Korean J Helicobacter Up Gastrointest Res.  2012 Sep;12(3):171-177. 10.7704/kjhugr.2012.12.3.171.

The Clinical Significance of Specialized Intestinal Metaplasia in the Diagnosis of Barrett's Esophagus: Nationwide Prospective Multicenter Study

Affiliations
  • 1Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea. nayoungkim49@empal.com
  • 2Department of Internal Medicine, Catholic University of Korea, College of Medicine, Seoul, Korea.
  • 3Health Promotion Center, Seoul St. Mary's Hospital, Seoul, Korea.
  • 4Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
  • 5Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea.
  • 6Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea.
  • 7Department of Internal Medicine, Hallym University College of Medicine, Seoul, Korea.
  • 8Department of Internal Medicine, Chonnam National University School of Medicine, Gwangju, Korea.
  • 9Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea.
  • 10Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea.
  • 11Department of Internal Medicine, Digestive Disease Research Institute, Wonkang University College of Medicine, Iksan, Korea.
  • 12Department of Internal Medicine, Inje University College of Medicine, Busan, Korea.
  • 13Department of Pathology, Yonsei University Wonju College of Medicine, Wonju, Korea.
  • 14Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.
  • 15Department of Internal Medicine, Gachon Medical School, Incheon, Korea.
  • 16Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea.
  • 17Department of Internal Medicine, Gangneung Asan Hospital, Gangneung, Korea.
  • 18Korean National Cancer Center, Ilsan, Korea.
  • 19Department of Internal Medicine, Kwangju Christian Hospital, Gwangju, Korea.
  • 20Department of Internal Medicine, Eulji University College of Medicine, Daejeon, Korea.
  • 21Department of Internal Medicine, Kyung Hee University College of Medicine, Seoul, Korea.
  • 22Department of Internal Medicine, Seoul National University Boramae Hospital, Seoul, Korea.
  • 23Department of Internal Medicine, Keimyung University College of Medicine, Daegu, Korea.
  • 24Health Promotion Center, Inha University College of Medicine, Incheon, Korea.
  • 25Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea.
  • 26Department of Internal Medicine, Kosin University Gospel Hospital, Busan, Korea.
  • 27Department of Internal Medicine, Busan National University College of Medicine, Busan, Korea.
  • 28Department of Internal Medicine, Kyungsang National University College of Medicine, Jinju, Korea.
  • 29Department of Internal Medicine, Chonbuk National University School of Medicine, Jeonju, Korea.
  • 30Department of Internal Medicine, Kunyang University College of Medicine, Daejeon, Korea.
  • 31Cheju Halla General Hospital, Jeju, Korea.
  • 32Hanmaeum Hospital, Jeju, Korea.
  • 33Health Promotion Center, Seoul National University Bundang Hospital, Seongnam, Korea.
  • 34Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Korea.
  • 35Department of Internal Medicine, Chosun University College of Medicine, Gwangju, Korea.
  • 36Department of Internal Medicine, Dongguk University College of Medicine, Gyeongju, Korea.
  • 37Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.

Abstract

BACKGROUND/AIMS
The meaning of specialized intestinal metaplasia (SIM) in the diagnosis of Barrett's esophagus (BE) is not clear. This study was designed to determine the clinical significance of SIM in the diagnosis of Barrett's esophagus.
MATERIALS AND METHODS
Biopsies were taken from 601 subjects with endoscopically suspected columnar-lined esophagus. Under light microscopy with Alcian-blue stain, SIM was identified. Demographic characteristics, gastroesophageal (GE) reflux symptoms and endoscopic findings were compared between the SIM-present group and the SIM-absent group.
RESULTS
Among 601 subjects, 184 (30.6%) were confirmed by pathology to have SIM. Age over 40 years (P<0.001) and a medication history of proton pump inhibitor or H2 blocker were found more frequently in the SIM-present group (P=0.01) than in the SIM-absent group. Any of 7 GE reflux symptoms (heartburn, acid regurgitation, chest pain, hoarseness, globus sensation, cough and epigastric soreness) were more frequent in the SIM-present group than SIM-absent group (P<0.001). Specifically, heartburn, chest pain and cough were significantly more common in the SIM-present group. There was no clinically significant difference associated with endoscopic findings or other clinical characteristics.
CONCLUSIONS
When subjects with endoscopically suspected BE are analyzed based on the presence or absence of SIM, the SIM-present group was significantly associated with GE reflux symptoms suggestive of frequent GE reflux. However, the presence of SIM did not correlate with endoscopic findings.

Keyword

Barrett esophagus; Metaplasia; Gastroesophageal reflux
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