Original Scientific Paper

European Surgery

, Volume 44, Issue 5, pp 304-313

First online:

Assessment of columnar-lined esophagus in controls and patients with gastroesophageal reflux disease with and without proton-pump inhibitor therapy

  • I. MesteriAffiliated withDepartment of Surgery, Medical University of Vienna
  • , J. LenglingerAffiliated withDepartment of Surgery, Medical University of Vienna
  • , L. BellerAffiliated withDepartment of Surgery, Medical University of Vienna
  • , S. Fischer-SeeAffiliated withDepartment of Surgery, Medical University of Vienna
  • , Sebastian F. SchoppmannAffiliated withDepartment of Surgery, Medical University of Vienna
  • , F. WrbaAffiliated withInstitute for Clinical Pathology, Medical University of Vienna
  • , F. M. RieglerAffiliated withDepartment of Surgery, Medical University of Vienna Email author 
  • , J. ZacherlAffiliated withDepartment of Surgery, Medical University of Vienna

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Summary

Background

Gastroesophageal reflux disease (GERD) is associated with columnar-lined esophagus (CLE) without and with intestinal metaplasia (IM), i.e., nondysplastic Barrett’s esophagus (NDBE; 0.5 % annual cancer risk). We aimed to compare endoscopy and histopathology in controls and GERD patients with and without proton-pump inhibitor (PPI) therapy.

Methods

We conducted endoscopy with four-quadrant multi-level biopsy sampling of any endoscopically visible columnar-lined esophagus (CLEv) in 0.5 cm increments and at 0.5 and 1.0 cm distal to the level of the rise of the endoscopic gastric-type folds in controls (n = 76), GERD patients with (n = 177) and without (n = 38) PPI therapy. Squamous epithelium (Squ) of the esophagus and oxyntic mucosa (OM) of the proximal stomach defined normalcy. CLE included oxyntocardiac, cardiac mucosa (CM) ± IM.

Results

All persons had CLE interposed between Squ and OM. Frequency and distribution of endoscopic and histopathologic findings did not differ between the three groups (p > 0.05). Frequency of IM was 13.2, 26.3, and 20.9 % in controls, GERD patients with and without PPI therapy, respectively (p = 0.194). The frequency of IM increased with longer CLEv. In 50 % of the cases, CLE included more than the proximal 1.0 cm portion of the endoscopically visible gastric-type folds.

Conclusions

The frequency of IM is independent from the presence or absence of GERD symptoms and increases with increased length of CLEv. The proximal portion of the endoscopic gastric-type folds contains CLE and not OM. Thus, what is taken for proximal stomach during endoscopy represents gastric folds forming sac-like CLE.

Keywords

Barrett’s esophagus Columnar-lined esophagus Endoscopy Dilated distal esophagus Gastroesophageal reflux disease Histopathology Squamooxyntic gap