Tongue-like Barrett’s esophagus is associated with gastroesophageal reflux disease

Abstract

AIM:To test this hypothesis of barrett esophagus (BE) classified into two types and to further determine if there was any correlation between the shape of endoscopically suspected esophageal metaplasia (ESEM), prevalence of reflux esophagitis (RE) and heartburn. METHODS: A total of 6504 Japanese who underwent endoscopy for their annual stomach check-up were enrolled in this study. BE was detected without histological confirmation that is ESEM. We originally classified cases of ESEM into 3 types based on its shape: Tongue-like (T type), Dome-like (D type) and Wave-like (W type) ESEM. The respective subjects were prospectively asked to complete questionnaires concerning the symptoms of heartburn, dysphagia, and abdominal pain for a one-month period. RESULTS: ESEM was observed in 10.3% of 6504 subjects (ESEM < 1 cm, 9.4%; 1 cm ≤ ESEM < 3 cm, 1.7%; ESEM ≥ 3 cm, 0.5%). The frequency of ESEM was significantly higher in males compared with female subjects. Statistical analysis showed that the prevalence of heartburn and RE were significantly higher in the T type ESEM than in the W type ESEM (P < 0.05). CONCLUSION: The T type ESEM was strongly associated with reflux symptoms and RE whereas the W type ESEM was not associated with GERD.

Pathophysiology of Barrett's Esophagus-Associated Neoplasia: Circumferential Spatial Predilection

“…Therefore, the difference in acid reflux pattern between low- and high-grade reflux esophagitis may be associated with the circumferential distribution of mucosal breaks. Consistent with our findings, several reports have also shown a similar localization of mucosal breaks [35]. …”

“…Recently, three-dimensional high-resolution manometric imaging also revealed decreased competency within the right-sided portion of the LES pressure zone as compared with the left side [33]. These findings suggest that asymmetrical LES pressure generated by the anatomical proportion may be a major cause of asymmetrical gastroesophageal acid and/or bile reflux, and correlate with the predominant axial location of mucosal breaks in the esophagus [34,35]. …”

Does Short-Segment Columnar-Lined Esophagus Elongate During a Mean Follow-Up Period of 5.7 YEARS?

“…Our patients with flame‐shaped SS‐CLE tended to have more RE than those with lotus‐shaped SS‐CLE, which suggested that flame‐shaped SS‐CLE was associated with more acid reflux. Although we did not evaluate the detailed differences of pathophysiology between the flame‐shaped SS‐CLE and the lotus‐shaped SS‐CLE, a recent large‐scale Japanese study found that tongue‐like endoscopic esophageal metaplasia (which was similar to our definition of flame‐shaped SS‐CLE) was closely associated with gastroesophageal reflux disease (GERD) 15 . Several previous studies have also suggested that intestinal metaplasia at a normal‐looking GE junction may be associated with intestinal metaplasia of the stomach and Helicobacter pylori infection, whereas SS‐CLE in the distal esophagus (usually tongue‐like) is associated with GERD 22,23 .…”

“…Yamagishi et al recently reported a new morphological classification of CLE, which classifies it into three types. 15 However, their classification seems to be complicated, which could lead to interobserver variability. Therefore, we devised a new simple classification for this study.…”

Prevalence of Barrett’s Esophagus in Asian Countries: A Systematic Review and Meta-analysis

“…77–81 In our study, approximately 80% of BE was short-segment BE; and, among the short-segment cases, most were < 1cm. 49, 53, 63, 70 It remains unclear whether BE <1cm has a potential risk for the development of esophageal adenocarcinoma. This uncertainty is related to the low interobserver reliability 16, 82 and the exclusion of subjects with BE <1cm from total BE in some studies.…”