Elsevier

The Lancet

Volume 344, Issue 8936, 3 December 1994, Pages 1533-1536
The Lancet

Articles
Prevalence of metaplasia at the gastro-oesophageal junction

https://doi.org/10.1016/S0140-6736(94)90349-2Get rights and content

Abstract

Summary

Specialised columnar epithelium (SCE), a form of intestinal metaplasia usually found in Barrett's oesophagus, cannot be distinguished endoscopically from normal gastric epithelium. Endoscopists seldom obtain biopsy specimens from a normal-appearing gastro-oesophageal junction, and therefore short segments of SCE in this region may go unrecognised.

We studied patients who had short segments of SCE at the gastro-oesophageal junction. All patients scheduled for elective endoscopic examinations in our general endoscopy unit, irrespective of indication, were questioned for symptoms of gastro-oesophageal reflux disease. At endoscopy, severity of oesophagitis was graded, and biopsy specimens obtained from the squamocolumnar junction, irrespective of its appearance or location in the oesophagus. Among 142 patients without endoscopically apparent Barrett's oesophagus, 26 (18%) were found to have SCE. All patients with SCE were white, and the male/ female ratio was 1·9. In contrast, non-whites accounted for 14% of the 114 patients without SCE and the male/female ratio was 0·8. The groups did not differ significantly in the frequency of symptoms and endoscopic signs of gastro-oesophageal reflux.

We conclude that adults frequently have unrecognised segments of SCE at the gastro-oesophageal junction; this may underlie the rising frequency of cancer of the gastro-oesophageal junction in the USA and Europe.

References (31)

  • H. Moller

    Incidence of cancer of the oesophagus, cardia and stomach in Denmark

    Eur J Cancer Prev

    (1992)
  • Le Hansson et al.

    Increasing incidence of both major histological types of esophageal carcinomas among men in Sweden

    Int J Cancer

    (1993)
  • A. Paull et al.

    The histologic spectrum of Barrett's esophagus

    N Engl J Med

    (1976)
  • Sj Spechler et al.

    Barrett's esophagus

    N Engl J Med

    (1986)
  • Bj Reid et al.

    Barrett's esophagus and adenocarcinoma

    Annu Rev Med

    (1987)
  • Cited by (0)

    View full text