Comparison of clinical, endoscopic and functional findings in patients with intestinal metaplasia at the cardia, carditis and short-segment columnar epithelium of the distal esophagus with and without intestinal metaplasia

In recent years, the diagnosis of short segments of intestinal metaplasia l ining the distal esophagus has increased. The aim of the present study was to determine the clinical, endoscopic, histologic and functional results in patients with intestinal metaplasia at the cardia (IMC), carditis and shor t-segment columnar epithelium (CE) lining the distal esophagus with and wit hout intestinal metaplasia. Four groups were studied: 48 patients with card itis, 105 patients with IMC, 78 patients with short-segment CE (SSCE) witho ut IM and 69 patients with short-segment CE with IM. All had clinical quest ionnaire, endoscopic and histological evaluation, manometric studies and me asurements of acid and bilirubin exposition of the distal esophagus over 24 h. Patients without IM were found to be younger than those with IM. Erosiv e esophagitis was observed in similar proportions, but hiatal hernia was pr esent in patients with SSCE with or without IM. Patients without IM had mai nly cardial mucosa more than fundic mucosa. However, patients with IM had a lmost exclusively cardial mucosa. Low-grade dysplasia was observed only in patients with IM. Manometric evaluation demonstrated a structural defective lower esophageal sphincter in all groups. Acid and duodenal exposures of t he distal esophagus over 24 h were significantly greater in patients with S SCE with IM. In the presence of pathologic gastroesophageal reflux (GER), t here are several histological changes at the mucosa distal to the squamous columnar junction. The first metaplastic change is one from fundic to cardi al mucosa and, when duodenal reflux occurs, a second metaplastic change to intestinal metaplasia from cardial mucosa occurs. Therefore, in all patient s with symptoms of GER, biopsies specimens distal to the squamous columnar junction should be taken routinely.