The esophageal Z-line appearance correlates to the prevalence of intestinal metaplasia

Background: Intestinal metaplasia at the gastroesophageal junction is assoc iated with Barrett esophagus, gastric cardiac cancer, and gastritis. The ai m of this study was to determine the prevalence of intestinal metaplasia am ong patients with symptoms suggestive of gastroesophageal reflux disease (G ERD) and to study clinical, endoscopic, and histologic associations with in testinal metaplasia at the squamocolumnar junction. Methods: One hundred an d eighty-six patients with symptoms indicating gastroesophageal reflux were included in the study. A new classification of the Z-line appearance was u sed. Results: The Z-line appearance was found to correlate with the prevale nce of intestinal metaplasia at the squamocolumnar junction (P = 0.0001). I ntestinal metaplasia at the squamocolumnar junction was found in 15.0% of t he patients. There was a statistically significant association between inte stinal metaplasia at the squamocolumnar junction and tongues of columnar ep ithelium at the Z-line (P = 0.020), intestinal metaplasia in the cardia (P = 0.020), positive CLO test (P = 0.026), smoking (P = 0.041), and age (P = 0.050). There was no association with endoscopic or histologic signs of eso phagitis or with the severity or duration of GERD symptoms. Conclusion: Int estinal metaplasia at the squamocolumnar junction correlates with the Z-lin e appearance, which would justify a new classification.