Esophageal strictures and lower esophagus lined with columnar epithelium. Functional and morphologic studies.

Abstract

Radiographic, manometric, simultaneous radiographic-manometric, endoscopic, histologic and gastric secretory studies were performed on 12 consecutive patients with a benign peptic esophageal stricture. All patients had a segment of esophagus lined with columnar epithelium below the stricture and a small hiatal hernia. Four of them had a normotensive competent gastroesophageal sphincter and no evidence for reflux. Eight patients had free gastroesophageal reflux through a weak, incompetent sphincter. Esophagitis was not universally present. The type of heterotopic mucosa as well as the gastric secretory values showed no uniform pattern. Four patients with a fundic type of epithelium in the lower esophagus had discrete esophageal ulcers, but only 2 of them had evident gastroesophageal reflux. Local secretion of gastric juice seems to play a role in the genesis of these ulcers. There are strong arguments in favor of a congenital heterotopic mucosal lining in the lower esophagus in some patients, although a contributing role for reflux esophagitis cannot be excluded in others.