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J Thorac Cardiovasc Surg 1999;117:572-580
© 1999 Mosby, Inc.

GENERAL THORACIC SURGERY

THE EXTENT OF BARRETT'S ESOPHAGUS DEPENDS ON THE STATUS OF THE LOWER ESOPHAGEAL SPHINCTER AND THE DEGREE OF ESOPHAGEAL ACID EXPOSURE

From the University of Southern California, Department of Surgery, Los Angeles, Calif.

Read at the Seventy-eighth Annual Meeting of The American Association for Thoracic Surgery, Boston, Mass, May 3-6, 1998.

Received for publication May 13, 1998. Revisions requested July 6, 1998; revisions received Nov 6, 1998. Accepted for publication Nov 6, 1998. Address for reprints: Tom R. DeMeester, MD, University of Southern California, School of Medicine, Department of Surgery, 1510 San Pablo St, Suite 514, Los Angeles, CA 90033-4612.*Department of Surgery, Lund University, Lund, Sweden.

Objective: The purpose of this study was to assess whether the extent of intestinal metaplasia is related to the severity of the gastroesophageal reflux disease.
Methods: A total of 556 consecutive patients with symptoms suggestive of foregut disease had upper gastrointestinal endoscopy with extensive biopsies from the gastroesophageal junction and the esophagus. All patients had esophageal motility and 24-hour pH monitoring. In 411 patients, cardiac-type mucosa was identified; in 147 patients, the cardiac-type mucosa showed intestinal metaplasia. They were divided into 3 groups based on the extent of intestinal metaplasia commonly seen clinically: long segments (>3 cm), short segments (<3 cm), and limited to the gastroesophageal junction. The duration of symptoms, the status of the lower esophageal sphincter, the degree of esophageal acid exposure, and the time to clear a reflux episode were assessed in each group.
Results: The presence of intestinal metaplasia in cardiac-type mucosa was associated with the hallmarks of gastroesophageal reflux disease. The extent of intestinal metaplasia correlated strongly with the degree of esophageal acid exposure (r = 0.711; P < .001) and inversely with the lower esophageal sphincter pressure (r = 0.351; P < .001) and length (r = 0.259; P = .002). Patients with a long segment of intestinal metaplasia (>3 cm) had longer duration of symptoms (16 years) than those patients with a segment of intestinal metaplasia less than 3 cm (10 years; P = .048) or those patients with intestinal metaplasia limited to the gastroesophageal junction (10 years; P = .01).
Conclusion: The extent of intestinal metaplasia, that is, Barrett's esophagus, is related to the status of the lower esophageal sphincter and the degree of esophageal acid exposure.

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