Assessment of columnar-lined esophagus in controls and patients with gastroesophageal reflux disease with and without proton-pump inhibitor therapy

Gastroesophageal reflux disease (GERD) is associated with columnar-lined esophagus (CLE) without and with intestinal metaplasia (IM), i.e., nondysplastic Barrett's esophagus (NDBE; 0.5 % annual cancer risk). We aimed to compare endoscopy and histopathology in controls and GERD patients with and without proton-pump inhibitor (PPI) therapy. We conducted endoscopy with four-quadrant multi-level biopsy sampling of any endoscopically visible columnar-lined esophagus (CLEv) in 0.5 cm increments and at 0.5 and 1.0 cm distal to the level of the rise of the endoscopic gastric-type folds in controls (n = 76), GERD patients with (n = 177) and without (n = 38) PPI therapy. Squamous epithelium (Squ) of the esophagus and oxyntic mucosa (OM) of the proximal stomach defined normalcy. CLE included oxyntocardiac, cardiac mucosa (CM) +/- IM. All persons had CLE interposed between Squ and OM. Frequency and distribution of endoscopic and histopathologic findings did not differ between the three groups (p > 0.05). Frequency of IM was 13.2, 26.3, and 20.9 % in controls, GERD patients with and without PPI therapy, respectively (p = 0.194). The frequency of IM increased with longer CLEv. In 50 % of the cases, CLE included more than the proximal 1.0 cm portion of the endoscopically visible gastric-type folds. The frequency of IM is independent from the presence or absence of GERD symptoms and increases with increased length of CLEv. The proximal portion of the endoscopic gastric-type folds contains CLE and not OM. Thus, what is taken for proximal stomach during endoscopy represents gastric folds forming sac-like CLE.