title: Specialized columnar epithelium of the esophagogastric junction: prevalence and associations. The Central Finland Endoscopy Study Group.
abstract: OBJECTIVE
  In Barrett's esophagus (BE) normal squamous esophageal epithelium is replaced by specialized columnar epithelium (SCE). BE is related to gastroesophageal reflux disease (GERD) and is a risk factor for esophageal adenocarcinoma. SCE is detected also at normal-appearing esophagogastric junction without BE (junctional SCE). The relationships between junctional SCE, GERD, and cardia adenocarcinoma are obscure and controversial. The aims of the present study were to investigate the prevalence and demographics of junctional SCE and to compare these figures with those reported for BE, and esophageal and cardia adenocarcinoma. A further aim was to examine the association between junctional SCE and GERD, Helicobacter pylori infection, and gastritis.
  
  
  METHODS
  One thousand one hundred-nineteen consecutive dyspeptic patients underwent gastroscopy and were enrolled into the study.
  
  
  RESULTS
  Junctional SCE was detected in 110 patients (10%). The age-specific prevalence of junctional SCE increased with age. The male:female ratio was 1:1.1. In multivariate analysis, junctional SCE was independently and positively related to endoscopic erosive esophagitis (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.1-3.1), cardia inflammation (carditis) (OR, 3.1; 95% CI, 1.4-6.8), and age (OR, 1.4 per decade; 95% CI, 1.2-1.6), but not to corpus H. pylori infection (OR, 1.4; 95% CI, 0.7-2.8), antral (OR, 1.0; 95% CI, 0.5-2.1) or corpus (OR, 0.8; 95% CI, 0.4-1.8) gastritis, or intestinal metaplasia of the antral mucosa in stomach (OR, 1.2; 95% CI, 0.7-2.1). In univariate analysis, junctional SCE was, however, significantly more common in patients with antral-predominant atrophic gastritis (20%), compared with those with normal gastric histology (8%, p < 0.001).
  
  
  CONCLUSIONS
  Junctional SCE is age related and may therefore be an acquired lesion. It is associated with cardia inflammation and endoscopic erosive esophagitis, but not with H. pylori infection or gastric intestinal metaplasia. Unlike BE and cardia cancer, junctional SCE occurs with similar frequency in men and women.
authors: Department of Internal Medicine, Jyväskylä Central Hospital, Finland.
authors: M
authors: M
authors: Voutilainen
authors: M
authors: M
authors: Färkkilä
authors: M
authors: M
authors: Juhola
authors: K
authors: K
authors: Nuorva
authors: K
authors: K
authors: Mauranen
authors: T
authors: T
authors: Mäntynen
authors: I
authors: I
authors: Kunnamo
authors: J P
authors: JP
authors: Mecklin
authors: P
authors: P
authors: Sipponen
mesh_terms: D000367:Age Factors; D000368:Aged; D001471:Barrett Esophagus / Q000453:epidemiology* / Q000473:pathology; D001706:Biopsy; D004943:Esophagogastric Junction / Q000473:pathology*; D005260:Female; D005387:Finland / Q000453:epidemiology; D005756:Gastritis / Q000453:epidemiology; D005764:Gastroesophageal Reflux / Q000453:epidemiology; D016481:Helicobacter Infections / Q000453:epidemiology; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012737:Sex Factors