title: Cardia-type metaplasia arising in the remnant esophagus after cardia resection.
abstract: BACKGROUND
  Specialized intestinalized metaplasia in the distal esophagus (Barrett's esophagus) is a recognized precursor of esophageal adenocarcinoma, but its pathogenesis is incompletely understood. The aim of this study was to investigate the mucosal effects of esophagogastrostomy, an artificial interface between esophageal squamous and gastric oxyntic epithelium.
  
  
  METHODS
  EGD was performed in 14 consecutive patients (median age 63 years, range 26-71 years) who had undergone esophagogastrostomy from 3 to 88 months earlier. Biopsy specimens were obtained in 13 patients from the anastomosis and, when present, columnar epithelium in the remnant esophagus.
  
  
  RESULTS
  In 10 patients, EGD demonstrated tongue-shaped segments of columnar epithelium extending from 0.3 to 7 cm into the remnant esophagus. Biopsy specimens revealed cardia-type mucosa in all patients, whether at the anastomosis or proximally in esophageal segments of columnar epithelium. Magnification endoscopy of cardia-type mucosa visualized a long-oval, tubular, or ridged surface pattern. In 3 cases, complete intestinal metaplasia was observed within the cardia-type mucosa.
  
  
  CONCLUSIONS
  The frequent transformation of squamous epithelium into cardia-type mucosa in the distal remnant esophagus after esophagogastrostomy supports the concept that cardia-type mucosa is a reflux-induced metaplasia that may give rise to the subsequent development of specialized intestinalized metaplasia.
authors.affiliation: Department of Gastroenterology, Hepatology and Infectiology, Otto-von-Guericke University, Magdeburg, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Peitz
authors.forename: Michael
authors.initials: M
authors.lastname: Vieth
authors.forename: Matthias
authors.initials: M
authors.lastname: Pross
authors.forename: Andreas
authors.initials: A
authors.lastname: Leodolter
authors.forename: Peter
authors.initials: P
authors.lastname: Malfertheiner
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D001706:Biopsy; D002299:Cardia / Q000473:pathology* / Q000601:surgery; D004938:Esophageal Neoplasms / Q000601:surgery*; D004943:Esophagogastric Junction; D004945:Esophagoscopy; D004947:Esophagus / Q000473:pathology* / Q000601:surgery; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology*; D005773:Gastroscopy; D006801:Humans; D008297:Male; D008679:Metaplasia; D008875:Middle Aged; D009092:Mucous Membrane / Q000473:pathology