The gastric cardia: Fact or fiction?

OBJECTIVE: It is unclear whether the gastric cardia is present from birth o r is metaplastic and develops as a result of gastroesophageal reflux diseas e. To this end, we evaluated the histology of the entire esophagogastric ju nction in consecutive pediatric autopsies to determine the presence and ext ent of cardiac mucosa. METHODS: The entire esophagogastric junction of 33 consecutive pediatric (l ess than or equal to 18 yr) autopsies was examined. The precise location of the squamocolumnar junction and its relationship to the esophagogastric ju nction was noted in all cases. Slides were evaluated by two pathologists in a blinded fashion to look for cardiac mucose, characterized by unequivocal periodic acid-Schiff (PAS)-positive mucous glands in a lobular configurati on. Sections from the antrum and esophagogastric junction were examined for the presence of Helicobacter pylori. RESULTS: Three cases were excluded due to autolysis. The mean age of the 30 remaining patients was 6.3 yr (range: 16 days-18 yr). A regular-appearing squamocolumnar junction was identified at the esophagogastric junction in a ll 30 cases. Cardiac mucosa was present in all specimens (mean length: 1.8 mm; range: 1.0-4.0 mm), always on the gastric side of the esophagogastric j unction. There was no significant association between patient age or gender and length of cardiac mucosa. None of the patients had a known history of gastroesophageal reflux disease or Barrett's esophagus, and none were takin g acid-suppressing medications before death. All were negative for Helicoba cter pylori by Giemsa stain. CONCLUSIONS: In an unselected pediatric patient population with Little or n o propensity for gastroesophageal reflux disease, a short segment of cardia c mucosa was consistently present on the gastric side of the esophagogastri c junction, independent of gender or age. These results support the concept that the gastric cardia is present from birth as a normal structure. (C) 2 000 by Am. Cell. of Gastroenterology.