Gastroenterology

Gastroenterology

Volume 116, Issue 2, February 1999, Pages 277-285
Gastroenterology

Alimentary Tract
Specialized intestinal metaplasia, dysplasia, and cancer of the esophagus and esophagogastric junction: Prevalence and clinical data,☆☆,,★★

Presented at the 1997 meeting of the American Gastroenterological Association Research Forum, Digestive Disease Week, Washington, D.C., as an oral presentation (Gastroenterology 1997;112:A149 and A577).
https://doi.org/10.1016/S0016-5085(99)70123-XGet rights and content

Abstract

Background & Aims: Adenocarcinoma of the esophagus and esophagogastric junction (EGJ) is increasing, the earliest lesion being specialized intestinal metaplasia (SIM). This study determined the prevalence and demographic features of patients with SIM, dysplasia, and cancer in the esophagus and EGJ. Methods: Two antegrade biopsy specimens were taken distal to the squamocolumnar junction (SCJ) and any tongues of pink mucosa proximal to the SCJ. Patients were categorized endoscopically and histologically as having long-segment (LSBE) or short-segment Barrett's esophagus (SSBE), EGJ-SIM, or a normal EGJ. Results: Of 889 patients studied, 56 were undergoing esophagoduodenoscopy screening or surveillance and were not included in the prevalence calculation. The overall prevalence of SIM was 13.2%, with 1.6% LSBE, 6.0% SSBE, and 5.6% EGJ-SIM. Dysplasia or cancer was noted in 31% of LSBE, 10% of SSBE, and 6.4% of EGJ-SIM patients (P ≤ 0.043). Two cancers were associated with LSBE, 1 with SSBE, and 1 with EGJ-SIM. Patients with LSBE and SSBE were predominantly white (P ≤ 0.001), male (P ≤ 0.009), and smokers (P ≤ 0.004), with LSBE patients having a longer history of heartburn (P ≤ 0.009). In contrast, patients with EGJ-SIM were similar in gender and ethnicity to the reference group, tended to be older (P ≤ 0.05), drank less alcohol (P ≤ 0.02), and had a higher prevalence of Helicobacter pylori infection (P ≤ 0.05). Conclusions: The prevalence of SSBE and EGJ-SIM is similar, but each entity is 3.5 times more prevalent than LSBE. However, the prevalence of dysplasia in LSBE is 2 times greater than in SSBE and 4 times greater than in EGJ-SIM. Demographically, EGJ-SIM patients are different from patients with Barrett's esophagus and have a higher prevalence of H.pylori infection. These data help to explain the increasing incidence of adenocarcinoma of the distal esophagus and EGJ.

GASTROENTEROLOGY 1999;116:277-285

Section snippets

Patients

The Walter Reed Army Medical Center (WRAMC) Gastroenterology Service is a tertiary referral center whose patient referral base comprises all Department of Defense beneficiaries, which include active-duty military and family members, public health service personnel, retirees, and all eligible Department of Defense designees. Study participants were selected from this population with the following exclusion criteria: (1) failure to give informed consent, (2) age less than 18 years, (3)

Patient characteristics

From January 1995 to September 1996, 1181 consecutive patients were referred for an endoscopic evaluation; 889 (75%) were eligible and consented to participate in the study (Figure 1).

. Study population.

Fifty-six of these patients had suspected or known Barrett's esophagus and were not included in the prevalence calculations, but were included in the demographic data calculations. Of the 292 patients who did not participate in this study, 131 (45%) declined to participate and 161 (55%) were

Discussion

The clinical distinction between SIM of the esophagus and EGJ has not been well characterized. Investigators interested in the increasing incidence of adenocarcinoma of the esophagus postulate that Barrett's epithelium as defined by the presence of SIM in the esophagus is the precursor lesion to dysplasia and possible progression to cancer.18 In addition, the increase in the incidence of adenocarcinoma of the gastric cardia is thought to represent either the downward extension of, or possible

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  • Cited by (0)

    Address requests for reprints to: Roy K. H. Wong, M.D., Walter Reed Army Medical Center, 6900 Georgia Avenue Northwest, Building 2, Room 7F, Washington, D.C. 20307-5001.

    ☆☆

    Supported by the Department of Clinical Investigation under Work Unit no. 1432.

    Dr. Hirota's current address is: Madigan Army Medical Center, Tacoma, Washington 98431; Dr. Loughney's current address is: Tripler Army Medical Center, Honolulu, Hawaii 96859.

    ★★

    The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of the Army or the Department of Defense.

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