Magnitude of gastric or duodenal reflux, clinical and endoscopic findings in patients with cardial intestinal metaplasia, short Barrett esofhagus andcontrols

Background: The diagnosis of patients with short segments of intestinal met aplasia in the distal esophagus, has increased in recent years. Aim: To ass ess the clinical, pathological and functional features of patients with eso phageal intestinal metaplasia. Patients and methods: A prospective study wa s performed in 95 control subjects, 115 patients with cardial intestinal me taplasia and 89 patients with short Barret esophagus with intestinal metapl asia. All had clinical and endoscopic assessments, esophageal manometry and determination of 24 h esophageal exposure to acid and doudenal content. Re sults: Control patients were younger and, in this group, the pathological f indings in the mucosa distal to the squamous-columnar change, showed a prep onderance of fundic over cardial mucosa. In patients with intestinal metapl asia and short Barret esophagus, there was only cardial mucosa, that is the place where intestinal metaplasia implants. Low grade dysplasia was only s een in the presence of intestinal metaplasia. Gastroesophageal sphincter pr essure decreased and gastric and duodenal reflux increased along with incre ases in the extension of intestinal metaplasia. Conclusions: These findings confirm the need to obtain multiple biopsies from the squamous-columnar mu cosal function in all patients with gastroesophageal reflux symptoms, for t he detection of early pathological changes of Barret esophagus and eventual dysplasia.