Reflux esophagitis or Helicobacter infection? – Diagnostic value of the inflammatory pattern in metaplastic mucosa at the squamocolumnar junction

Abstract

Objectives Metaplastic glandular mucosa with goblet cells at the squamocolumnar junction is induced either by reflux or by Helicobacter infection. We investigated whether the accompanying inflammation may give information about the etiology of these metaplastic changes and whether there are further criteria which are helpful in differentiating Helicobacter-induced vs. reflux-caused metaplasia. Methods One hundred and nine patients with intestinal metaplasia diagnosed in biopsies obtained immediately below the Z-line were evaluated. Further biopsies were taken from the gastric body and antrum. Patients were diagnosed as having a normal Z-line, or as showing short tongues or segments of Barrett's esophagus endoscopically. Inflammation was graded according to the updated Sydney-system. Metaplasia was typed using Gomori's-aldehyde-fuchsin-Alcianblue staining. Results Compared to patients with Barrett's esophagus, the active ( p=0.0002) and chronic inflammation ( p=0.0004) at the squamocolumnar junction was higher in patients with a normal Z-line and frequently accompanied by lymphoid aggregates ( p<0.0001) and regular cardia- ( p=0.0044) and/or corpus-type glands ( p=0.0004). Pseudogoblet cells were more frequent in Barrett's esophagus ( p=0.0159). Conclusions The endoscopic aspect of the Z-line, the inflammatory pattern, and the type of glands in biopsies from the squamocolumnar junction, as well as the presence of pseudogoblet cells are helpful tools in distinguishing Barrett's mucosa from Helicobacter-associated intestinal metaplasia.