Proliferative characteristics of intestinalized mucosa in the distal esophagus and gastroesophageal junction (short-segment Barrett's esophagus): A case control study

Intestinalized epithelium in traditional long-segment Barrett's esophagus ( BE) shows increased proliferative activity, which is postulated to be an ea rly step in the metaplasia-dysplasia-carcinoma sequence, The aim of this st udy was to evaluate the proliferative activity of intestinalized epithelium of the distal esophagus and gastroesophageal junction (IMEGEJ). Tissue sec tions from 78 consecutive patients (20 with IMEGEJ, 58 without IMEGEJ) who had elective upper gastrointestinal endoscopy over a 6-month period were im munohistochemically stained with MIB-1, the Ki-67 proliferation-antigen-ass ociated marker, for evaluation of the crypt MIB-1 proliferation index (PI), size of the proliferative zone (PZ), and the presence of surface epithelia l staining. Data from the IMEGEJ and non-IMEGEJ groups, and from 15 age-mat ched patients with traditional long-segment BE (>3.0 cm), were compared sta tistically. IMEGEJ patients showed a statistically significant increase in the mean crypt PI compared with non-IMEGEJ controls (21.9 +/- 19.5 v 14.3 /- 9.3; P = .01), In addition, IMEGEJ cases showed an increase in the mean crypt PZ (52.3 +/- 16.4 v 45.2 +/- 17.2; P = .05), and a trend toward an in crease in the percentage of cases with MIB-1-positive surface epithelial ce lls (50% v 33%, P = .18). Patients with IMEGEJ did not differ from patients without IMEGEJ with respect to any other clinical or histological feature, including signs or symptoms of gastroesophageal reflux disease and presenc e or absence of esophagitis or carditis. The MIB-1 results of the patients with long-segment BE (MIB-1 PI = 22.6 +/- 20.5, MIB-1 PZ = 51.8 +/- 19.6, p roportion of cases with MIE-l-positive surface cells = 66%) were similar to those with IMEGEJ. Intestinalized epithelium in the distal esophagus or ga stroesophageal junction shows increased proliferative activity in compariso n with patients without intestinalized epithelium. This finding supports an increased risk of carcinogenesis in patients with IMEGEJ. Copyright (C) 19 99 by W.B. Saunders Company.