Is Cellular Senescence Commonly Found in Barrett's Esophagus?

Abstract

Background: GEJ biopsies that contain inflamed squamous and columnar epithelium may represent distal esophageal columnar metaplasia or proximal gastritis (“carditis”). Pathologically, differentiation of these two disorders is difficult regardless of the presence or absence of goblet cells (GC). The aim of this study was to evaluate a wide variety of histologic features in GEJ biopsies, from a large prospective cohort of GERD patients, in order to determine their utility in predicting the presence of columnar-lined esophagus (CLE). Design: 2208 mucosal biopsies of the GEJ, from 552 GERD patients (M/F ratio: 305/247, mean age: 51 years), all of whom were endoscoped and interviewed prospectively as part of a large community clinic-based study of GERD patients in Washington state, were evaluated blindly for a wide variety of histologic features, such as mucosal and submucosal glands/ducts, multilayered epithelium (ME), type of glands (mucous, oxyntic, mixed), squamous islands, and buried columnar epithelium and correlated with the endoscopic evidence of, and length, of CLE, and with the presence of GC. The findings were also correlated with patient's clinical risk factors for BE, such as gender, race, waist:hip ratio, smoking history, and body mass index (BMI). Results: Overall, 56% of patients revealed CLE. The prevalence rates of relevant histologic features in GEJ biopsies were as follows: submucosal glands (0.6%), ducts (4%), ME (17%), GC (26%), mucous glands only (20%), oxyntic glands only (25%), mixed mucous/oxyntic glands (52%), squamous islands (15%), buried columnar epithelium (19%). The presence of ME (p=0.03), GC (p=0.001), pure mucous glands (p= 25, at least weekly heartburn, and increased waist:hip ratio (male≥0.9, female≥0.8) were all associated with CLE. Conclusion: Certain histologic features, such as submucosal glands and/or ducts, ME, pure mucous glands, squamous islands, and buried columnar epithelium, when detected in GEJ biopsies of GERD patients, are indicative of the presence of CLE at endoscopy. Any of these findings, even in the absence of GC, should warrant clinical suspicion for CLE in endoscopically ambiguous cases.