Estudio prospectivo endoscópico y biópsico de la prevalencia de metaplasia intestinal en la unión gastro-esofágica en controles y en pacientes con reflujo gastroesofágico / Endoscopic assessment of the prevalence of gastro esophageal junction intestinal metaplasia in gastroesophageal reflux

RESUMO

Background: The Classic diagnosis of Barret esophagus is based on the finding of three or more cm of distal esophagus covered by specialized columnar epithelium. However, at the present time, it is based on the presence of intestinal metaplasia in the jucntion of aquamous-columnar mucosae. Aim: To assess the prevalence of Barret esophagus using endoscopic and pathological criteria in healthy subjects and in individuals with gastroesophageal reflux. Patients and methods: One hundred thirty nine controls and 372 patients with symptoms of gastroesophageal reflux subjects to an upper gastrointestinal endoscopy were studied. Patients with Barret esophagus was classified as being a "mini Barret" wben the pathological presence of intestinal metaplasia was the only finding. A "short Barret esophagus" was diagnoses when less than 3 cm were covered with fingerings of mucosal substitutions and "extensive Barret esophagus" when more than 13 cm of esophageal mucosa were substituted. Results: Two percent of controls, 12.4 percent of patients with gastroesophageal reflux without esophagitis and l1,7 percent of such patients with esophagitis had intestinal metaplasia in the gastresophageal junction. Patients with Barret esophagus were older than the rest of patients. "Short Barret esophagus" is six times more frequent than "extensive Barret esophagus". Esophageal erosions, peptic ulcer and stenosis were more frequent in patients with extensive Barret esophagus. The prevalence of dysplasia was similar in all types of Barret esophagus. Conclusions: Intestinal metaplasia was very infrequent in control patients. In subjects with gastroesophageal reflux, classic endoscopic diagnosis may miss up to 80 percent of patients with Barret esophagus. Thus, gastroesophageal junction biopsies must be obtained in all patients with symptoms of gastroesophageal reflux