Intestinal Metaplasia In Biopsies Research Articles

Unsedated transnasal endoscopy for the detection of Barrett's esophagus: systematic review and meta-analysis.

Conventional esophagogastroduodenoscopy (cEGD) is currently the gold standard endoscopic procedure for diagnosis and surveillance of Barrett's esophagus (BE). This procedure is however less suitable for widespread screening because of its invasiveness and costs. An alternative endoscopic procedure is unsedated transnasal endoscopy (uTNE). We performed a systematic review and meta-analysis to evaluate the diagnostic accuracy, patient tolerability, technical success rate, and safety of uTNE compared with cEGD for detecting BE and related neoplasia. PubMed, EMBASE, and Cochrane Library were searched for studies that reported the diagnostic accuracy of uTNE compared with cEGD for detecting BE and related neoplasia. Eight prospective studies were included, in which 623 patients underwent both uTNE and cEGD. Pooled sensitivity and specificity of uTNE for detecting columnar epithelium were 98% (95% CI 83-100%) and 99% (95% CI 82-100%), respectively. Pooled sensitivity and specificity of uTNE for detecting intestinal metaplasia in biopsies were 89% (95% CI 78-95%) and 93% (95% CI 71-98%), respectively. In three of the six studies that reported patient tolerability, a higher patient tolerability of uTNE compared with cEGD was reported. The technical success rate of uTNE ranged from 89% to 100% and no (serious) adverse events were reported. This systematic review and meta-analysis provides evidence that uTNE is an accurate, safe, and well-tolerated procedure for the detection of columnar epithelium and can be considered as screening modality for BE.

Barrett's Esophagus and Intestinal Metaplasia of Gastric Cardia: Prevalence, Clinical, Endoscopic and Histological Features

Over the past few decades, the incidence of adenocarcinomas of the gastroesophageal junction has rapidly increased. Barrett's esophagus is a risk factor for esophageal adenocarcinoma, but the role of intestinal metaplasia of the gastric cardia as a precursor in cardia-related cancer is controversial. The aims of the present study were to examine the prevalence of intestinal metaplasia in the gastroesophageal junction and to evaluate the clinical, endoscopical and histological features of patients with intestinal metaplasia in the gastric cardia and patients with Barrett's esophagus. 286 consecutive patients undergoing gastroduodenoscopy were enrolled in a prospective study. Biopsy specimens were performed in the distal esophagus, squamocolumnar junction, gastric cardia, gastric corpus and antrum. We identified 44 patients (15.3%) with intestinal metaplasia in biopsies from gastric cardia and 24 patients (8.3%) with Barrett's esophagus. Cardia intestinal metaplasia was significantly associated with older age (p=0.03), with intestinal metaplasia in the antrum (p=0.017) and H. pylori infection (p<0.0001). Severe chronic cardia inflammation increased the presence of cardia intestinal metaplasia 6.2 fold (OR=6.288; p<0.0001). Patients with Barrett's esophagus were predominantly men. Barrett's esophagus presence significantly correlated with reflux symptoms(p<0.0001), endoscopic esophagitis (p<0.0001) and hiatal hernia >2 cm (p=0.002). No patient had dysplasia in the gastroesophageal region. Presence of intestinal metaplasia at the gastroesophageal region correlated with reflux symptoms and endoscopic signs of reflux disease in patients with Barrett's esophagus and with H.pylori infection and distal intestinal metaplasia in patients with cardia intestinal metaplasia.

Clinical and Pathologic Characteristics of Patients with a Diagnosis of Intestinal Metaplasia in Biopsies of the Gastroesophageal Junction

Clinical and Pathologic Characteristics of Patients with a Diagnosis of Intestinal Metaplasia in Biopsies of the Gastroesophageal Junction

The Epidemiology and Natural History of Barrettʼs Esophagus and Intestinal Metaplasia of Gastroesophageal Junction in Korea

