European Surgery

, Volume 44, Issue 5, pp 304–313 | Cite as

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

  • I. Mesteri
  • J. Lenglinger
  • L. Beller
  • S. Fischer-See
  • Sebastian F. Schoppmann
  • F. Wrba
  • F. M. Riegler
  • J. Zacherl
Original Scientific Paper



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.


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.


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.


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.


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


Conflict of interest statement

The authors inform that there exists no conflict of interest.


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Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • I. Mesteri
    • 1
  • J. Lenglinger
    • 1
  • L. Beller
    • 1
  • S. Fischer-See
    • 1
  • Sebastian F. Schoppmann
    • 1
  • F. Wrba
    • 2
  • F. M. Riegler
    • 1
  • J. Zacherl
    • 1
  1. 1.Department of SurgeryMedical University of ViennaViennaAustria
  2. 2.Institute for Clinical PathologyMedical University of ViennaViennaAustria

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