Intestinal Metaplasia Around The Gastroesophageal Junction Is Frequently Associated With Antral Reactive Gastropathy: Implications For Carcinoma At The Gastroesophageal Junction.

2020 
Increasing evidence suggests that bile reflux (BR) plays a major role in mucosal injury leading to adenocarcinoma of the proximal stomach and distal esophagus. However, gastric BR is difficult to diagnose and investigate. Reactive gastropathy (RG), in the absence of non-steroidal anti-inflammatory drugs (NSAIDs) and other known causes likely represents bile-mediated injury to gastric mucosa. The goal of this study is to explore the association between antral RG and gastroesophageal junction (GEJ) mucosal inflammation and intestinal metaplasia. The pathology database was searched for patients who had gastric biopsies with a diagnosis of antral RG and concurrent gastric cardia/GEJ/distal esophagus biopsies from 2013-2015. Age and sex matched patients with normal gastric antral biopsies served as controls. Biopsies from the GEJ region were evaluated for histological changes, including inflammation, antral and pancreatic metaplasia, RG, type of gastric glands, proton-pump inhibitor (PPI) changes and intestinal metaplasia. Detailed clinical history and medication use (including PPIs and NSAIDs) were recorded. Intestinal metaplasia in the GEJ region was more frequent in patients with antral RG compared to controls [33.0% vs. 5.2%, 95% CI (18.3%-37.3%)]. In addition, inflammation, other mucosal changes around the GEJ (RG & foveolar hyperplasia), antral IM and PPI associated mucosal changes were also more frequently seen in patients with antral RG. Our results show that antral RG is associated with mucosal injury and intestinal metaplasia around GEJ suggesting a role for bile reflux. Further studies are needed to study duodenogastric-esophageal bile reflux and its role in development of proximal gastric and distal esophageal adenocarcinoma.
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