Extension of squamous epithelium into the proximal stomach: A newly recognized mucosal abnormality

Background and Study Aims: The presence of squamous epithelium in the stoma ch has been rarely noted in the past with only sporadic case reports of squ amous cell carcinoma of the stomach and a variety of other pathological pro cesses. We report the documentation, over a period of 9 months, of squamous epithelium extending beyond the esophagogastric junction and into the prox imal stomach in 16 patients who underwent upper endoscopy. Patients ann Methods: This newly recognized mucosal abnormality was systema tically identified by both antegrade and retrograde views of the esophagoga stric junction during routine upper endoscopy. Other associated mucosal abn ormalities were also evaluated (Barrett's esophagus, erosive esophagitis, e tc.). Biopsies were obtained from the distal esophagus, cardia, antrum and the squamous extension. Additionally, all patients underwent a detailed int erview. Results: Of the patients, 14 were Caucasian and two Hispanic; all were male s, with a mean age 61.2 +/- 4.2. Indications for upper endoscopy included d ysphagia, Barrett's esophagus surveillance, failure of antireflux treatment and anemia. Heartburn was reported by 12 patients (75%). None of the patie nts reported a history of corrosive injury, foreign body ingestion or surge ry. A total of 12 patients had a solitary tongue of squamous cell extension , three had two tongues and in addition, two had squamous islands. Hiatal h ernia was present in all patients, Barrett's esophagus in six (37.5 %), and esophageal stricture in four. Conclusion: Squamous cell extension into the proximal stomach is a newly re cognized mucosal abnormality with presently unknown clinical significance. This mucosal abnormality may represent an esophageal mucosal response to pr oximal gastric injury.