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The gastric cardia in gastro-oesophageal disease
  1. Hala M T El-Zimaity1,
  2. Vino J Verghese2,
  3. Jacqueline Ramchatesingh1,
  4. David Y Graham2
  1. 1Gastrointestinal Mucosa Pathology Laboratory, Room 3A352, Veterans Affairs Medical Center (111-D), 2002 Holcombe Blvd, Houston, Texas 77030, USA
  2. 2Department of Medicine, Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas, USA
  1. Dr El-Zimaity email: hzimaity{at}


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.

  • Barrett's oesophagus
  • gastro-oesophageal disease
  • cardia
  • Helicobacter pylori

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