Definition of Histopathologic Changes in Gastroesophageal Reflux Disease

Chandrasoma, Parakrama; Lokuhetty, D M; DeMeester, Tom R.; Bremmer, Cedric G.; Peters, Jeffrey H.; Öberg, Stefan; Groshen, Susan

doi:10.1097/00000478-200003000-00002

Cited by 174 publications

(124 citation statements)

References 19 publications

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“…Because the incidence and extent of the cardiac glands were linked to excessive gastroesophageal reflux, this led Chandrosoma et al [9] to speculate that cardiac glands may be an acquired change from esophageal squamous mucosa. However, cardiac glands were subsequently identified in most children, the newborn, and even in fetuses [10][11][12], suggesting that they are present from early in life, representing a functionally distinct, albeit small, anatomical region of the normal stomach.…”

Section: The Gastric Cardia and Gca: Anatomy And Definitional Issuesmentioning

confidence: 99%

Obesity and related risk factors in gastric cardia adenocarcinoma

Olefson

Moss

2014

Gastric Cancer

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Over recent decades, the incidence of cancers of the gastroesophageal junction, including gastric cardia tumors, has increased markedly. This is a trend that has been well documented, especially in studies from the USA and northern Europe that have also demonstrated a concomitant rise in the ratio of cardia to distal gastric cancers. The rise in the prevalence of gastric cardia adenocarcinoma has been paralleled by the worldwide obesity epidemic, with almost all epidemiological studies reporting increased body mass index and obesity increase the risk of cardia cancer development. However, the strength of this association is less marked than the link between obesity and esophageal adenocarcinoma, and the mechanisms remain poorly understood. Other possible confounders of the relationship between obesity and cardia cancer include the decline in Helicobacter pylori infection and the widespread use of proton pump inhibitors, although these have rarely been controlled for in case-control and cohort studies investigating associations between obesity and cardia cancer. We review these epidemiological trends and discuss proposed mechanisms for the association, drawing attention to controversies over the difficulty of defining cardia cancer. The relative paucity of high-quality epidemiological studies from other regions of the world should prompt further investigation of this issue, especially in populations undergoing rapid socioeconomic change.

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Section: The Gastric Cardia and Gca: Anatomy And Definitional Issuesmentioning

confidence: 99%

Obesity and related risk factors in gastric cardia adenocarcinoma

Olefson

Moss

2014

Gastric Cancer

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“…Several studies have also shown that the length of mucosa composed of mucous glands at the GEJ region increases with more severe degrees of GERD (17,24,28,33,34). Chandrasoma et al postulated that expansion of the zone of mucosa at the GEJ composed of pure mucous glands occurs exclusively as a result of GERD-induced squamous to columnar metaplasia of the distal esophagus (34).…”

Section: Histopathology Of the Distal Esophagusmentioning

confidence: 99%

“…Chandrasoma et al postulated that expansion of the zone of mucosa at the GEJ composed of pure mucous glands occurs exclusively as a result of GERD-induced squamous to columnar metaplasia of the distal esophagus (34). Although it is well-known that GERD increases in prevalence with age, it is unclear whether small amounts of GERD may be "physiologic" in some individuals.…”

Section: Histopathology Of the Distal Esophagusmentioning

confidence: 99%

Unraveling the Mystery of the Gastroesophageal Junction: A Pathologist's Perspective

