Background: There is an increasing awareness that short (less than 3 cm) se
gments of Barrett's epithelium and macroscopically normal cardia epithelium
may harbour specialized intestinal metaplasia (SIM), a premalignant phenot
ype. The prevalence of SIM was studied prospectively in an unselected popul
ation of patients attending for endoscopy, and the association of SIM with
symptoms, lifestyle, medication, endoscopic oesophagitis and carditis was i
nvestigated.
Methods: Two hundred consecutive patients underwent endoscopy. Biopsies tak
en from just below the squamocolumnar junction were stained for SIM, and we
re analysed for carditis and Helicobacter pylori infection. A detailed ques
tionnaire of symptoms, tobacco consumption and the use of proton pump inhib
itors was completed.
Results: Forty-two patients (21 per cent) had SIM: 19 (15 per cent) of 126
in an endoscopically normal oesophagus, 15 (24 per cent) of 63 in a short s
egment of Barrett's epithelium and eight of 11 in classical Barrett's oesop
hagus. There was a significant association between SIM and carditis (P < 0.
0001) and endoscopic oesophagitis (P = 0.03).
Conclusion: SIM is prevalent in patients undergoing endoscopy, does not cor
relate with symptoms or H. pylori infection, but is significantly associate
d with endoscopic and pathological markers of gastro-oesophageal reflux.