Does Histology of Gastroesophageal Junction (GEJ) Biopsies Predict Future Development of Barrett's Esophagus (BE).
Tanya A Rege, John R Goldblum, Gary Falk, Frank Kuo, Robert D Odze. Brigham & Women's Hospital, Boston, MA; Cleveland Clinic, OH; University of Pennsylvania Health System, Philadelphia
Background: Mucosal biopsies of the GEJ in patients with GERD, but without endoscopic evidence of columnar-lined esophagus (CLE), often show abnormalities such as increased inflammation, multilayered epithelium (ME), squamous islands, and elongation of mucosa consisting of pure mucous glands. It is unclear if these changes represent an early manifestation or precursor of CLE. The aim of this study was to determine if histologic features of GEJ biopsies in patients without endoscopic evidence of CLE are predictive of future development of CLE upon follow up.
Design: 204 GEJ mucosal biopsies from 102 GERD patients (M/F ratio: 39/63, mean age: 54 years) without CLE or goblet cells were evaluated for a variety of histologic features, including the presence or absence of ME, type of glands, degree of inflammation, presence or absence of squamous islands, and presence or absence of subsquamous columnar epithelium, among others. The findings were correlated with the histologic features and endoscopic appearance of the esophagus at follow up endoscopy (mean follow up: 60.5 months). All patients had at least 1 follow up endoscopy.
Results: Of the 102 study patient index biopsies, 14.7% had ME, 79.4% mucous or mixed mucous and oxyntic glands, 46.1% pure oxyntic glands, 24.5% active inflammation, 77.5% chronic inflammation, 32.4% active inflammation of the squamous mucosa, 15.7% squamous islands, and 34.3% subsquamous columnar epithelium. None of these histologic features changed significantly in frequency upon follow up endoscopy. 24 of 102 (23.5%) patients developed goblet cells [involving <10% of crypts in 16 (15.7%) and 10-50% of crypts in 8 (7.8%)]. Of all the features evaluated in the index biopsy, none were significantly predictive of the development of CLE or goblet cells upon follow up except the presence of ME, which was significantly associated with the future development of CLE (p=0.046).
Conclusions: The data supports the theory that ME represents a precursor to CLE, and is predictive of the future development of this condition when detected in biopsies of the GEJ region.
Monday, February 28, 2011 1:00 PM
Poster Session II # 84, Monday Afternoon