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Clinical, endoscopic, and functional studies in 408 patients with Barrett's esophagus, compared to 174 cases of intestinal metaplasia of the cardia.
Am J Gastroenterol. 2002 Mar; 97(3):554-60.AJ

Abstract

OBJECTIVE

The pathophysiology of gastroesophageal reflux disease (GERD) has been studied extensively in patients with long-segment Barrett's esophagus (LSBE), but few reports have explored GERD pathophysiology in patients who have short-segment Barrett's esophagus (SSBE) or intestinal metaplasia at the cardia (IMC). We aimed to compare clinical, endoscopic, histological, and functional features in patients with LSBE, SSBE, and IMC.

METHODS

We identified 582 patients who had intestinal metaplasia at the squamocolumnar junction in the distal esophagus and divided them into three groups based on the extent of columnar-lined esophagus observed endoscopically: 1) patients with IMC who had no columnar-lined esophagus (i.e., the squamocolumnar and gastroesophageal junctions coincided), 2) patients with LSBE who had >3 cm of columnar-lined esophagus, and 3) patients with SSBE who had <3 cm of columnar-lined esophagus. All patients had esophageal manometric evaluation, and 24-h esophageal pH monitoring was performed to determine the extent of acid and bile (bilirubin) reflux.

RESULTS

There were 174 patients with IMC, 155 with LSBE, and 25 with SSBE. Compared to patients with LSBE and SSBE, patients with IMC had significantly lower frequencies of GERD symptoms, hiatal hernia, and erosive esophagitis; significantly higher lower esophageal sphincter pressures; and significantly shorter durations of acid and bile reflux. Between patients with SSBE and LSBE, significant differences were found in the frequency of hiatal hernia and duration of acid reflux (both greater in the patients with LSBE). Also, dysplasia was significantly more frequent in patients with LSBE than in those with SSBE or IMC.

CONCLUSION

GERD symptoms, signs, and physiological abnormalities are found more often in patients with Barrett's esophagus than in those with IMC, and the duration of acid reflux in patients with LSBE is greater than that in patients with SSBE. These findings suggest that the extent of intestinal metaplasia in the esophagus is related directly to the severity of underlying GERD.

Authors+Show Affiliations

Department of Surgery and Pathology, University Hospital, Santiago, Chile.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

11922546

Citation

Csendes, Attila, et al. "Clinical, Endoscopic, and Functional Studies in 408 Patients With Barrett's Esophagus, Compared to 174 Cases of Intestinal Metaplasia of the Cardia." The American Journal of Gastroenterology, vol. 97, no. 3, 2002, pp. 554-60.
Csendes A, Smok G, Quiroz J, et al. Clinical, endoscopic, and functional studies in 408 patients with Barrett's esophagus, compared to 174 cases of intestinal metaplasia of the cardia. Am J Gastroenterol. 2002;97(3):554-60.
Csendes, A., Smok, G., Quiroz, J., Burdiles, P., Rojas, J., Castro, C., & Henríquez, A. (2002). Clinical, endoscopic, and functional studies in 408 patients with Barrett's esophagus, compared to 174 cases of intestinal metaplasia of the cardia. The American Journal of Gastroenterology, 97(3), 554-60.
Csendes A, et al. Clinical, Endoscopic, and Functional Studies in 408 Patients With Barrett's Esophagus, Compared to 174 Cases of Intestinal Metaplasia of the Cardia. Am J Gastroenterol. 2002;97(3):554-60. PubMed PMID: 11922546.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical, endoscopic, and functional studies in 408 patients with Barrett's esophagus, compared to 174 cases of intestinal metaplasia of the cardia. AU - Csendes,Attila, AU - Smok,Gladys, AU - Quiroz,Juan, AU - Burdiles,Patricio, AU - Rojas,Jorge, AU - Castro,César, AU - Henríquez,Ana, PY - 2002/4/2/pubmed PY - 2002/4/20/medline PY - 2002/4/2/entrez SP - 554 EP - 60 JF - The American journal of gastroenterology JO - Am. J. Gastroenterol. VL - 97 IS - 3 N2 - OBJECTIVE: The pathophysiology of gastroesophageal reflux disease (GERD) has been studied extensively in patients with long-segment Barrett's esophagus (LSBE), but few reports have explored GERD pathophysiology in patients who have short-segment Barrett's esophagus (SSBE) or intestinal metaplasia at the cardia (IMC). We aimed to compare clinical, endoscopic, histological, and functional features in patients with LSBE, SSBE, and IMC. METHODS: We identified 582 patients who had intestinal metaplasia at the squamocolumnar junction in the distal esophagus and divided them into three groups based on the extent of columnar-lined esophagus observed endoscopically: 1) patients with IMC who had no columnar-lined esophagus (i.e., the squamocolumnar and gastroesophageal junctions coincided), 2) patients with LSBE who had >3 cm of columnar-lined esophagus, and 3) patients with SSBE who had <3 cm of columnar-lined esophagus. All patients had esophageal manometric evaluation, and 24-h esophageal pH monitoring was performed to determine the extent of acid and bile (bilirubin) reflux. RESULTS: There were 174 patients with IMC, 155 with LSBE, and 25 with SSBE. Compared to patients with LSBE and SSBE, patients with IMC had significantly lower frequencies of GERD symptoms, hiatal hernia, and erosive esophagitis; significantly higher lower esophageal sphincter pressures; and significantly shorter durations of acid and bile reflux. Between patients with SSBE and LSBE, significant differences were found in the frequency of hiatal hernia and duration of acid reflux (both greater in the patients with LSBE). Also, dysplasia was significantly more frequent in patients with LSBE than in those with SSBE or IMC. CONCLUSION: GERD symptoms, signs, and physiological abnormalities are found more often in patients with Barrett's esophagus than in those with IMC, and the duration of acid reflux in patients with LSBE is greater than that in patients with SSBE. These findings suggest that the extent of intestinal metaplasia in the esophagus is related directly to the severity of underlying GERD. SN - 0002-9270 UR - https://www.unboundmedicine.com/medline/citation/11922546/Clinical_endoscopic_and_functional_studies_in_408_patients_with_Barrett's_esophagus_compared_to_174_cases_of_intestinal_metaplasia_of_the_cardia_ L2 - http://Insights.ovid.com/pubmed?pmid=11922546 DB - PRIME DP - Unbound Medicine ER -