SPECIALIZED INTESTINAL METAPLASIA IN PATIENTS WITH GASTROOESOPHAGEAL REFLUX DISEASE

Barrett's metaplasia is commonly a long-term sequel of reflux oesophagitis. It is a recognised risk factor for developing 
adenocarcinoma. There is compelling evidence linking specialized intestinal metaplasia (SIM) in Barrett’s oesophagus (BE) with adenocarcinoma of the lower oesophagus. The prevalence of SIM was studied in 839 patients with symptoms of gastrooesophageal reflux and endoscopically confirmed reflux oesophagitis and/or BE. The association of SIM with age, symptoms, smoking, non-steroidal anti-inflammatory drugs (NSAIDs), endoscopic and histopathological findings was investigated. 
Patients were divided into three groups: (1)those with SIM, (2)those with gastric-type columnar lined oesophagus (G-CLO), and (3)those with oesophagitis only. SIM was histologically detected in 119(14.18%) patients, G-CLO in 75(8.94%) and oesophagitis (endoscopically and/or histologically) in 645(76.88%). Patients with SIM or G-CLO were significantly older. 
Patients with grade III and IV oesophagitis were also significantly older. No statistically significant correlation with 
symptoms, smoking, the use of NSAIDs, hiatus hernia and Helicobacter pylori infection was found between the three groups. 
Also, no statistical correlation was found between SIM and the length of the BE or oesophagitis. 
In conclusion, the presence of SIM and G-CLO is associated with older age. Grade III and IV oesophagitis are also associated with older age. SIM does not correlate with symptoms, smoking, NSAIDs, oesophagitis, hiatus hernia, Helicobacter pylori infection or the length of the BE.