Purpose: The incidence of esophageal adenocarcinoma (EAC) is rapidly increasing in western countries. However, the diagnosis of EAC and Barrett's esophagus (BE), its precursor, in Asian countries are still uncommon in spite of increased western food pattern or obesity. There are few studies describing prevalence of EAC and BE in asymptomatic people who undergo endoscopy (EGD) for health check. However, no study has described the natural history of BE. We aimed to investigate the epidemiology and natural history of BE and intestinal metaplasia of gastroesophageal junction (IMGEJ) initially diagnosed during an asymptomatic health check EGD at a single center in South Korea. Methods: From 2001 to 2010, 180,087 asymptomatic people who underwent EGD for health check at a tertiary care center were identified. Their EGD report, photographs, and pathology were reviewed and BE (columnar segment ≥ 1 cm with specialized intestinal metaplasia, or IMGEJ (intestinal metaplasia in biopsies from the gastroesophageal junction) were identified. Serum Helicobacter pylori (HP) IgG antibody was checked in all subjects. Their subsequent EGD and pathology reports and medical records were reviewed. Results: A total of 126 subjects (M:F = 91:35, mean age = 51.9±10.3) were identified. 73 subjects (0.04%) were diagnosed with BE and 53 subjects (0.03%) with IMGEJ. The mean number of biopsies taken was 1.6±0.8. Of the 73 subjects with BE, 72 (98.6%) had short-segment BE (SSBE), and 1 (1.4%) had longsegment BE (LSBE). HP IgG antibody was positive in 35 (47.9%) of BE and 27 (50.9%) of IMGEJ. Erosive esophagitis was identified in 27 (37.0%) BE subjects (13 with grade A, 12 with grade B, and 2 with grade C using the Los Angeles classification system) and 25 (47.2%) IMGEJ subjects (12 with grade A, 4 grade B). Hiatal hernia was diagnosed in 11 (15.1%) BE and 9 (17.0%) IMGEJ subjects. Among the 126 subjects diagnosed with either BE or IMGEJ, 50 were lost to follow-up and 76 received endoscopic surveillance with a mean duration of follow-up of 3.4±2.1 years (range 0.3-8.5 years). No subject developed EAC or high-grade dysplasia, and all 76 subjects were alive in May 2011. Conclusion: The prevalence of BE in Korea is still low and when it occurs, it is almost exclusively SSBE. In this limited descriptive report of subjects with BE and IMGEJ in an asymptomatic cohort in Korea, no one developed EAC or highgrade dysplasia over 3 years follow-up. A prospective well-organized standardized protocol of consecutive persons undergoing EGD in Asia is warranted.

Epidemiology and Natural History of Intestinal Metaplasia of the Gastroesophageal Junction and Barrett's Esophagus: A Population-Based Study

Population-based data on the epidemiology and outcomes of subjects with intestinal metaplasia of the gastroesophageal junction (IMGEJ) and Barrett's esophagus (BE) are limited. The objectives of this study were to (i) estimate the incidence of IMGEJ and BE diagnosed from clinically indicated endoscopy in Olmsted County, MN, over three decades (1976-2006) and prevalence as of 1 January 2007, (ii) compare baseline characteristics of subjects with IMGEJ and BE, and (iii) study the natural history and survival of both cohorts. This was a population-based cohort study. The study setting was Olmsted County, MN. Patients with BE (columnar segment >1 cm with intestinal metaplasia) and IMGEJ (intestinal metaplasia in biopsies from the gastroesophageal junction) from 1976 to 2006 in Olmsted County, MN, were identified using Rochester Epidemiology Project resources. Demographic and clinical data were abstracted from medical records and pathology confirmed by gastrointestinal pathologists. The association of baseline characteristics with overall and progression-free survival was assessed using proportional hazards regression models. Outcome measures were baseline characteristics and overall survival of subjects with IMGEJ compared to those with BE. In all, 487 patients (401 with BE and 86 with IMGEJ) were identified and followed for a median interval of 7 (BE subjects) to 8 (IMGEJ subjects) years. Subjects with BE were older, heavier, reported reflux symptoms more often, and had higher prevalence of advanced neoplasia than those with IMGEJ. No patient with IMGEJ progressed to esophageal adenocarcinoma (EAC) in contrast to BE subjects who had a cumulative risk of progression of 7% at 10 years and increased risk of death from EAC (standardized mortality ratio 9.62). The overall survival of subjects with BE and IMGEJ did not differ from that expected in similar age- and sex-distributed white Minnesota populations. Subjects with IMGEJ appear to have distinct clinical characteristics and substantially lower cancer progression risk compared to those with BE.

Predicting presence of intestinal metaplasia and dysplasia in columnar-lined esophagus: a multivariate analysis

In patients with presumed Barrett esophagus we evaluated clinical risk factors that could predict the presence of intestinal metaplasia and dysplasia in biopsies of columnar-lined esophagus (CLE), independently of histological results. In 908 patients with CLE of length > or = 2 cm, data on age, sex, reflux symptoms, tobacco and alcohol use, medication use, and upper gastrointestinal endoscopy findings were prospectively collected. Multivariate logistic regression analysis was performed, and a model for predicting the histological results was developed. In 127/908 patients, biopsies of CLE did not contain intestinal metaplasia. Of the 781 patients with intestinal metaplasia, 663 patients (85%) had no dysplasia, and 118 (15%) had low grade dysplasia (LGD). The most important predictors for the presence of intestinal metaplasia were length of CLE, size of hiatal hernia, and male sex, while among those with intestinal metaplasia, age and male sex were most important for the presence of LGD. Multivariate combinations of these predictors yielded reliable models, which were able to discriminate intestinal metaplasia well from no intestinal metaplasia (area under receiver operating characteristic [ROC] curve 0.82), but only reasonably discriminated LGD from no dysplasia (area under ROC 0.65). A simple model based on clinical findings can be used to predict the presence of intestinal metaplasia in biopsies from CLE. In contrast, predicting the presence of LGD versus no dysplasia in intestinal metaplasia is more difficult. Predictions from these models may aid decision making on whether a patient with CLE should have surveillance, in view of the known sampling error at endoscopy and interobserver variability at histology.

