Intestinal metaplasia is the probable common precursor of adenocarcinoma in Barrett esophagus and adenocarcinoma of the gastric cardia

BACKGROUND. Intestinal metaplasia in the tubular esophagus is the recognize d precancerous lesion of adenocarcinoma in Barrett esophagus. However, it i s not yet clear whether adenocarcinoma of the gastric cardia arises from th e same premalignant lesion, i.e., intestinal metaplasia of the gastric card ia, The purpose of this study was to compare adenocarcinomas in Barrett eso phagus and adenocarcinomas of the gastric cardia at an early stage, when it was more likely that intestinal metaplasia had not been completely overgro wn by the tumor. METHODS. The authors compared the epidemiologic, clinical, and pathologic f eatures of early stage adenocarcinoma in Barrett esophagus and adenocarcino ma of the gastric cardia from 42 patients who underwent resection surgery. The presence of intestinal metaplasia was assessed in the resected specimen s by using Alcian blue (pH 2.5) staining. RESULTS. Intestinal metaplasia was detected in the nucosa adjacent to neopl asia in 25 of 26 patients with adenocarcinoma in Barrett esophagus and in 1 1 of 16 (69%) patients with adenocarcinoma of the gastric cardia. Patient a nd tumor characteristics and survival were comparable in both groups. CONCLUSIONS, Intestinal metaplasia is a very common finding in the mucosa a djacent to early stage adenocarcinoma of the gastric cardia. Adenocarcinoma in Barrett esophagus and adenocarcinoma of the gastric cardia may represen t the same disease; the former arises from longer segments of intestinal me taplasia and the latter from intestinal metaplasia of the cardia. (C) 2000 American Cancer Society.