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Intestinal metaplasia at the gastroesophageal junction is associated with gastroesophageal reflux but not with Helicobacter pylori infection

Hall, Mats LU ; Wenner, Jörgen LU ; Scherman, Peter LU and Öberg, Stefan LU (2018) In Scandinavian Journal of Gastroenterology 53(10-11). p.1179-1185
Abstract

Objective: Studies of the etiology of intestinal metaplasia (IM) at a normal appearing gastroesophageal junction (GEJ) are conflicting as associations with both H. Pylori (HP) infection and gastroesophageal reflux has been reported. The aim of this study was to investigate whether IM at the GEJ is associated with gastroesophageal reflux or HP infection. Material and methods: Fifty asymptomatic volunteers and 149 patients with reflux symptoms underwent endoscopy with biopsies obtained from the gastric antrum and the squamocolumnar junction (SCJ). All subjects underwent wireless 48 h pH monitoring with the electrode placed immediately above the SCJ and a fecal antigen test for HP infection. Clinical characteristics and the pattern of... (More)

Objective: Studies of the etiology of intestinal metaplasia (IM) at a normal appearing gastroesophageal junction (GEJ) are conflicting as associations with both H. Pylori (HP) infection and gastroesophageal reflux has been reported. The aim of this study was to investigate whether IM at the GEJ is associated with gastroesophageal reflux or HP infection. Material and methods: Fifty asymptomatic volunteers and 149 patients with reflux symptoms underwent endoscopy with biopsies obtained from the gastric antrum and the squamocolumnar junction (SCJ). All subjects underwent wireless 48 h pH monitoring with the electrode placed immediately above the SCJ and a fecal antigen test for HP infection. Clinical characteristics and the pattern of reflux were compared in subjects with and without IM. Results: Three asymptomatic volunteers and 35 patients who had clearly irregular SCJs with short extensions of columnar mucosa were excluded from the study. In the remaining 47 asymptomatic volunteers and 114 patients, variables that reached a significance level of 0.1 or less on univariate analyses were used in a binomial regression analysis to assess their relative importance for the finding of IM. IM at the GEJ was significantly associated with abnormal distal esophageal acid exposure (5.5 (1.2–24.6), p =.026), the frequency of reflux episodes/hour (1.5 (1.1–2.2), p =.031), and an endoscopic appearance of the SCJ corresponding to ZAP grade I (4.6 (1.4–15.6), p =.013). There was no association with HP infection. Conclusion: The finding of IM at an endoscopically normal-appearing GEJ is associated with gastroesophageal reflux but not with HP infection.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Barretts esophagus, esophageal adenocarcinoma, gastroesophageal reflux, GERD, Helicobacter pylori infection, Intestinal Metaplasia, pH monitoring
in
Scandinavian Journal of Gastroenterology
volume
53
issue
10-11
pages
1179 - 1185
publisher
Taylor & Francis
external identifiers
  • pmid:30516400
  • scopus:85058147862
ISSN
0036-5521
DOI
10.1080/00365521.2018.1526967
language
English
LU publication?
yes
id
ab4f7aaf-fa23-46ea-b379-fe0e33e0b47c
date added to LUP
2019-01-02 09:56:57
date last changed
2020-07-01 04:54:17
@article{ab4f7aaf-fa23-46ea-b379-fe0e33e0b47c,
  abstract     = {<p>Objective: Studies of the etiology of intestinal metaplasia (IM) at a normal appearing gastroesophageal junction (GEJ) are conflicting as associations with both H. Pylori (HP) infection and gastroesophageal reflux has been reported. The aim of this study was to investigate whether IM at the GEJ is associated with gastroesophageal reflux or HP infection. Material and methods: Fifty asymptomatic volunteers and 149 patients with reflux symptoms underwent endoscopy with biopsies obtained from the gastric antrum and the squamocolumnar junction (SCJ). All subjects underwent wireless 48 h pH monitoring with the electrode placed immediately above the SCJ and a fecal antigen test for HP infection. Clinical characteristics and the pattern of reflux were compared in subjects with and without IM. Results: Three asymptomatic volunteers and 35 patients who had clearly irregular SCJs with short extensions of columnar mucosa were excluded from the study. In the remaining 47 asymptomatic volunteers and 114 patients, variables that reached a significance level of 0.1 or less on univariate analyses were used in a binomial regression analysis to assess their relative importance for the finding of IM. IM at the GEJ was significantly associated with abnormal distal esophageal acid exposure (5.5 (1.2–24.6), p =.026), the frequency of reflux episodes/hour (1.5 (1.1–2.2), p =.031), and an endoscopic appearance of the SCJ corresponding to ZAP grade I (4.6 (1.4–15.6), p =.013). There was no association with HP infection. Conclusion: The finding of IM at an endoscopically normal-appearing GEJ is associated with gastroesophageal reflux but not with HP infection.</p>},
  author       = {Hall, Mats and Wenner, Jörgen and Scherman, Peter and Öberg, Stefan},
  issn         = {0036-5521},
  language     = {eng},
  month        = {12},
  number       = {10-11},
  pages        = {1179--1185},
  publisher    = {Taylor & Francis},
  series       = {Scandinavian Journal of Gastroenterology},
  title        = {Intestinal metaplasia at the gastroesophageal junction is associated with gastroesophageal reflux but not with Helicobacter pylori infection},
  url          = {http://dx.doi.org/10.1080/00365521.2018.1526967},
  doi          = {10.1080/00365521.2018.1526967},
  volume       = {53},
  year         = {2018},
}