Comparative study of intestinal metaplasia and mucin staining at the cardia and esophagogastric junction in 225 symptomatic patients presenting for diagnostic open-access gastroscopy

Objective: Adenocarcinoma around the esophagogastric junction (EGJ) is incr easing in incidence, and is frequently associated with areas of macroscopic or microscopic intestinal metaplasia (IM). The aim of this study was to de fine the incidence and type of metaplastic changes in the cardia and at the EGJ in symptomatic patients in whom there was no endoscopic columnar segme nt. Methods: Patients attending for open-access gastroscopy had three sets of endoscopic biopsies taken at 3-cm intervals, from cardia, EGJ, and dista l esophagus. Hematoxylin and eosin, Alcian blue/PAS (AB/PAS), and high-iron diamine/Alcian blue (AB/HID) were used to define and characterize IM. Resu lts: Of 225 patients, eight (4%) had carcinoma, eight (4%) had conventional long-segment Barrett's esophagus, 15 (7%) showed endoscopic short-segment Barrett's change, with no endoscopic Barrett's in 194 (86.2%). Of the latte r, 34 (17.5%) had IM at the EGJ, and nine (4.6%) had IRI at the cardia on h ematoxylin and eosin. Acid mucin stains were positive at the EGJ in 135 (69 .6%) and at the cardia in 75 (38.7%). Metaplasia at the EGJ was associated with sulphomucins (p < 0.0001) and involved the surface glandular epitheliu m (p < 0.0001) more frequently than the cardia. Metaplasia was not related to reflux symptoms, hiatus hernia, or endoscopic esophageal inflammation. N inety percent of those with IM detectable by hematoxylin and eosin were tak ing acid suppression, compared with 72.8% overall. Conclusions: Intestinal metaplasia is very common at the esophagogastric junction and gastric cardi a, with marked differences in incidence and characteristics of mucin staini ng between the two sites. The relationship of intestinal metaplasia to the development of carcinoma is yet to be determined. (C) 1999 by Am. Cell. of Gastroenterology.