Validity of the Specialized Columnar Epithelium as a Diagnostic Criterion of the Short Segment Barrett`s Esophagus

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Abstract
In areas where intestinal metaplasia of the stomach is highly prevalent, diagnosing Barrett’s esophagus solely by the presence of specialized columnar epithelium in the distal esophagus may lead to many false positive diagnoses. The aim of this study was to test the validity of the specialized columnar epithelium as a diagnostic criterion of the short segment Barrett’s esophagus in Korea. During routine gastroscopy, the length of columnar-lined esophagus was measured and biopsy samples were taken from the mucosa immediately distal to the squamocolumnar junction. Under light microscopy, alcian blue-positive cells were identified. Prevalence of the specialized columnar epithelium in cases without the columnar-lined esophagus and with the short segment columnar-lined esophagus was 57.1% and 31.2%, respectively (P=0.0281). The specialized columnar epithelium is frequently seen around the cardia in Koreans with or without the columnar-lined esophagus. Simple presence of the specialized columnar epithelium is not a valid criterion for a diagnosis of Barrett’s esophagus. We propose that both the short segment Barrett’s esophagus and the goblet cell metaplasia of the cardia might be grouped together under a title of “the specialized columnar epithelium around the gastroesophageal junction” as a potential preceding condition of adenocarcinoma around the cardia.