title: Barrett's esophagus and intestinal metaplasia of gastric cardia: prevalence, clinical, endoscopic and histological features.
abstract: OBJECTIVE
  Over the past few decades, the incidence of adenocarcinomas of the gastroesophageal junction has rapidly increased. Barrett's esophagus is a risk factor for esophageal adenocarcinoma, but the role of intestinal metaplasia of the gastric cardia as a precursor in cardia-related cancer is controversial. The aims of the present study were to examine the prevalence of intestinal metaplasia in the gastroesophageal junction and to evaluate the clinical, endoscopical and histological features of patients with intestinal metaplasia in the gastric cardia and patients with Barrett's esophagus.
  
  
  METHODS
  286 consecutive patients undergoing gastroduodenoscopy were enrolled in a prospective study. Biopsy specimens were performed in the distal esophagus, squamocolumnar junction, gastric cardia, gastric corpus and antrum.
  
  
  RESULTS
  We identified 44 patients (15.3%) with intestinal metaplasia in biopsies from gastric cardia and 24 patients (8.3%) with Barrett's esophagus. Cardia intestinal metaplasia was significantly associated with older age (p=0.03), with intestinal metaplasia in the antrum (p=0.017) and H. pylori infection (p<0.0001). Severe chronic cardia inflammation increased the presence of cardia intestinal metaplasia 6.2 fold (OR=6.288; p<0.0001). Patients with Barrett's esophagus were predominantly men. Barrett's esophagus presence significantly correlated with reflux symptoms(p<0.0001), endoscopic esophagitis (p<0.0001) and hiatal hernia >2 cm (p=0.002). No patient had dysplasia in the gastroesophageal region.
  
  
  CONCLUSIONS
  Presence of intestinal metaplasia at the gastroesophageal region correlated with reflux symptoms and endoscopic signs of reflux disease in patients with Barrett's esophagus and with H.pylori infection and distal intestinal metaplasia in patients with cardia intestinal metaplasia.
authors.affiliation: Department of Gastroenterology, Mures County Hospital, University of Medicine and Pharmacy, Targu Mures, Romania. ofeliapascarenco25@yahoo.com.
authors.forename: Ofelia Daniela
authors.initials: OD
authors.lastname: Pascarenco
authors.affiliation: Department of Gastroenterology, Mures County Hospital, University of Medicine and Pharmacy, Targu Mures, Romania.
authors.forename: Alina
authors.initials: A
authors.lastname: Boeriu
authors.affiliation: Department of Pathology University of Medicine and Pharmacy, Targu Mures, Romania.
authors.forename: Simona
authors.initials: S
authors.lastname: Mocan
authors.affiliation: Department of Surgery, Mures County Hospital, University of Medicine and Pharmacy, Targu Mures, Romania.
authors.forename: Ghenadie
authors.initials: G
authors.lastname: Pascarenco
authors.affiliation: Department of Gastroenterology, Mures County Hospital, University of Medicine and Pharmacy, Targu Mures, Romania.
authors.forename: Silvia
authors.initials: S
authors.lastname: Drasoveanu
authors.affiliation: Department of Gastroenterology, Municipal Hospital, Campulung Moldovenesc, Suceava Romania.
authors.forename: Marinela
authors.initials: M
authors.lastname: Galeanu
authors.affiliation: Department of Gastroenterology, Mures County Hospital, University of Medicine and Pharmacy, Targu Mures, Romania.
authors.forename: Daniela
authors.initials: D
authors.lastname: Dobru
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis* / Q000382:microbiology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000175:diagnosis* / Q000382:microbiology; D001706:Biopsy; D002299:Cardia / Q000473:pathology*; D004384:Duodenoscopy; D004938:Esophageal Neoplasms / Q000175:diagnosis* / Q000382:microbiology; D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000382:microbiology; D005773:Gastroscopy; D016481:Helicobacter Infections / Q000150:complications; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D008679:Metaplasia / Q000175:diagnosis / Q000382:microbiology; D008875:Middle Aged; D011230:Precancerous Conditions / Q000175:diagnosis* / Q000382:microbiology; D011446:Prospective Studies; D055815:Young Adult