title: Barrett's oesophagus: intestinal metaplasia is not essential for cancer risk.
abstract: OBJECTIVE
  Barrett's oesophagus is the main identifiable risk factor for oesophageal adenocarcinoma. It has been suggested that only patients with intestinal metaplasia are at risk of cancer, but the British Society of Gastroenterology (BSG) guidelines suggest that glandular mucosa is all that is needed. The aim of this study was to quantify the risk of adenocarcinoma in columnar-lined lower oesophagus, with or without specialized intestinal metaplasia.
  
  
  METHODS
  All patients who had endoscopic biopsies of the lower oesophagus between 1980 and 1994 in a single-centre teaching hospital were included in the study. All histological specimens were re-examined and reported according to whether they contained columnar epithelial-lined lower oesophagus, glandular mucosa, with or without intestinal metaplasia. The primary outcome measure was the development of adenocarcinoma.
  
  
  RESULTS
  In total, 712 patients were identified. Of these, 379 (55.1%) were found to have specialized intestinal metaplasia (SIM), and the remaining 309 (44.9%, p = NS) were reported as having glandular mucosa (GM). The median follow-up for patients was 12 years (range 8-20 years). Twenty-eight patients went on to develop adenocarcinoma (4.1%) during the follow-up period - 17 in the SIM group (4.5%) and 11 in the GM group (3.6%, p =NS). The oesophageal malignancy rate was 0.34% per year (SIM 0.37%, GM 0.30%; p =NS).
  
  
  CONCLUSIONS
  Patients who have glandular mucosa on biopsy without intestinal metaplasia have a similar cancer risk to those with specialized intestinal metaplasia.
authors.affiliation: Department of Surgery, Royal Hallamshire Hospital, Sheffield, UK. clive.kelty@bigfoot.com
authors.forename: Clive J
authors.initials: CJ
authors.lastname: Kelty
authors.forename: Martin D
authors.initials: MD
authors.lastname: Gough
authors.forename: Quintin
authors.initials: Q
authors.lastname: Van Wyk
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Stephenson
authors.forename: Roger
authors.initials: R
authors.lastname: Ackroyd
mesh_terms: D000230:Adenocarcinoma / Q000209:etiology* / Q000473:pathology*; D001471:Barrett Esophagus / Q000150:complications* / Q000473:pathology*; D001706:Biopsy; D004938:Esophageal Neoplasms / Q000209:etiology* / Q000473:pathology*; D004947:Esophagus / Q000473:pathology*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008679:Metaplasia; D009092:Mucous Membrane / Q000473:pathology; D012307:Risk Factors