SHORT SEGMENT BARRETTS-ESOPHAGUS - PREVALENCE, DIAGNOSIS AND ASSOCIATIONS

Background-Prevalence of short segment Barrett's (SSB) oesophagus, def ined as the absence of macroscopic Barrett's but histologically identi fiable intestinal metaplasia, has been reported to be 18% based on hae matoxylin and eosin (H&E) staining. Aims-To define the prevalence of S SB oesophagus using H&E and alcian blue staining and to determine whet her SSB oesophagus is associated with inflammation at the gastro-oesop hageal junction (GOJ). Subjects-Consecutive patients (n = 158) present ing for endoscopy completed a structured interview. Methods-Two biopsy specimens taken from the GOJ were stained with H&E, alcian blue and G iemsa. A third specimen was obtained from the distal oesophagus. Intes tinal metaplasia was diagnosed if goblet cells were definitely identif ied by two independent observers. Results-SSB oesophagus was present i n 46 (prevalence 36%, 95% confidence interval (CI) 28.5-43.5) using al cian blue staining. If H&E had been the sole staining method used, 50% cases of intestinal metaplasia would have been overlooked. There were no cases of intestinal metaplasia identified by H&E but missed by alc ian blue staining. Logistic regression analysis identified age (odds r atio (OR) per decade 1.03, 95% CI 1.01-1.06), histological oesophagiti s (OR 3.2, 95% CI 1.4-7.2) and inflammation at the gastrooesophageal j unction (OR 5.9, 95% CI 2.2-15.6) as independent risk factors for SSB oesophagus. Conclusion-Unrecognised SSB oesophagus is highly prevalent in patients presenting for diagnostic upper endoscopy if alcian blue staining is applied.