The gastric cardia in gastro-oesophageal disease.
BACKGROUND
There have been conflicting reports concerning the use of cardia biopsies in screening patients for gastro-oesophageal disease.


OBJECTIVE
To define the histopathological changes in the gastric cardia of patients with and without gastro-oesophageal disease.


METHODS
Topographically mapped gastric biopsy specimens were obtained from patients with gastro-oesophageal disease and from controls. Biopsies were scored on a visual analogue scale of 0 to 5 for Helicobacter pylori, intestinal metaplasia, pancreatic metaplasia, foveolar hyperplasia, and active inflammation. The presence or absence of cardiac glands was recorded.


RESULTS
Sixty-five patients with gastro-oesophageal disease and 71 controls were examined. Intestinal metaplasia was present in cardia biopsies of 10 patients with gastro-oesophageal disease and 11 controls. Only two patients with gastro-oesophageal disease and intestinal metaplasia in the cardia had no evidence of exposure to H pylori. Intestinal metaplasia was not found in the cardia of those with long segment Barrett's oesophagus. Carditis was strongly associated with active H pylori infection (p = 0.000) and resolved after treatment of the infection. A negative association was present between gastro-oesophageal disease and the presence of cardiac glands in cardiac biopsies (p = 0.003). Pancreatic metaplasia was found in 15 of 65 and foveolar hyperplasia in 19 of 65 cases but neither was related to gastro-oesophageal disease.


CONCLUSIONS
Intestinal metaplasia in the cardia is uncommon in gastro-oesophageal disease in the absence of H pylori infection. With chronic H pylori infection the junction between the cardia and corpus expands in a cardia-corpal direction.
el-Zimaity
H M
HM
Gastrointestinal Mucosa Pathology Laboratory, Veterans Affairs Medical Center, Houston, Texas 77030, USA. hzimaity@bcm.tmc.edu
Verghese
V J
VJ
Ramchatesingh
J
J
Graham
D Y
DY
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000473:pathology*; D002299:Cardia / Q000473:pathology*; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology; D005756:Gastritis / Q000382:microbiology / Q000473:pathology*; D016481:Helicobacter Infections / Q000150:complications; D016480:Helicobacter pylori / Q000302:isolation & purification; D006801:Humans; D006965:Hyperplasia; D008297:Male; D008679:Metaplasia / Q000382:microbiology; D008875:Middle Aged; D012189:Retrospective Studies