Published online Aug 14, 2015. doi: 10.3748/wjg.v21.i30.9126
Peer-review started: January 16, 2015
First decision: March 10, 2015
Revised: April 6, 2015
Accepted: May 27, 2015
Article in press: May 27, 2015
Published online: August 14, 2015
Processing time: 213 Days and 18 Hours
AIM: To investigate the nature and origin of cardiac mucosa (CM).
METHODS: Biopsy samples from sixty-one individuals were included in this study. The specimens were taken “at”, “just below”, or “just above” the gastroesophageal junction, including the histologic squamocolumnar junction. Clinical data were obtained by reviewing electronic medical records for each patient. Patients with a history of stomach adenoma or carcinoma and esophageal carcinoma were excluded, and cases that were endoscopically suspicious of Barrett’s esophagus or a polyp were also ruled out. Histologic and endoscopic reviews were performed blinded to the patient’s clinical data. Histologic evaluation was conducted by two pathologists, and endoscopic review was performed by a endoscopist with wide experience in the field. Histologically, the columnar epithelium of squamocolumnar junction, presence and severity of acute and chronic inflammation, atrophy, intestinal metaplasia, and presence of carditis were evaluated. Endoscopically, reflux esophagitis was evaluated by Los Angeles (LA) classification, hiatal hernias were classified by Hill grade, and gastroesophageal flap valves were assessed.
RESULTS: Fifty-nine of the 61 (96.7%) patients were Korean; 65.6% (40/61) of the patients underwent endoscopy according to the schedule of the National Health Insurance Program as a screening inspection. Of these, only 20.0% (8/40) of cases had reflux symptoms. CM was present in 41/61 (67.2%) individuals, and its presence was associated with older age compared to oxyntocardiac mucosa/oxyntic mucosa (60.59 ± 2.02 years vs 51.55 ± 3.35 years; P = 0.018). The presence of CM was associated with endoscopic diagnosis of esophagitis according to the LA classification (P = 0.022). CM was associated with mononuclear cell infiltration and neutrophilic infiltration, which were statistically significant (P = 0.001, and P = 0.004, respectively). The inflammation of CM, “carditis”, showed a statistically significant association with endoscopic diagnosis of reflux esophagitis according to the LA classification (P = 0.008).
CONCLUSION: CM at the gastroesophageal junction is a common histologic finding in biopsy specimens, though not always present, and associated with gastroesophageal reflux disease and carditis severity.
Core tip: Incidence of gastroesophageal reflux disease and gastroesophageal junction (GEJ) adenocarcinomas is increasing in Asia, though with a lower prevalence than Western countries. The existence and origin of cardiac mucosa (CM) at the GEJ is debated, but most data were from a Western population. This study shows that CM at the GEJ is a common histologic finding in a chiefly Korean population, and 4.4% showed direct continuity of oxyntic mucosa and squamous epithelium even in single biopsy specimens. CM was associated with gastroesophageal reflux disease and carditis severity, suggesting CM may be an acquired structure and is associated with reflux stimuli, similar to results from Western populations.