Small-bowel metaplasia arising in the remnant esophagus after esophagojejunostomy--a [corrected] prospective study in patients with a history of total gastrectomy.
OBJECTIVE
The pathogenesis of Barrett's mucosa is incompletely understood. Acidic gastro-esophageal reflux is considered an essential causative factor. The aim of this study was to detect esophageal columnar metaplasia after total gastrectomy with esophagojejunostomy, a condition of enteric, but nonacidic reflux.


METHODS
In a prospective study, patients with a history of total gastrectomy and esophagojejunostomy were investigated for the presence of columnar metaplasia in the remnant esophagus. Patients with such history, who were now referred for esophagogastroduodenoscopy, were included during a 2-yr period. Biopsies for histopathology were taken from the anastomosis and any columnar metaplasia of the esophagus.


RESULTS
In 8 of 25 patients (32%) with a history of gastrectomy, columnar metaplasia was found in the remnant esophagus, mostly in shape of tongues, partly associated with erosive reflux esophagitis. Histopathology showed a typical small-bowel mucosa, but with some villous atrophy. In a resection specimen, a double-layered muscularis mucosa was present, which proved the metaplastic nature of the intestinal mucosa. Length of the columnar metaplasia correlated with the time interval since surgery.


CONCLUSIONS
Esophageal mucosa, if exposed long term to an enteric, but nongastric refluxate, can evolve into a highly differentiated intestinal metaplasia, which resembles small-bowel mucosa. This proves that complete-type intestinal metaplasia may arise not only in the stomach, but also in the esophagus. Esophageal intestinalization seems to reflect adaptation to enteric reflux.
Peitz
Ulrich
U
Clinic of Gastroenterology, Hepatology, and Infectiology, Otto-von-Guericke University, Magdeburg, Germany.
Vieth
Michael
M
Ebert
Matthias
M
Kahl
Stefan
S
Schulz
Hans-Ulrich
HU
Roessner
Albert
A
Malfertheiner
Peter
P
D000368:Aged; D000714:Anastomosis, Surgical; D016629:Esophagectomy; D004947:Esophagus / Q000473:pathology*; D005260:Female; D005743:Gastrectomy; D005774:Gastrostomy; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008679:Metaplasia; D008875:Middle Aged; D009092:Mucous Membrane / Q000473:pathology; D011446:Prospective Studies