ORIGINAL CONTRIBUTIONS Clinical, Endoscopic, and Functional Studies in 408 Patients With Barrett’s Esophagus, Compared to 174 Cases of Intestinal Metaplasia of the Cardia Attila Csendes, M.D., Gladys Smok, M.D., Juan Quiroz, M.D., Patricio Burdiles, M.D., Jorge Rojas, M.D., Ce ´sar Castro, M.D., and Ana Henrı ´quez, M.T. Department of Surgery and Pathology, University Hospital, Santiago, Chile OBJECTIVE: The pathophysiology of gastroesophageal reflux disease (GERD) has been studied extensively in patients with long-segment Barrett’s esophagus (LSBE), but few reports have explored GERD pathophysiology in patients who have short-segment Barrett’s esophagus (SSBE) or intestinal metaplasia at the cardia (IMC). We aimed to compare clinical, endoscopic, histological, and functional features in patients with LSBE, SSBE, and IMC. METHODS: We identified 582 patients who had intestinal metaplasia at the squamocolumnar junction in the distal esophagus and divided them into three groups based on the extent of columnar-lined esophagus observed endoscopi- cally: 1) patients with IMC who had no columnar-lined esophagus (i.e., the squamocolumnar and gastroesophageal junctions coincided), 2) patients with LSBE who had 3 cm of columnar-lined esophagus, and 3) patients with SSBE who had 3 cm of columnar-lined esophagus. All patients had esophageal manometric evaluation, and 24-h esopha- geal pH monitoring was performed to determine the extent of acid and bile (bilirubin) reflux. RESULTS: There were 174 patients with IMC, 155 with LSBE, and 25 with SSBE. Compared to patients with LSBE and SSBE, patients with IMC had significantly lower fre- quencies of GERD symptoms, hiatal hernia, and erosive esophagitis; significantly higher lower esophageal sphincter pressures; and significantly shorter durations of acid and bile reflux. Between patients with SSBE and LSBE, signif- icant differences were found in the frequency of hiatal hernia and duration of acid reflux (both greater in the pa- tients with LSBE). Also, dysplasia was significantly more frequent in patients with LSBE than in those with SSBE or IMC. CONCLUSION: GERD symptoms, signs, and physiological abnormalities are found more often in patients with Barrett’s esophagus than in those with IMC, and the duration of acid reflux in patients with LSBE is greater than that in patients with SSBE. These findings suggest that the extent of intes- tinal metaplasia in the esophagus is related directly to the severity of underlying GERD. (Am J Gastroenterol 2002;97: 554 –560. © 2002 by Am. Coll. of Gastroenterology) INTRODUCTION Barrett’s esophagus (BE) is an acquired condition in which the squamous epithelium at the distal esophagus is replaced by specialized columnar epithelium (1, 2). It is a frequent condition in patients with symptoms of gastroesophageal reflux (GER), and its importance is based not only on its frequency and pathogenesis, but also on its association with adenocarcinoma of the esophagus and the esophagogastric junction (1, 3–5). The classic endoscopic diagnosis of BE has been based on the finding of at least 3 cm of the distal esophagus covered by columnar epithelium (6 –10). Re- cently, BE has been defined according to the findings of specialized columnar epithelium, when the metaplastic gob- let cell type of epithelium (intestinal metaplasia) is found within the esophageal lumen at any level, provided it is in continuity distally with gastric epithelium (11–13). Several endoscopic and functional studies have been performed in patients with long-segment BE (3, 13–17), but few have explored the functional results in patients with short-seg- ment BE (SSBE) (15) and less even in patients with intes- tinal metaplasia at the cardia (IMC) without endoscopic findings of BE (18 –20). Therefore the aim of the present prospective study was to evaluate the clinical, endoscopic, histological, and functional features in three groups of pa- tients with intestinal metaplasia at the gastric cardia and at the distal esophagus, according to the extent of columnar lining, with special emphasis on the esophageal exposure to gastric and duodenal juice. MATERIALS AND METHODS Patients Studied This prospective study, which started on January, 1992 and ended on December, 1999, included 582 consecutive pa- tients who came to endoscopic evaluation because of typical symptoms of foregut disease (heartburn, regurgitation, and dysphagia), symptoms suggesting aspiration (chronic pos- terior laringytis, cough, or wheezing), or symptoms such as epigastric pain, intolerance to food, and epigastric discom- fort. They were selected from a total universe of 5350 patients who were submitted to upper endoscopies at the THE AMERICAN JOURNAL OF GASTROENTEROLOGY Vol. 97, No. 3, 2002 © 2002 by Am. Coll. of Gastroenterology ISSN 0002-9270/02/$22.00 Published by Elsevier Science Inc. PII S0002-9270(01)04091-6