Role of surveillance in intestinal metaplasia of the esophagus and gastroesophageal junction.

This article reviews current concepts of cancer surveillance in esophageal columnar metaplasia (Barrett's esophagus) and intestinal metaplasia at the gastroesophageal junction. An overview is given of the available data on the prevalence of intestinal metaplasia in biopsies from the distal esophagus and from the gastroesophageal junction. Furthermore, special attention is given to the endoscopic detection of dysplasia and early malignancy. Finally, the costs of endoscopic surveillance and its effect on mortality rates from esophageal adenocarcinoma are discussed.

Short segment Barrett's esophagus: relationship of age with extent of intestinal metaplasia.

Short segment Barrett's esophagus (SSBE) is defined by the presence of intestinal metaplasia in biopsies obtained from mucosa with an appearance suggestive of Barrett's that extends <3 cm into the esophagus. It has been suggested that this lesion may represent a stage in an ongoing process of Barrett's esophagus progression. If so, then the prevalence of SSBE would be expected to decrease with advancing age, and patients followed over time should exhibit an increase in the extent of columnar-lined esophagus. The aim of this study was to determine whether SSBE length progresses or regresses over time by following a prospective cohort and by assessing the relationship between age and the length, as well as prevalence of SSBE. The study included consecutive patients who were evaluated prospectively by an upper endoscopy and were found to have SSBE between October, 1983, and December, 1999, at the Southern Arizona VA Health Care System. All patients underwent a systematic biopsy protocol, and a designated pathologist who reviewed all specimens confirmed the diagnosis of Barrett's esophagus. Patients were subsequently interviewed for demographic information. In those patients who were enrolled into our surveillance program, SSBE length was remeasured and intestinal metaplasia reconfirmed on follow-up endoscopies. Of 343 patients with endoscopically proven Barrett's esophagus, 116 (33.8%) were found to have SSBE. Almost all were male (97.4%) and white (85.3%), with a mean age of 60.1+/-1.0 yr. The prevalence of SSBE increased with age and reached a plateau during the seventh decade of life. One-way analysis of variance showed that there was no significant difference in the mean length of SSBE among the various age groups (p = 0.84). This trend was maintained when only the white group was assessed. Follow-up endoscopies were performed in 57 patients, revealing a mean interval of 64 months to the latest endoscopy, with no significant difference in SSBE length between the first and last endoscopy (p = 0.16). The prevalence of SSBE increases with age until the seventh decade of life. Finding that SSBE length does not change across the various age groups and during a 64-month mean follow-up, suggests that SSBE does not progress over time.

Short segment Barrett’s esophagus: relationship of age with extent of intestinal metaplasia

OBJECTIVE:Short segment Barrett’s esophagus (SSBE) is defined by the presence of intestinal metaplasia in biopsies obtained from mucosa with an appearance suggestive of Barrett’s that extends <3 cm into the esophagus. It has been suggested that this lesion may represent a stage in an ongoing process of Barrett’s esophagus progression. If so, then the prevalence of SSBE would be expected to decrease with advancing age, and patients followed over time should exhibit an increase in the extent of columnar-lined esophagus. The aim of this study was to determine whether SSBE length progresses or regresses over time by following a prospective cohort and by assessing the relationship between age and the length, as well as prevalence of SSBE.METHODS:The study included consecutive patients who were evaluated prospectively by an upper endoscopy and were found to have SSBE between October, 1983, and December, 1999, at the Southern Arizona VA Health Care System. All patients underwent a systematic biopsy protocol, and a designated pathologist who reviewed all specimens confirmed the diagnosis of Barrett’s esophagus. Patients were subsequently interviewed for demographic information. In those patients who were enrolled into our surveillance program, SSBE length was remeasured and intestinal metaplasia reconfirmed on follow-up endoscopies.RESULTS:Of 343 patients with endoscopically proven Barrett’s esophagus, 116 (33.8%) were found to have SSBE. Almost all were male (97.4%) and white (85.3%), with a mean age of 60.1 ± 1.0 yr. The prevalence of SSBE increased with age and reached a plateau during the seventh decade of life. One-way analysis of variance showed that there was no significant difference in the mean length of SSBE among the various age groups (p = 0.84). This trend was maintained when only the white group was assessed. Follow-up endoscopies were performed in 57 patients, revealing a mean interval of 64 months to the latest endoscopy, with no significant difference in SSBE length between the first and last endoscopy (p = 0.16).CONCLUSIONS:The prevalence of SSBE increases with age until the seventh decade of life. Finding that SSBE length does not change across the various age groups and during a 64-month mean follow-up, suggests that SSBE does not progress over time.