Biopsies from the GEJ Area Composed of Pure Oxyntic Glands Is Not Necessarily Indicative of the Proximal Stomach
Genevieve Soucy, Thomas L Vaughan, Lynn E Onstad, Robert D Odze. Brigham and Women's Hospital, Boston; Fred Hutchinson Cancer Research Center, Seattle
Background: Barrett's esophagus (BE) has been proposed to develop via conversion of mucosa comprised of oxyntic glands to one comprised of mucous glands prior to goblet cell metaplasia. Based on this theory, some authorities have suggested that biopsies from the GEJ area composed of pure oxyntic glands always represent mucosa from the proximal stomach. The aim of this study was to evaluate the prevalence and significance of mucosa composed of pure oxyntic glands when detected in biopsies of the GEJ region in a large study of GERD patients either with (N=214) or without (N=295) columnar-lined esophagus (CLE).
Design: Biopsies of the GEJ region from 509 GERD patients (M/F ratio: 281/228, mean age: 51 years), all of whom were endoscoped and interviewed prospectively as part of a community clinic-based study of GERD patients in Washington state, were evaluated in a blinded fashion for the presence or absence of pure oxyntic-type mucosa and goblet cells, without knowledge of the clinical characteristics or anatomic location (esophagus or stomach) of the biopsy. Patient endoscopic features, presence or absence of CLE and clinical risk factors for BE, such as gender, race, waist/hip ratio, smoking history, severity of GERD symptoms, and body mass index (BMI) were compared between patients with vs without pure oxyntic-type mucosa and, of the former, with or without goblet cells.
Results: Biopsies composed of pure oxyntic glands occurred in 126/509 (24.8%) patients overall. Pure oxyntic-type mucosa was significantly more common in patients without CLE (30.5%) compared to patients with CLE (18.9%, p=0.003), and no significant difference was observed in short (21.8%) vs long segment (15.8%) type. Goblet cells occurred in 11/126 (8.7%) cases, and no significant differences were observed in CLE (12.5%) vs non-CLE (7%). No measured risk factors for BE or demographic characteristics of the patients were significantly related to the presence of pure oxyntic-type mucosa, or to those cases with or without goblet cells with one exception; males (80%) were more likely to have pure oxyntic-type mucosa vs females (68%, p=0.004).
Conclusions: Pure oxyntic-type mucosa may occur in a substantial proportion of esophageal biopsies in patients with CLE; thus, mucosa with this phenotype does not necessarily represent tissue from the proximal stomach. Contrary to the prevailing theory of BE pathogenesis, in some cases, goblet cells may be derived directly from pure oxyntic-type mucosa, without an intervening stage of mucous gland metaplasia.
Monday, March 19, 2012 1:00 PM
Poster Session II # 89, Monday Afternoon