title: Progression of specialized intestinal metaplasia at the cardia to macroscopically evident Barrett's esophagus: an entity of concern in the ProGERD study.
abstract: OBJECTIVE
  Histological Barrett's esophagus, defined as specialized intestinal metaplasia (SIM+) at the cardia without endoscopic suspicion of columnar epithelium, is found frequently in biopsies at the gastro-esophageal junction although its clinical relevance is unknown. The authors aim was to evaluate prospectively the progression of SIM+ to macroscopically evident Barrett's esophagus (BE/SIM+), and to identify risk factors for this progression.
  
  
  METHODS
  Data were obtained from a sub-group of patients (no visible BE at presentation, but SIM+) included in the ProGERD study, a prospective evaluation of the clinical course of GERD under routine clinical care. They had esomeprazole 20-40 mg/day for 2-8 weeks. Symptom assessment was performed annually, and endoscopy with biopsy was planned at baseline, after healing treatment and after 2 and/or 5 years.
  
  
  RESULTS
  128 of 171 (74.8%) patients with unequivocal SIM at the z-line after healing were biopsied again after 2 and/or 5 years. At follow-up, 33 (25.8%) of these patients showed progression to BE/SIM+. Factors significantly associated with progression were smoking, a long history of GERD and severe esophagitis at baseline. Patients who had progressed to BE/SIM+ already at 2 years showed consistent findings at 5 years.
  
  
  CONCLUSIONS
  More than 20% of GERD patients with SIM+ in this study were found to have BE/SIM+ within 2-5 years. This finding supports the hypothesis that SIM+ at the cardia could be the missing link explaining increased cancer risk in GERD patients without overt BE and merits further investigation in a prospective study.
authors.affiliation: Department of Gastroenterology, Hepatology and Infectious Diseases, Sana-Klinikum Remscheid, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Leodolter
authors.forename: Marc
authors.initials: M
authors.lastname: Nocon
authors.forename: Michael
authors.initials: M
authors.lastname: Vieth
authors.forename: Tore
authors.initials: T
authors.lastname: Lind
authors.forename: Daniel
authors.initials: D
authors.lastname: Jaspersen
authors.forename: Kai
authors.initials: K
authors.lastname: Richter
authors.forename: Stefan
authors.initials: S
authors.lastname: Willich
authors.forename: Manfred
authors.initials: M
authors.lastname: Stolte
authors.forename: Peter
authors.initials: P
authors.lastname: Malfertheiner
authors.forename: Joachim
authors.initials: J
authors.lastname: Labenz
mesh_terms: D000328:Adult; D000368:Aged; D001471:Barrett Esophagus / Q000209:etiology / Q000473:pathology*; D001706:Biopsy; D002299:Cardia / Q000473:pathology*; D016001:Confidence Intervals; D016099:Endoscopy, Gastrointestinal; D064098:Esomeprazole / Q000627:therapeutic use; D004941:Esophagitis / Q000209:etiology; D004943:Esophagogastric Junction / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D005764:Gastroesophageal Reflux / Q000150:complications / Q000188:drug therapy / Q000473:pathology*; D006801:Humans; D008297:Male; D008679:Metaplasia; D008875:Middle Aged; D016017:Odds Ratio; D011446:Prospective Studies; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D012907:Smoking; D013997:Time Factors
chemical_list: D054328:Proton Pump Inhibitors; D064098:Esomeprazole