Necrotizing Sialometaplasia-Like Change of the Esophageal Submucosal Glands Is Associated with Barrett's Esophagus
David R Braxton, Dana C Nickleach, Yuan Liu, Alton B Farris. Emory University School of Medicine, Atlanta, GA; Winship Cancer Institute of Emory University, Atlanta, GA
Background: The esophageal submucosal glands (SMG) secrete mucins and bicarbonate that function to protect the squamous epithelium from insults such as gastroesophageal reflux. We have observed metaplastic changes within the SMG that we have termed oncocytic glandular metaplasia (OGM), and necrotizing sialometaplasia-like change (NSMLC). We hypothesize that these metaplasias arise from reflux-induced damage of the SMG. The aim of this study is to evaluate the associations between these metaplasias and clinicopathological parameters.
Design: Routinely stained sections from adult esophagectomy cases were retrospectively evaluated for SMG metaplasia and assigned to either a BE or control group. SMG involved by, or adjacent to, tumor were excluded. Clincopathological data was collected for each case. Univariate analysis was performed using chi-square tests or ANOVA. Separate multivariable logistic regression models were performed for each main predictor, IM (intestinal metaplasia), BE, and GERD, to assess the adjusted association with NSMLC and OGM.
Results: A total of 82 esophagi containing SMG were studied. NSMLC was found in 25/45 (56%) of BE cases and 8/37 (22%) of control cases. OGM was in 15/37 (41%) of controls and 29/45 (64%) of BE cases. On univariate analysis NSMLC was associated with BE (p=0.002) and GERD (p=0.005). There was no relationship between NSMLC and patient age, sex, tumor size, or treatment history (i.e. fundoplication, myotomy, surgical resection, chemoradiation). OGM was associated with IM (p=0.005), BE (p=0.031), and GERD (p=0.01). No relationship was found between OGM and patient age, sex, tumor size, or T stage. On multivariable analysis NSMLC was independently predicted by BE (OR 5.50, p-value=0.002) and GERD (OR 5.22, p-value=0.006). OGM was independently predicted by IM (OR 2.87, p-value=0.035), and GERD (OR 3.36, p-value=0.019). Treatment history was also a predictor of NSMLC (OR 3.38, p-value=0.028).
Conclusions: NSMLC is strongly associated with BE and GERD on multivariable analysis. OGM is associated with IM, and GERD, but to a lesser degree than NSMLC. While our study suggests that SMG metaplasia may be the result of reflux-induced pathology, an association with treatment history was also found. Thus, while reflux appears to be the major contributor to NSMLC, the causes may be heterogeneous.
Monday, March 4, 2013 1:00 PM
Poster Session II # 110, Monday Afternoon