TY - JOUR T1 - The gastric cardia in gastro-oesophageal disease JF - Journal of Clinical Pathology JO - J Clin Pathol SP - 619 LP - 625 DO - 10.1136/jcp.53.8.619 VL - 53 IS - 8 AU - Hala M T El-Zimaity AU - Vino J Verghese AU - Jacqueline Ramchatesingh AU - David Y Graham Y1 - 2000/08/01 UR - http://jcp.bmj.com/content/53/8/619.abstract N2 - 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. ER -