Predictors of specialized intestinal metaplasia in patients with an incidental irregular Z line

Eur J Gastroenterol Hepatol. 2010 Feb;22(2):135-8. doi: 10.1097/MEG.0b013e3283318f69.


Introduction: Barrett's esophagus is a well-known complication of gastroesophageal reflux disease (GERD) and is associated with dysplasia and esophageal adenocarcinoma. Data on the prevalence of specialized intestinal metaplasia (SIM) in biopsy taken from an incidental irregular Z line are scarce.

Aim: To determine the prevalence of SIM in biopsies taken from an incidental irregular Z line in consecutive patients undergoing upper endoscopy.

Methods: During the study period, we identified all adult patients who underwent an upper endoscopy with biopsies from an incidental finding of an irregular Z line. Demographic characteristics, prevalence of endoscopic findings, and major complaints were compared between those with SIM and those without.

Results: A total of 166 out of 2000 (8.3%) consecutive patients were identified. Specialized intestinal metaplasia was found in 43.5% of all cases. Male sex and the presence of hiatus hernia were predictors of SIM (P=0.043 and 0.001, respectively), with relative risks of 2.02 (95% confidence interval: 1.01-4.0) and 3.31 (95% confidence interval: 1.66-6.58), respectively.

Conclusion: In this endoscopic and histological study, SIM was found to be a common finding in patients with irregular Z line. Male sex and the presence of diaphragmatic hernia were significantly associated with the presence of SIM.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Barrett Esophagus / ethnology
  • Barrett Esophagus / etiology
  • Barrett Esophagus / pathology*
  • Biopsy
  • Esophagoscopy*
  • Esophagus / pathology*
  • Female
  • Gastroesophageal Reflux / complications
  • Gastroesophageal Reflux / ethnology
  • Gastroesophageal Reflux / pathology*
  • Hernia, Hiatal / complications
  • Humans
  • Israel / epidemiology
  • Logistic Models
  • Male
  • Metaplasia
  • Middle Aged
  • Prevalence
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Sex Factors
  • Young Adult