A postfundoplication study on Z-line appearance and intestinal metaplasia in the gastroesophageal junction

The purpose of this study was investigate the Z-line appearance by using a previously proposed classification, the ZAP classification, and to investig ate the prevalence of intestinal metaplasia in the Z-line. among fundoplica ted patients. Sixty patients, who had undergone fundoplication 2 to 17 year s earlier, were included in the study. The prevalence of intestinal metapla sia was 20%. Intestinal metaplasia was found to be associated with age. mor e than 10 years of symptoms of gastroesophageal reflux disease preoperative ly, tongues of columnar epithelium in the distal esophagus, carditis, and Z AP grade. ZAP grade. furthermore. was associated with male gender and more than 10 years of symptoms of gastroesophageal reflux disease preoperatively . Among patients with intestinal metaplasia, different ZAP grades can indic ate different etiologic factors. Even among patients undergoing fundoplicat ion (i.e.. patients with an anatomically altered gastroesophageal junction) , the ZAP classification is a feasible tool to characterize the Z-line appe arance. The ZAP classification could prove valuable in selecting patients f or follow-up treatment.