The significance and etiology of intestinal metaplasia of the esophagogastric junction.

Biopsies from the vicinity of the esophagogastric junction occasionally show foci of intestinal metaplasia. Whether these biopsies represent Barrett's esophagus in all cases is controversial and of clinical importance because patients with Barrett's esophagus are at significantly increased risk for developing esophageal adenocarcinoma. Recent evidence suggests that intestinal metaplasia of the gastric cardia is also quite common. Although prospective data are relatively sparse, it has been suggested that the risk of progressing to dysplasia and adenocarcinoma is significantly lower for intestinal metaplasia of the gastric cardia when compared with esophageal intestinal metaplasia (Barrett's esophagus). Immunohistochemical stains for cytokeratins 7 and 20 may be useful in more precisely localizing the site of intestinal metaplasia in biopsy specimens taken from the vicinity of the esophagogastric junction. Correlation of all clinical, endoscopic, histologic, and immunohistochemical data may be used by the gastroenterologist to determine the likely source of the intestinal metaplasia and whether the patient should be followed by endoscopic surveillance.