Histopathology of columnar-lined esophagus in patients with gastroesophageal reflux disease.
OBJECTIVE
The question of whether an endoscopically normal-appearing esophagogastric junction should be biopsied in patients with gastroesophageal reflux disease is controversial. We have addressed this issue using endoscopy and histopathology.


METHODS
A total of 114 consecutive patients (58 males) with symptoms of gastroesophageal reflux disease prospectively underwent endoscopy, including biopsy sampling from the esophagogastric junction. Endoscopically visible columnar-lined esophagus was defined by the presence of gastric-type mucosa above the level of the rise of the gastric folds. Histopathology was conducted using the Paull-Chandrasoma classification.


RESULTS
Of the 114 patients, 85 (74.6%) had endoscopically visible columnar-lined esophagus of length < or =0.5 cm (n = 82), 1 cm (n = 2) and 7 cm (n = 1); 29 patients (25.4%) had a normal endoscopic junction. All patients had histopathologic columnar-lined esophagus. Intestinal metaplasia and low-grade dysplasia was identified in 26 (22.8%) and 5 (4.4%) individuals, respectively, and was not statistically different in endoscopically normal vs. abnormal junction (P = 0.408 for intestinal metaplasia, P = 0.775 for low grade dysplasia). Intestinal metaplasia was independent from endoscopic esophagitis (P = 0.398) and hiatal hernia (P = 0.405).


CONCLUSIONS
Columnar-lined esophagus cannot be excluded by endoscopy. In patients with gastroesophageal reflux disease, biopsy sampling of normal-appearing junction is recommended for histopathologic exclusion of intestinal metaplasia and low-grade dysplasia.
University Clinic of Surgery, Medical University Vienna, Währinger Gürtel 18-20, Vienna, Austria. johannes.lenglinger@meduniwien.ac.at
Johannes
J
Lenglinger
Claudia
C
Ringhofer
Margit
M
Eisler
Roland
R
Sedivy
Fritz
F
Wrba
Johannes
J
Zacherl
Enrico P
EP
Cosentini
Gerhard
G
Prager
Michael
M
Haefner
Martin
M
Riegler
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D002299:Cardia / Q000473:pathology; D004938:Esophageal Neoplasms / Q000473:pathology*; D004942:Esophagitis, Peptic / Q000473:pathology; D004943:Esophagogastric Junction / Q000473:pathology*; D004945:Esophagoscopy; D004947:Esophagus / Q000473:pathology; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology*; D005764:Gastroesophageal Reflux / Q000473:pathology*; D006551:Hernia, Hiatal / Q000473:pathology; D006801:Humans; D008297:Male; D008679:Metaplasia; D008875:Middle Aged; D010295:Parietal Cells, Gastric / Q000473:pathology; D011230:Precancerous Conditions / Q000473:pathology*; D011446:Prospective Studies; D014741:Video Recording