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Published on: September 22, 2023
The gastric cardia in gastro-oesophageal disease
H M el-Zimaity1, V J Verghese, J Ramchatesingh
1Gastrointestinal Mucosa Pathology Laboratory, Veterans Affairs Medical Center, Houston, Texas 77030, USA. hzimaity@bcm.tmc.edu
Insights
Gastric cardia biopsies reveal intestinal metaplasia is rare in gastro-oesophageal disease without H pylori infection. Carditis strongly links to H pylori, resolving post-treatment.
Area of Science:
- Gastroenterology
- Pathology
- Oncology
Background:
- Conflicting reports exist on using cardia biopsies for screening gastro-oesophageal disease.
- Understanding histopathological changes in the gastric cardia is crucial for accurate diagnosis.
Purpose of the Study:
- To define histopathological changes in the gastric cardia of patients with and without gastro-oesophageal disease.
- To investigate the association between H pylori infection and metaplasia in the gastric cardia.
Main Methods:
- Topographically mapped gastric biopsy specimens were analyzed from patients with gastro-oesophageal disease and controls.
- Biopsies were scored for H pylori, intestinal metaplasia, pancreatic metaplasia, foveolar hyperplasia, and active inflammation.
- Presence of cardiac glands was recorded.
Main Results:
- Intestinal metaplasia was uncommon in the cardia, especially in gastro-oesophageal disease patients without H pylori.
- Carditis was strongly associated with active H pylori infection and resolved after treatment.
- No significant association was found between gastro-oesophageal disease and pancreatic metaplasia or foveolar hyperplasia.
Conclusions:
- Intestinal metaplasia in the gastric cardia is infrequent in gastro-oesophageal disease unless H pylori is present.
- Chronic H pylori infection leads to an expansion of the cardia-corpus junction.
Background:
There have been conflicting reports concerning the use of cardia biopsies in screening patients for gastro-oesophageal disease.
Aim:
To define the histopathological changes in the gastric cardia of patients with and without gastro-oesophageal disease.
Methods:
Topographically mapped gastric biopsy specimens were obtained from patients with gastro-oesophageal disease and from controls. Biopsies were scored on a visual analogue scale of 0 to 5 for Helicobacter pylori, intestinal metaplasia, pancreatic metaplasia, foveolar hyperplasia, and active inflammation. The presence or absence of cardiac glands was recorded.
Results:
Sixty-five patients with gastro-oesophageal disease and 71 controls were examined. Intestinal metaplasia was present in cardia biopsies of 10 patients with gastro-oesophageal disease and 11 controls. Only two patients with gastro-oesophageal disease and intestinal metaplasia in the cardia had no evidence of exposure to H pylori. Intestinal metaplasia was not found in the cardia of those with long segment Barrett's oesophagus. Carditis was strongly associated with active H pylori infection (p = 0.000) and resolved after treatment of the infection. A negative association was present between gastro-oesophageal disease and the presence of cardiac glands in cardiac biopsies (p = 0.003). Pancreatic metaplasia was found in 15 of 65 and foveolar hyperplasia in 19 of 65 cases but neither was related to gastro-oesophageal disease.
Conclusion:
Intestinal metaplasia in the cardia is uncommon in gastro-oesophageal disease in the absence of H pylori infection. With chronic H pylori infection the junction between the cardia and corpus expands in a cardia-corpal direction.
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