The Z-line appearance and prevalence of intestinal metaplasia among patients without symptoms or endoscopical signs indicating gastroesophageal reflux

Surg Endosc. 2001 Aug;15(8):886-9. doi: 10.1007/s004640090025. Epub 2001 May 2.


Background: A four-graded classification of the Z-line appearance (ZAP) has been proposed, which was shown to correlate with the prevalence of intestinal metaplasia (IM) among patients with gastroesophageal reflux disease (GERD). The aim of this study was to determine the ZAP grade and the prevalence of IM among patients without GERD.

Methods: In this study, 53 consecutive patients without signs or symptoms of GERD were included.

Results: A normal Z-line (ZAP grade 0) was found in 26 patients (51%), and this group had a lower prevalence of Helicobacter pylori infection and atrophy in the cardia than ZAP grade patients. The non-GERD patients in this study had less ZAP pathology than the GERD patients in our previous study. Intestinal metaplasia at the Z-line, observed in 17% of the patients, was found to associate with peptic ulcer and carditis.

Conclusion: The normal Z-line is feasibly defined as ZAP grade 0.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Biopsy
  • Comorbidity
  • Duodenum / pathology*
  • Endoscopy, Digestive System
  • Esophagus / pathology
  • Female
  • Gastroesophageal Reflux / diagnosis*
  • Gastroesophageal Reflux / epidemiology*
  • Helicobacter Infections / epidemiology*
  • Helicobacter pylori / isolation & purification
  • Humans
  • Intestinal Diseases / epidemiology*
  • Male
  • Metaplasia / epidemiology
  • Middle Aged
  • Myocarditis / epidemiology
  • Peptic Ulcer / epidemiology
  • Prevalence
  • Stomach / microbiology
  • Stomach / pathology