The location and frequency of intestinal metaplasia at the esophagogastricjunction in 223 consecutive autopsies: Implications for patient treatment and preventive strategies in Barrett's esophagus

The frequency of intestinal metaplasia at the esophagogastric junction is a s high as 36% in endoscopy studies; the majority of cases (approximately 67 %) occur in short segments of esophageal columnar mucosa. The validity of t hese studies has been questioned, however, because of heterogenous underlyi ng diseases prompting endoscopy. To determine the frequency and origin of i ntestinal metaplasia at the esophagogastric junction, we histologically eva luated the entire esophagogastric junction for the presence of intestinal m etaplasia using Alcian blue/periodic acid-Schiff mucin stains in 223 consec utive autopsies. Precise localization of the Z Line in relation to the esop hagogastric junction and tongues of esophageal columnar-appearing mucosa we re noted in each case. Mean patient age was 47 years; 69% of patients were male, and 63% were white. Twenty five of 223 cases (11%) had intestinal met aplasia at the esophagogastric junction. Only 2 of 25 cases (8%) had intest inal metaplasia in the esophagus; the remaining 23 cases (92%) had intestin al metaplasia in the gastric cardia. Male gender, advanced age, white ethni c origin, and short tongues of esophageal columnar mucosa were not associat ed with gastric cardia intestinal metaplasia An association of distal gastr ic intestinal metaplasia (P < .01) and chronic gastritis (P < .01) with gas tric cardia intestinal metaplasia suggests a role for Helicobacter pylori i nfection in this process, The frequency of intestinal metaplasia at the eso phagogastric junction in an unselected autopsy population is low (11%) even after exhaustive histologic evaluation using Alcian blue mucin stains. Fur thermore, intestinal metaplasia is confined to the gastric cardia in more t han 90% of cases with no association to male gender, white ethnic origin, a dvanced age, or the presence of short segments of esophageal columnar-appea ring mucosa at endoscopy, These results demonstrate that caution is warrant ed when applying the findings of endoscopy studies to the development of pr eventive and screening strategies aimed at identifying Barrett's esophagus in an asymptomatic general population.