Columnar-lined oesophagus without intestinal metaplasia: results from a cohort with a mean follow-up of 7 years.
BACKGROUND
The definition of Barrett's oesophagus lacks consensus, particularly the requirement of intestinal metaplasia for diagnosis. Scarce information exists on the prevalence and natural history of columnar-lined oesophagus without intestinal metaplasia.


OBJECTIVE
To evaluate the demographics and natural history of columnar-lined oesophagus without intestinal metaplasia ≥ 2 cm in length.


METHODS
Patients with columnar-lined oesophagus ≥ 2 cm in length and no intestinal metaplasia in biopsy specimens from two consecutive endoscopies with at least a 1-year interval were prospectively followed. A cohort of Barrett's oesophagus patients was used as a control.


RESULTS
Columnar-lined oesophagus without intestinal metaplasia (n = 15) had a similar gender distribution, reflux symptoms prevalence and length as those of Barrett's oesophagus (n = 205). Patients were significantly younger (28.6 vs. 60 years, P < 0.0001) and accounted for 48% of patients aged <40 years in the two cohorts, but only 1% of those aged >40 years (P < 0.001). Patient distribution in both cohorts in 5 age brackets (0-19, 20-29, 30-39, 40-49, and >50 years) was significantly different, except for patients aged 40-49 years. Intestinal metaplasia was documented in 60% of the cohort after a mean follow-up of 7.1 years.


CONCLUSIONS
Columnar-lined oesophagus without intestinal metaplasia ≥ 2 cm is infrequent in the setting of a systematic biopsy protocol, is associated with a younger age in comparison with Barrett's oesophagus, and appears to be an intermediate step between squamous and intestinal lining of the oesophagus.
Department of Gastroenterology, Instituto Português de Oncologia de Lisboa de Francisco Gentil, EPE, Lisbon, Portugal. adiaspereira1@gmail.com
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Chaves
D000293:Adolescent; D000328:Adult; D001471:Barrett Esophagus / Q000150:complications / Q000473:pathology*; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008679:Metaplasia / Q000150:complications / Q000473:pathology; D008875:Middle Aged; D012720:Severity of Illness Index; D055815:Young Adult