Correlation between intestinal metaplasia of the gastric cardia and gastroesophageal reflux disease

Background/Aims: IMC (intestinal metaplasia of the cardia) has been a subje ct of great interest, given the rapidly increasing incidence of adenocarcin oma in this location, over the past two decades. Whether this histological alteration is a consequence of gastroesophageal reflux disease, or a manife station of an H. pylori-related multifocal atrophic gastritis, is unclear. Furthermore, whether IMC should be considered a premalignant lesion of gast ric cardia is still unknown. We performed a prospective study in order to d etermine the prevalence of IMC in patients presenting for elective esophago gastric-duodenal endoscopy and to evaluate a potential association between IMC and some clinical, endoscopic and histological variables. Methodology: Biopsy specimens were taken from 105 unselected patients under going routine diagnostic endoscopy. Eight biopsies were taken from differen t sides, for histological evaluation: 1 above and 3 below the squamocolumna r junction, 2 from gastric fundus and 2 from gastric antrum. All specimens were stained with hematoxylin and eosin-Alcian blue and modified Giemsa to facilitate the detection of H. pylori. Results: Eighty-six patients (50 males, 36 females) with a mean age of 46.5 years (range: 23-75 years), were included in the study. Twenty-one (24.5%) were found to have IMC; 4 (19%) of these had concomitant low-grade dysplas ia of the cardiac mucosa. IMC was associated with: males (P=0.04), endoscop ic diagnosis of esophagitis (P=0.02), histological diagnosis of esophagitis (P=0.008), mucosa of the cardiac type (P=0.02), chronic carditis (P=0.002) and dysplasia (P=0.04). There was no correlation with: age, reflux symptom s, activity of carditis, H. pylori infection of the cardia and intestinal m etaplasia of the distal gastric mucosa. Conclusions: IMC is common in our area. It is associated with endoscopic an d histological changes of gastroesophageal reflux disease, but not with H. pylori infection of the cardia. Although 19% of patients presented concomit ant dysplasia (of low grade), long-term follow-up studies will be necessary to assess the effective risk of IMC for cancer transformation.