Intestinal metaplasia of the gastric cardia

findings in patients with versus without Barrett's esophagus

Hassan A. Siddiki, Dora M. Lam-Himlin, Allon Kahn, M. Veronica Bandres, George E. Burdick, Michael D. Crowell, Rahul Pannala, Francisco C Ramirez, Marcelo F. Vela, David E. Fleischer

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
JournalGastrointestinal Endoscopy
DOIs
StateAccepted/In press - Jan 1 2019

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Cardia
Barrett Esophagus
Metaplasia
Stomach
Biopsy
Mucous Membrane
Odds Ratio
Confidence Intervals
Pathology
Digestive System Endoscopy
Therapeutics
Gastric Mucosa
Endoscopy
Adenocarcinoma

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

Cite this

Siddiki, H. A., Lam-Himlin, D. M., Kahn, A., Bandres, M. V., Burdick, G. E., Crowell, M. D., ... Fleischer, D. E. (Accepted/In press). Intestinal metaplasia of the gastric cardia: findings in patients with versus without Barrett's esophagus. Gastrointestinal Endoscopy. https://doi.org/10.1016/j.gie.2018.10.048

Intestinal metaplasia of the gastric cardia : findings in patients with versus without Barrett's esophagus. / Siddiki, Hassan A.; Lam-Himlin, Dora M.; Kahn, Allon; Bandres, M. Veronica; Burdick, George E.; Crowell, Michael D.; Pannala, Rahul; Ramirez, Francisco C; Vela, Marcelo F.; Fleischer, David E.

In: Gastrointestinal Endoscopy, 01.01.2019.

Research output: Contribution to journalArticle

Siddiki, Hassan A. ; Lam-Himlin, Dora M. ; Kahn, Allon ; Bandres, M. Veronica ; Burdick, George E. ; Crowell, Michael D. ; Pannala, Rahul ; Ramirez, Francisco C ; Vela, Marcelo F. ; Fleischer, David E. / Intestinal metaplasia of the gastric cardia : findings in patients with versus without Barrett's esophagus. In: Gastrointestinal Endoscopy. 2019.
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abstract = "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.",
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AU - Siddiki, Hassan A.

AU - Lam-Himlin, Dora M.

AU - Kahn, Allon

AU - Bandres, M. Veronica

AU - Burdick, George E.

AU - Crowell, Michael D.

AU - Pannala, Rahul

AU - Ramirez, Francisco C

AU - Vela, Marcelo F.

AU - Fleischer, David E.

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Y1 - 2019/1/1

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AB - 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.

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