Background and Aims

There is controversy about finding intestinal metaplasia (IM) of the gastric cardia on biopsy. The most recent American College of Gastroenterology guideline comments that IM cardia is not more common in patients with Barrett’s esophagus (BE). It provides limited guidance on whether the cardia should be treated when patients with BE undergo endoscopic eradication therapy (EET) and whether the cardia should undergo biopsy after ablation. The aims of our study were to determine the frequency in the proximal stomach of (1) histologic gastric cardia mucosa and (2) IM cardia. A third aim was to explore the frequency of advanced pathology (dysplasia and adenocarcinoma) in the cardia after patients with BE have undergone EET.

Methods

Consecutive patients undergoing esophagogastroduodenoscopy between January 2008 and December 2014 who had proximal stomach biopsies were included. Patients who had histologically confirmed BE were compared with those without BE.

Results

Four hundred sixty-two patients, 289 with BE and 173 without BE, were included. Histologically confirmed cardiac mucosa was found in 81.6% of all patients. This was more frequent in those with versus without BE (86% vs 75%; odds ratio [OR], 2.06; 95% confidence interval [CI], 1.28-3.32; P = .003). IM cardia was more common in the BE group (17% vs 7%; OR, 2.67; 95% CI, 1.38-5.19; P = .004). Advanced pathology was more likely in the patients with BE who had undergone EET.

Conclusions

Cardiac mucosa is present in most patients who undergo endoscopy for upper GI symptoms. IM cardia is more common in patients with BE than those without. Advanced histologic changes in the cardia were seen only in the subgroup of patients with BE who had undergone EET.

中文翻译：

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胃card门的肠上皮化生：巴雷特食管与非巴雷特食管患者的发现

背景和目标

关于在活检中发现胃card门的肠上皮化生（IM）存在争议。最新的美国胃肠病学院指南指出，IM心脏在Barrett食管（BE）患者中并不常见。它对BE患者接受内镜根除治疗（EET）时是否应治疗card门以及消融后是否应进行活检提供了有限的指导。我们研究的目的是确定（1）组织学gastric门粘膜和（2）IM card门在胃近端的频率。第三个目标是探讨BE患者接受EET后the门的高级病理（不典型增生和腺癌）的发生频率。

方法

包括2008年1月至2014年12月间接受食管胃十二指肠镜检查的连续患者，并进行了近端胃活检。在组织学上证实BE的患者与没有BE的患者进行比较。

结果

纳入462例患者，其中289例患有BE，173例未患有BE。组织学证实的心脏黏膜在所有患者中占81.6％。在有无BE的患者中这种情况更为常见（86％vs 75％；优势比[OR]为2.06； 95％置信区间[CI]为1.28-3.32；P  = 0.003）。在BE组中，IM card门更为常见（17％vs 7％； OR，2.67； 95％CI，1.38-5.19；P  = .004）。在接受EET的BE患者中，晚期病理学的可能性更高。

结论

接受内镜检查的上消化道症状的大多数患者都存在心脏粘膜。在有BE的患者中，IM心脏比没有BE的患者更为常见。仅在接受过EET的BE患者亚组中才能观察到the门的高级组织学改变。