Columnar-lined Esophagus: Its Prevalence and Predictors in Patients With Gastroesophageal Reflux Disease (Am J Gastroenterol 2012;107:1655-1661)

Abstract

The prevalence of Barrett's esophagus has varied based on the study population diversity and the definition of Barrett's esophagus used. Because intestinal metaplasia in the distal esophagus predisposes to esophageal adenocarcinoma, Barrett's esophagus is defined as a condition in which normal stratified squamous epithelium is replaced by metaplastic columnar epithelium in the distal esophagus with histopathological evidence of intestinal metaplasia.1 However in other areas (UK and Asia), Barrett's esophagus is diagnosed solely based on the presence of columnar-lined esophagus (CLE) on endoscopy without the need to document intestinal metaplasia.2,3 This definition has been supported by some previous studies suggesting comparable cancer risk among those with CLE with and without intestinal metaplasia, and sampling error to identify goblet cells.4,5 Recently, Balasubramanian et al6 conducted a prospective study on 1,058 subjects with gastroesophageal reflux disease (GERD) to evaluate the prevalence and predictors of CLE. In this study, the prevalence of CLE was 23.3%, whereas of CLE with documented intestinal metaplasia was 14.1%. By time trend analysis, there was no significant changes in the prevalence of CLE over the study period. On univariate analysis, male gender, Caucasian race, heartburn duration > 5 years, presence and size of hiatal hernia were significantly associated with the presence of CLE. On multivariate analysis, heartburn duration > 5 years (OR, 1.50; 95% CI, 1.07-2.09), Caucasian race (OR, 2.40; 95% CI, 1.42-4.03), and hiatal hernia (OR, 2.07; 95% CI, 1.50-2.87) were found to be independent predictors for CLE. Therefore, they concluded that if BE is defined by the presence of CLE alone on upper endoscopy, up to 25% of GERD patients would be diagnosed with this lesion, and enrolling all these patients in surveillance programs would have significant ramifications on health-care resources.