Cardiac mucosa at the gastroesophageal junction: An Eastern perspective.
To investigate the nature and origin of cardiac mucosa (CM).



Biopsy samples from sixty-one individuals were included in this study. The specimens were taken "at", "just below", or "just above" the gastroesophageal junction, including the histologic squamocolumnar junction. Clinical data were obtained by reviewing electronic medical records for each patient. Patients with a history of stomach adenoma or carcinoma and esophageal carcinoma were excluded, and cases that were endoscopically suspicious of Barrett's esophagus or a polyp were also ruled out. Histologic and endoscopic reviews were performed blinded to the patient's clinical data. Histologic evaluation was conducted by two pathologists, and endoscopic review was performed by a endoscopist with wide experience in the field. Histologically, the columnar epithelium of squamocolumnar junction, presence and severity of acute and chronic inflammation, atrophy, intestinal metaplasia, and presence of carditis were evaluated. Endoscopically, reflux esophagitis was evaluated by Los Angeles (LA) classification, hiatal hernias were classified by Hill grade, and gastroesophageal flap valves were assessed.



Fifty-nine of the 61 (96.7%) patients were Korean; 65.6% (40/61) of the patients underwent endoscopy according to the schedule of the National Health Insurance Program as a screening inspection. Of these, only 20.0% (8/40) of cases had reflux symptoms. CM was present in 41/61 (67.2%) individuals, and its presence was associated with older age compared to oxyntocardiac mucosa/oxyntic mucosa (60.59 ± 2.02 years vs 51.55 ± 3.35 years; P = 0.018). The presence of CM was associated with endoscopic diagnosis of esophagitis according to the LA classification (P = 0.022). CM was associated with mononuclear cell infiltration and neutrophilic infiltration, which were statistically significant (P = 0.001, and P = 0.004, respectively). The inflammation of CM, "carditis", showed a statistically significant association with endoscopic diagnosis of reflux esophagitis according to the LA classification (P = 0.008).



CM at the gastroesophageal junction is a common histologic finding in biopsy specimens, though not always present, and associated with gastroesophageal reflux disease and carditis severity.
Ahrong Kim, Won-Young Park, Nari Shin, Hyun Jung Lee, Young Keum Kim, So Jeong Lee, Cheong-Soo Hwang, Do Youn Park, Department of Pathology, BioMedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan 602-739, South Korea.
Ahrong
A
Kim
Ahrong Kim, Won-Young Park, Nari Shin, Hyun Jung Lee, Young Keum Kim, So Jeong Lee, Cheong-Soo Hwang, Do Youn Park, Department of Pathology, BioMedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan 602-739, South Korea.
Won-Young
WY
Park
Ahrong Kim, Won-Young Park, Nari Shin, Hyun Jung Lee, Young Keum Kim, So Jeong Lee, Cheong-Soo Hwang, Do Youn Park, Department of Pathology, BioMedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan 602-739, South Korea.
Nari
N
Shin
Ahrong Kim, Won-Young Park, Nari Shin, Hyun Jung Lee, Young Keum Kim, So Jeong Lee, Cheong-Soo Hwang, Do Youn Park, Department of Pathology, BioMedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan 602-739, South Korea.
Hyun Jung
HJ
Lee
Ahrong Kim, Won-Young Park, Nari Shin, Hyun Jung Lee, Young Keum Kim, So Jeong Lee, Cheong-Soo Hwang, Do Youn Park, Department of Pathology, BioMedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan 602-739, South Korea.
Young Keum
YK
Kim
Ahrong Kim, Won-Young Park, Nari Shin, Hyun Jung Lee, Young Keum Kim, So Jeong Lee, Cheong-Soo Hwang, Do Youn Park, Department of Pathology, BioMedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan 602-739, South Korea.
So Jeong
SJ
Lee
Ahrong Kim, Won-Young Park, Nari Shin, Hyun Jung Lee, Young Keum Kim, So Jeong Lee, Cheong-Soo Hwang, Do Youn Park, Department of Pathology, BioMedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan 602-739, South Korea.
Cheong-Soo
CS
Hwang
Ahrong Kim, Won-Young Park, Nari Shin, Hyun Jung Lee, Young Keum Kim, So Jeong Lee, Cheong-Soo Hwang, Do Youn Park, Department of Pathology, BioMedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan 602-739, South Korea.
Do Youn
DY
Park
Ahrong Kim, Won-Young Park, Nari Shin, Hyun Jung Lee, Young Keum Kim, So Jeong Lee, Cheong-Soo Hwang, Do Youn Park, Department of Pathology, BioMedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan 602-739, South Korea.
Gwang Ha
GH
Kim
Ahrong Kim, Won-Young Park, Nari Shin, Hyun Jung Lee, Young Keum Kim, So Jeong Lee, Cheong-Soo Hwang, Do Youn Park, Department of Pathology, BioMedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan 602-739, South Korea.
Bong Eun
BE
Lee
Ahrong Kim, Won-Young Park, Nari Shin, Hyun Jung Lee, Young Keum Kim, So Jeong Lee, Cheong-Soo Hwang, Do Youn Park, Department of Pathology, BioMedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan 602-739, South Korea.
Hong-Jae
HJ
Jo
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D002299:Cardia / Q000473:pathology*; D004847:Epithelial Cells / Q000473:pathology*; D004942:Esophagitis, Peptic / Q000473:pathology*; D004943:Esophagogastric Junction / Q000473:pathology*; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology*; D005756:Gastritis / Q000473:pathology*; D005764:Gastroesophageal Reflux / Q000473:pathology*; D005773:Gastroscopy; D006551:Hernia, Hiatal / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D056910:Republic of Korea; D012189:Retrospective Studies; D012720:Severity of Illness Index
Cardiac mucosa; Carditis; Gastroesophageal junction; Gastroesophageal reflux disease; Histopathology