Specialized intestinal metaplasia in patients with gastro-oesophageal reflux disease.
BACKGROUND
There is an increasing awareness that short (less than 3 cm) segments of Barrett's epithelium and macroscopically normal cardia epithelium may harbour specialized intestinal metaplasia (SIM), a premalignant phenotype. The prevalence of SIM was studied prospectively in an unselected population of patients attending for endoscopy, and the association of SIM with symptoms, lifestyle, medication, endoscopic oesophagitis and carditis was investigated.


METHODS
Two hundred consecutive patients underwent endoscopy. Biopsies taken from just below the squamocolumnar junction were stained for SIM, and were analysed for carditis and Helicobacter pylori infection. A detailed questionnaire of symptoms, tobacco consumption and the use of proton pump inhibitors was completed.


RESULTS
Forty-two patients (21 per cent) had SIM: 19 (15 per cent) of 126 in an endoscopically normal oesophagus, 15 (24 per cent) of 63 in a short segment of Barrett's epithelium and eight of 11 in classical Barrett's oesophagus. There was a significant association between SIM and carditis (P < 0.0001) and endoscopic oesophagitis (P = 0.03).


CONCLUSIONS
SIM is prevalent in patients undergoing endoscopy, does not correlate with symptoms or H. pylori infection, but is significantly associated with endoscopic and pathological markers of gastro-oesophageal reflux.
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Department of Surgery, St James's Hospital, Dublin, Ireland.
Caldwell
M T
MT
McDonald
G
G
Rama
D
D
Tanner
W A
WA
Reynolds
J V
JV
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects; D016099:Endoscopy, Gastrointestinal / Q000379:methods; D005260:Female; D005764:Gastroesophageal Reflux / Q000209:etiology* / Q000473:pathology; D016481:Helicobacter Infections / Q000473:pathology; D006801:Humans; D007422:Intestines / Q000473:pathology*; D008297:Male; D008679:Metaplasia; D008875:Middle Aged; D011446:Prospective Studies; D054328:Proton Pump Inhibitors; D012907:Smoking / Q000009:adverse effects
D000894:Anti-Inflammatory Agents, Non-Steroidal; D054328:Proton Pump Inhibitors