Specialized intestinal metaplasia in patients with gastro-oesophageal reflux disease

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.