title: Pancreatic acinar metaplasia in the distal oesophagus and the gastric cardia: prevalence, predictors and relation to GORD.
abstract: OBJECTIVE
  The nature of pancreatic acinar metaplasia (PAM) in the gastro-oesophageal junction (GOJ) remains obscure. We aimed to estimate its prevalence and investigate into its risk factors in a population-based series of first-time endoscopy patients.
  
  
  METHODS
  We investigated consecutive patients, endoscoped for the first time, representing defined catchment area populations. Biopsies were taken immediately below the GOJ and from the distal oesophagus. Endoscopy room-based cross-sectional clinical data were supplemented with exposure data from 160 population controls. Associations, expressed as odds ratios (OR), were modelled with multivariable logistic regression. A subsample of 26 patients underwent oesophageal pH monitoring.
  
  
  RESULTS
  Among 644 patients (mean age 53 years, 43% men), PAM was found in 121 patients (19%), exclusively above the GOJ in 40 (6%), below GOJ in 67 (10%), and both above and below GOJ in 14 (2%). PAM exclusively above the GOJ and PAM exclusively below the GOJ were both borderline associated with age (2% increase in prevalence per year). PAM exclusively above the GOJ was significantly associated with female gender (OR 2.8, 95% CI 1.3-6.3) and presence of Helicobacter pylori immediately below the GOJ (OR 2.6, 95% CI 1.3-5.4). Out of 21 patients with Barrett's oesophagus (BO), 8 (38%) had PAM above the GOJ. The mean value for percentage time with oesophageal pH < 4.0 was 7.3% (95% CI 4.3-10.2%) among patients who had PAM above the GOJ (reference value 3.4%).
  
  
  CONCLUSIONS
  Pancreatic acinar metaplasia might be an age-dependent lesion, associated with H. pylori, female gender and gastro-oesophageal reflux if located above the GOJ.
authors.affiliation: Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, P.O. Box 281, 171 77, Stockholm, Sweden. Johan.Johansson@ki.se
authors.forename: Johan
authors.initials: J
authors.lastname: Johansson
authors.forename: Hans-Olof
authors.initials: HO
authors.lastname: Håkansson
authors.forename: Lennart
authors.initials: L
authors.lastname: Mellblom
authors.forename: Antti
authors.initials: A
authors.lastname: Kempas
authors.forename: Gerhard
authors.initials: G
authors.lastname: Kjellén
authors.forename: Lars
authors.initials: L
authors.lastname: Brudin
authors.forename: Fredrik
authors.initials: F
authors.lastname: Granath
authors.forename: Karl-Erik
authors.initials: KE
authors.lastname: Johansson
authors.forename: Olof
authors.initials: O
authors.lastname: Nyrén
mesh_terms: D000367:Age Factors; D002299:Cardia / Q000473:pathology*; D003430:Cross-Sectional Studies; D016145:Endoscopy, Digestive System / Q000379:methods; D004943:Esophagogastric Junction / Q000473:pathology*; D004947:Esophagus / Q000473:pathology*; D005260:Female; D005764:Gastroesophageal Reflux / Q000473:pathology*; D016481:Helicobacter Infections / Q000453:epidemiology / Q000382:microbiology; D016480:Helicobacter pylori / Q000302:isolation & purification; D006801:Humans; D006863:Hydrogen-Ion Concentration; D016015:Logistic Models; D008297:Male; D008679:Metaplasia / Q000473:pathology; D008875:Middle Aged; D010179:Pancreas / Q000473:pathology; D015995:Prevalence; D012307:Risk Factors; D012737:Sex Factors