SCE was independently and pos itively related to endoscopic erosive esophagitis (odds ratio [OR], 1.8; 95 % confidence interval [CI], 1.1-3.1), cardia inflammation (carditis) (OR, 3 .1; 95% CI, 1.4-6.8), and age (OR, 1.4 per decade; 95% CI, 1.2-1.6), but no t to corpus H. pylori infection (OR, 1.4; 95% CI, 0.7-2.8), antral (OR, 1.0 ; 95% CI, 0.5-2.1) or corpus (OR, 0.8; 95% CI, 0.4-1.8) gastritis, or intes tinal metaplasia of the antral mucosa in stomach (OR, 1.2; 95% CI, 0.7-2.1) . In univariate analysis, junctional SCE was, however, significantly more c ommon in patients with antral-predominant atrophic gastritis (20%), compare d with those with normal gastric histology (8%, p < 0.001). CONCLUSIONS: Junctional SCE is age related and may therefore be an acquired lesion. It is associated with cardia inflammation and endoscopic erosive e sophagitis, but not with H. pylori infection or gastric intestinal metaplas ia. Unlike BE and cardia cancer, junctional SCE occurs with similar frequen cy in men and women. (C) 1999 by Am. Coll. of Gastroenterology.