Odze

2005

Am J Gastroenterology

158

100

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The gastroesophageal junction (GEJ), which is defined as the point where the distal esophagus joins the proximal stomach (cardia), is a short anatomic area that is commonly exposed to the injurious effects of GERD and/or Helicobacter pylori infection. These disorders often lead to inflammation and intestinal metaplasia (IM) of this anatomic region. The true gastric cardia is an extremely short segment (<0.4 mm) of mucosa that is typically composed of pure mucous glands, or mixed mucous/oxyntic glands that are histologically indistinguishable from metaplastic mucinous columnar epithelium of the distal esophagus. In patients with GERD, whether physiologic or pathologic, the length of cardia-type epithelium increases and extends proximally above the level of the anatomic GEJ into the distal esophagus. Columnar metaplasia of the distal esophagus represents a squamous to columnar metaplastic reaction that develops from an esophageal stem cell and may pass through an intermediate phase characterized by the presence of a type of epithelium that possesses a mixture of squamous and columnar features, termed multilayered epithelium. In contrast, IM of the gastric cardia represents a columnar to columnar cell metaplastic reaction that develops from a gastric stem cell located in the deep foveolar compartment of the gastric mucosa. Intestinal metaplasia, particularly the incomplete type, is widely believed to represent the precursor lesion upon which dysplasia and cancer arises. The frequency of IM is probably greater in metaplastic columnar epithelium in the esophagus secondary to GERD, than in cases of true gastric carditis secondary to H. pylori, and may be a reason why there is a higher risk of carcinoma in the former compared to the latter. A variety of clinical, endoscopic, histologic, and histochemical methods can be used to distinguish GERD-induced columnar metaplasia of the distal esophagus from H. pylori-induced inflammation of true gastric cardia, and these are outlined in this review, but further controlled studies are needed to critically evaluate these techniques. Further prospective trials are needed to adequately evaluate the different etiologic and pathogenetic mechanisms and, most importantly, the risk of malignancy in these two conditions.

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“…However, an autopsy study has noted that the presence and extent of cardiac mucosa increases with age (12). The finding of cardiac-type mucosa in the lower esophagus, which does not meet the definition of BE, has been correlated with the presence and severity of gastroesophageal reflux disease (GERD) (13). These studies suggest that cardiactype mucosa may not be a normal finding in either the stomach or esophagus.…”

mentioning

confidence: 99%

“…The etiology of CIM may be different from BE. The main risk factor for BE is GERD (13)(14)(15). Although the presence of Helicobacter pylori infection is linked to CIM (16 -20), in the absence of H. pylori infection CIM may be related to GERD (21).…”

mentioning

confidence: 99%

Utilization of Cytokeratins 7 and 20 Does Not Differentiate between Barrett's Esophagus and Gastric Cardiac Intestinal Metaplasia

2002

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Long segment Barrett's esophagus (LSBE) is a recognized risk factor for the development of esophageal dysplasia and carcinoma. However, the risk of dysplasia arising within intestinal metaplasia below a normal-appearing Z-line (i.e., in native cardiac mucosa) is unknown. Regular endoscopic surveillance is required in patients with LSBE and is frequently performed in short segment BE (SSBE), but the need for surveillance in cardiac intestinal metaplasia (CIM) is unknown. Unfortunately IM arising in SSBE and immediately below a normal Z-line can be indistinguishable histologically on H&E stains. Previous reports suggest that the appearance of superficial CK20 immunohistochemical staining accompanied by intermediate and deep CK7 positivity is characteristic of BE, whereas CIM specimens show superficial and deep CK20 positivity and weak to absent CK7 staining. We hypothesized that CK7/20 immunostaining of metaplastic biopsies from the esophagus and stomach would allow complete differentiation of these two entities when correlated with the endoscopic appearance. We undertook an evaluation of gastric and esophageal specimens to determine whether these characteristics were valid. Cases of both BE (long and short segment) and CIM, as well as cases of gastric cardiac biopsies lacking IM, were evaluated for CK7 and CK20 and correlated with the endoscopic appearance. We observed that, although the "Barrett's" pattern of CK7/20 was maintained for many cases of BE, the sensitivity and specificity were only moderate (65% and 56%, respectively). The pattern of staining for the CIM was variable, i.e., some cases showed a CK7/20 Barrett's pattern despite a normal appearance at endoscopy. The differences between this and previous studies may be due to inaccurate visualization of SSBE on endoscopy, the development of very early SSBE cases, inter-observer variability, fixation differences, or antibody differences. Whatever the cause of the differences, if results between laboratories are not comparable, CK7/20 immunostaining cannot be used to differentiate reliably between IM present in biopsy specimens taken from above versus below the Z-line. However, further studies should be performed to determine whether the presence or absence of a Barrett's pattern of CK7/20 immunostaining could predict progression to dysplasia or carcinoma.

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Definition of Histopathologic Changes in Gastroesophageal Reflux Disease

Cited by 174 publications

References 19 publications

Obesity and related risk factors in gastric cardia adenocarcinoma

Obesity and related risk factors in gastric cardia adenocarcinoma

Unraveling the Mystery of the Gastroesophageal Junction: A Pathologist's Perspective

Utilization of Cytokeratins 7 and 20 Does Not Differentiate between Barrett's Esophagus and Gastric Cardiac Intestinal Metaplasia

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