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The normal squamocolumnar junction is circumferentially even and minimal irregularities are manifestations of gastroesophageal acid reflux

Guerrero Garcia Hall, Mats LU ; Wenner, Jörgen LU and Öberg, Stefan LU (2017) In Scandinavian Journal of Gastroenterology 52(3). p.270-275
Abstract

Background: The macroscopic appearance of the normal squamocolumnar junction (SCJ) is often described as serrated with short projections of columnar mucosa that extend into the esophagus. As studies of the normal SCJ are sparse, the aim of this study was to test the hypothesis that the normal SCJ is even and that irregularities are manifestations of acid reflux. Method: Fifty asymptomatic subjects and 149 patients with symptoms suggestive of gastroesophageal reflux disease underwent endoscopy and 48-h pH monitoring with a pH electrode positioned immediately above the SCJ. The shape of the SCJ was assessed according to the Z-line appearance classification and correlated with clinical characteristics and the degree of esophageal acid... (More)

Background: The macroscopic appearance of the normal squamocolumnar junction (SCJ) is often described as serrated with short projections of columnar mucosa that extend into the esophagus. As studies of the normal SCJ are sparse, the aim of this study was to test the hypothesis that the normal SCJ is even and that irregularities are manifestations of acid reflux. Method: Fifty asymptomatic subjects and 149 patients with symptoms suggestive of gastroesophageal reflux disease underwent endoscopy and 48-h pH monitoring with a pH electrode positioned immediately above the SCJ. The shape of the SCJ was assessed according to the Z-line appearance classification and correlated with clinical characteristics and the degree of esophageal acid exposure in the most distal esophagus. Results: Even SCJs without irregularities were significantly more common in asymptomatic subjects compared with patients (50% versus 10%, p < .001) and were never found in patients with erosive esophagitis. The median degree of distal esophageal acid exposure in individuals with an even SCJ was within normal limits. With increasing degree of irregularity of the SCJ, the frequency and duration of reflux episodes, the degree of distal esophageal acid exposure, and the prevalence of abnormal acid exposure increased progressively and significantly. Conclusion: The shape of the normal SCJ is even and also minimal irregularities are a consequence of acid reflux, likely due to the formation of small areas of metaplastic columnar mucosa.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
adenocarcinoma, Barrett’s esophagus, endoscopy-general, esophageal-disorders, GERD, pH monitoring
in
Scandinavian Journal of Gastroenterology
volume
52
issue
3
pages
6 pages
publisher
Taylor & Francis
external identifiers
  • scopus:84994850685
  • wos:000392488800004
ISSN
0036-5521
DOI
10.1080/00365521.2016.1249402
language
English
LU publication?
yes
id
aa300fd8-c215-4a96-9759-6635b2d5e4e6
date added to LUP
2016-11-29 08:15:14
date last changed
2018-01-07 11:37:30
@article{aa300fd8-c215-4a96-9759-6635b2d5e4e6,
  abstract     = {<p>Background: The macroscopic appearance of the normal squamocolumnar junction (SCJ) is often described as serrated with short projections of columnar mucosa that extend into the esophagus. As studies of the normal SCJ are sparse, the aim of this study was to test the hypothesis that the normal SCJ is even and that irregularities are manifestations of acid reflux. Method: Fifty asymptomatic subjects and 149 patients with symptoms suggestive of gastroesophageal reflux disease underwent endoscopy and 48-h pH monitoring with a pH electrode positioned immediately above the SCJ. The shape of the SCJ was assessed according to the Z-line appearance classification and correlated with clinical characteristics and the degree of esophageal acid exposure in the most distal esophagus. Results: Even SCJs without irregularities were significantly more common in asymptomatic subjects compared with patients (50% versus 10%, p &lt; .001) and were never found in patients with erosive esophagitis. The median degree of distal esophageal acid exposure in individuals with an even SCJ was within normal limits. With increasing degree of irregularity of the SCJ, the frequency and duration of reflux episodes, the degree of distal esophageal acid exposure, and the prevalence of abnormal acid exposure increased progressively and significantly. Conclusion: The shape of the normal SCJ is even and also minimal irregularities are a consequence of acid reflux, likely due to the formation of small areas of metaplastic columnar mucosa.</p>},
  author       = {Guerrero Garcia Hall, Mats and Wenner, Jörgen and Öberg, Stefan},
  issn         = {0036-5521},
  keyword      = {adenocarcinoma,Barrett’s esophagus,endoscopy-general,esophageal-disorders,GERD,pH monitoring},
  language     = {eng},
  number       = {3},
  pages        = {270--275},
  publisher    = {Taylor & Francis},
  series       = {Scandinavian Journal of Gastroenterology},
  title        = {The normal squamocolumnar junction is circumferentially even and minimal irregularities are manifestations of gastroesophageal acid reflux},
  url          = {http://dx.doi.org/10.1080/00365521.2016.1249402},
  volume       = {52},
  year         = {2017},
}