Short segment Barrett's oesophagus: prevalence, diagnosis and associations.
BACKGROUND
Prevalence of short segment Barrett's (SSB) oesophagus, defined as the absence of macroscopic Barrett's but histologically identifiable intestinal metaplasia, has been reported to be 18% based on haematoxylin and eosin (H&E) staining.


OBJECTIVE
To define the prevalence of SSB oesophagus using H&E and alcian blue staining and to determine whether SSB oesophagus is associated with inflammation at the gastro-oesophageal junction (GOJ).


METHODS
Consecutive patients (n = 158) presenting for endoscopy completed a structured interview.


METHODS
Two biopsy specimens taken from the GOJ were stained with H&E, alcian blue and Giemsa. A third specimen was obtained from the distal oesophagus. Intestinal metaplasia was diagnosed if goblet cells were definitely identified by two independent observers.


RESULTS
SSB oesophagus was present in 46 (prevalence 36%, 95% confidence interval (CI) 28.5-43.5) using alcian 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 alcian blue staining. Logistic regression analysis identified age (odds ratio (OR) per decade 1.03, 95% CI 1.01-1.06), histological oesophagitis (OR 3.2, 95% CI 1.4-7.2) and inflammation at the gastrooesophageal junction (OR 5.9, 95% CI 2.2-15.6) as independent risk factors for SSB oesophagus.


CONCLUSIONS
Unrecognised SSB oesophagus is highly prevalent in patients presenting for diagnostic upper endoscopy if alcian blue staining is applied.
Nandurkar
S
S
Department of Medicine, University of Sydney, Australia.
Talley
N J
NJ
Martin
C J
CJ
Ng
T H
TH
Adams
S
S
D000328:Adult; D000423:Alcian Blue; D001471:Barrett Esophagus / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology / Q000473:pathology; D004941:Esophagitis / Q000150:complications; D004943:Esophagogastric Junction / Q000473:pathology; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications; D005773:Gastroscopy; D006801:Humans; D008297:Male; D008679:Metaplasia; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D013194:Staining and Labeling / Q000379:methods
D000423:Alcian Blue