GASTROENTEROLOGY ARTICLE OF THE WEEK
March 4, 2004
Spechler SJ. Intestinal metaplasia at the gastroesophageal junction. Gastroenterology 2004;126:567-575.
1. Intestinal metaplasia in the gastroesophageal junction
a. a short segment of intestinal metaplasia may be normal
b. if intestinal metaplasia is present, and the Z line is 4 cm above the proximal border of
the gastric folds, the patient has Barrett’s esophagus
c. If intestinal metaplasia is present, and the Z line is 1 cm above the proximal
border of the gastric folds the patient has short-segment Barrett’s
d. Intestinal metaplasia found in patients in whom the SC junction coincides with
the end of the gastric folds is not a pathologic finding.
2. When counseling a patient with intestinal metaplasia located at the EGJ, the cancer risk should be quoted as
a. 2.9% per year
b. conclusively not higher than normal people
c. maximum of 0.5% per year, likely less
d. 5% per year
True or False
3. Routine biopsies of the GEJ should be obtained in all patients undergoing EGD for reflux symptoms.
4. Both, intestinal metaplasia of the cardia and the esophagus develop as a result of H. pylori infection.
5. The GE junction is defined as the proximal edge of the gastric folds, the SC junction is the area where the squamous epithelium ends and the columnar epithelium starts.
6. Parietal cells are never present in the gastric cardia.
7. Histologically, it is possible to differentiate intestinal metaplasia of the stomach from intestinal metaplasia of the esophagus
8. The risk of malignancy is substantially higher in IM of the esophagus compared to IM of the stomach or cardia.
9. Cytokerating staining is reliable in distinguishing IM of the esophagus from IM of the cardia
10. Patients with IM of the GEJ should:
a. Be treated with high dose PPI’s even if symptoms of GERD are absent.
b. Be referred for anti-reflux surgery to decrease risk of adenocarcinoma
c. Be treated with PPI’s if heartburn symptoms are present
d. Have H. pylori eradicated if infection is present, as this will decrease risk of adenocarcinoma
e. Be treated with selective COX-2 inhibtors to decrease risk of malignancy.
f. Undergo endoscopic surveillance every 3-5 years after two negatives EGD’s
