• OESOPHAGEAL DISEASE
• GASTROESOPHAGEAL REFLUX DISEASE
• BARRETT'S OESOPHAGUS

Botha opened his 1958 Hunterian Lecture on the gastro-oesophageal junction (GOJ) with the provocative statement that, despite a 300-year controversy and countless observations and experiments, ‘our knowledge of the cardia is still meagre and conflicting, and the vast literature abounds with more fantasy that fact.’1

The cardia, originally an anatomical term for the segment of stomach just distal to the oesophagus, owes its unfortunate name to Galen,2 who believed that the upper orifice of the stomach should be called cardia because it gave rise to symptoms similar to those associated with the heart. A more precise definition was hardly missed for many centuries, but in the last few decades interest in ‘cardiospasm’ and in the reflux of gastric contents into the oesophagus, the discovery of Barrett mucosa and the upsurge of junctional cancer have prompted searches for a more specific characterisation of this area. Meanwhile, pathologists and clinicians alike have shifted the meaning of cardia, from an anatomic location defined by its more famous neighbour to a short portion of the gastric mucosa with certain histological characteristics. Agreement on the nature of these histological characteristics has been so poor that the literature is replete with statements ranging from ‘the cardia does not exist’ to ‘the cardia extends 3 cm distal to the squamocolumnar junction.’ Unsurprisingly, our understanding of this region has been called a ‘a frustrating adventure in ambiguity’3 and, more harshly, a ‘fantasy.’4

These passionate phrases were written decades ago by researchers who, appalled by …