Inform Diagnostics, Irving, TX, USA.
Baylor College of Medicine, Houston, TX, USA.
Dig Dis Sci. 2021 May;66(5):1588-1592. doi: 10.1007/s10620-020-06357-5. Epub 2020 Jun 3.
The causes for the occurrence of goblet cells at the gastroesophageal junction (GEJ-GC) are unknown. The aim of our study was to compare the concurrent histologic changes of the stomach in (1) patients with GEJ-GC, but without Barrett's esophagus (BE) to those in (2) patients with BE and in (3) controls without GEJ-GC or BE.
We used an electronic database of histopathologic records from 1.3 million individual patients, who underwent esophago-gastro-duodenoscopy (EGD) in 2009-2018. We compared the prevalence of Helicobacter pylori-positive gastritis (HpG), gastric intestinal metaplasia (G-IM), chronic inactive gastritis (CIG), and reactive gastropathy (RG) among the 3 patient groups, using odds ratios and their 95% confidence intervals.
Of all EGD patients, 4.0% harbored BE and 2.4% GEJ-GC. The average age of patients with GEJ-GC (60 ± 14) was significantly younger than the age of patients with BE (63 ± 12) and significantly older than the age of controls (55 ± 17). Female subjects were more common among GEJ-GC (54%) than BE (37%), but less common than among controls (63%). The 3 gastric histopathology changes associated with H. pylori were significantly more common in GEJ-GC than BE (for HpG 2.42, 2.29-2.56; for G-IM 1.82, 1.73-1.92; for CIG 1.31, 1.22-1.41). The corresponding differences between GEJ-GC and controls were less striking (for HpG 0.97, 0.93-1.01; for G-IM 1.15, 1.11-1.19; for CIG 0.90, 0.85-0.95). RG was slightly less common in GEJ-GC than BE (0.89, 0.86-0.92) and controls (0.94, 0.91-0.96).
With respect to its demographic and histopathologic features, GEJ-GC likely represents gastric intestinal metaplasia as opposed to BE and should prompt gastric intestinal metaplasia screening and management.
胃食管交界处（GEJ-GC）出现杯状细胞的原因尚不清楚。本研究的目的是比较（1）无 Barrett 食管（BE）的 GEJ-GC 患者、（2）有 BE 的患者和（3）无 GEJ-GC 或 BE 的对照组中胃的同时存在的组织学变化。
我们使用了一个包含 130 万个体患者的电子数据库，这些患者在 2009 年至 2018 年间接受了食管胃十二指肠镜检查（EGD）。我们使用比值比及其 95%置信区间比较了三组患者中幽门螺杆菌阳性胃炎（HpG）、胃肠上皮化生（G-IM）、慢性非活动性胃炎（CIG）和反应性胃病（RG）的患病率。
在所有接受 EGD 的患者中，有 4.0%患有 BE，2.4%患有 GEJ-GC。GEJ-GC 患者的平均年龄（60±14）明显低于 BE 患者的年龄（63±12），明显高于对照组的年龄（55±17）。GEJ-GC 患者中女性（54%）多于 BE（37%），但少于对照组（63%）。与 H. pylori 相关的三种胃组织病理学改变在 GEJ-GC 中比在 BE 中更为常见（HpG 2.42，2.29-2.56；G-IM 1.82，1.73-1.92；CIG 1.31，1.22-1.41）。GEJ-GC 与对照组之间的差异则不那么显著（HpG 0.97，0.93-1.01；G-IM 1.15，1.11-1.19；CIG 0.90，0.85-0.95）。RG 在 GEJ-GC 中比在 BE（0.89，0.86-0.92）和对照组（0.94，0.91-0.96）中略少见。
就其人口统计学和组织病理学特征而言，GEJ-GC 可能代表胃肠上皮化生，而不是 BE，因此应提示进行胃肠上皮化生筛查和管理。
