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Pancreatic acinar metaplasia in the distal oesophagus and the gastric cardia: prevalence, predictors and relation to GORD

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Abstract

Purpose

The nature of pancreatic acinar metaplasia (PAM) in the gastro-oesophageal junction (GOJ) remains obscure. We aimed to estimate its prevalence and investigate into its risk factors in a population-based series of first-time endoscopy patients.

Methods

We investigated consecutive patients, endoscoped for the first time, representing defined catchment area populations. Biopsies were taken immediately below the GOJ and from the distal oesophagus. Endoscopy room-based cross-sectional clinical data were supplemented with exposure data from 160 population controls. Associations, expressed as odds ratios (OR), were modelled with multivariable logistic regression. A subsample of 26 patients underwent oesophageal pH monitoring.

Results

Among 644 patients (mean age 53 years, 43% men), PAM was found in 121 patients (19%), exclusively above the GOJ in 40 (6%), below GOJ in 67 (10%), and both above and below GOJ in 14 (2%). PAM exclusively above the GOJ and PAM exclusively below the GOJ were both borderline associated with age (2% increase in prevalence per year). PAM exclusively above the GOJ was significantly associated with female gender (OR 2.8, 95% CI 1.3–6.3) and presence of Helicobacter pylori immediately below the GOJ (OR 2.6, 95% CI 1.3–5.4). Out of 21 patients with Barrett’s oesophagus (BO), 8 (38%) had PAM above the GOJ. The mean value for percentage time with oesophageal pH < 4.0 was 7.3% (95% CI 4.3–10.2%) among patients who had PAM above the GOJ (reference value 3.4%).

Conclusions

Pancreatic acinar metaplasia might be an age-dependent lesion, associated with H. pylori, female gender and gastro-oesophageal reflux if located above the GOJ.

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References

  1. Doglioni C, Laurino L, Dei Tos AP, De Boni M, Franzin G, Braidotti P, et al. Pancreatic (acinar) metaplasia of the gastric mucosa. Histology, ultrastructure, immunocytochemistry, and clinicopathologic correlations of 101 cases. Am J Surg Pathol. 1993;17:1134–43.

    Article  CAS  PubMed  Google Scholar 

  2. Wang HH, Zeroogian JM, Spechler SJ, Goyal RK, Antonioli DA. Prevalence and significance of pancreatic acinar metaplasia at the gastroesophageal junction. Am J Surg Pathol. 1996;20:1507–10.

    Article  CAS  PubMed  Google Scholar 

  3. Krishnamurthy S, Dayal Y. Pancreatic metaplasia in Barrett’s esophagus. An immunohistochemical study. Am J Surg Pathol. 1995;19:1172–80.

    Article  CAS  PubMed  Google Scholar 

  4. Johansson J, Hakansson HO, Mellblom L, Kempas A, Johansson KE, Granath F, et al. Prevalence of precancerous and other metaplasia in the distal oesophagus and gastro-oesophageal junction. Scand J Gastroenterol. 2005;40:893–902.

    Article  PubMed  Google Scholar 

  5. Hakansson HO, Mellblom L, Johansson J, Bjartell A, Borgstrom A. Synthesis and localization of pancreatic secretory proteins in pancreatic acinar-like metaplasia in the distal part of the oesophagus. Pancreatic acinar metaplasia: another source of pancreatic enzymes!. Scand J Gastroenterol. 2003;38:10–3.

    CAS  PubMed  Google Scholar 

  6. Jhala NC, Montemor M, Jhala D, Lu L, Talley L, Haber MM, et al. Pancreatic acinar cell metaplasia in autoimmune gastritis. Arch Pathol Lab Med. 2003;127:854–7.

    PubMed  Google Scholar 

  7. el-Zimaity HM, Verghese VJ, Ramchatesingh J, Graham DY. The gastric cardia in gastro-oesophageal disease. J Clin Pathol. 2000;53:619–25.

    Article  CAS  PubMed  Google Scholar 

  8. Polkowski W, van Lanschot JJ, ten Kate FJ, Rolf TM, Polak M, Tytgat GN, et al. Intestinal and pancreatic metaplasia at the esophagogastric junction in patients without Barrett’s esophagus. Am J Gastroenterol. 2000;95:617–25.

    Article  CAS  PubMed  Google Scholar 

  9. Johansson J, Hakansson HO, Mellblom L, Kempas A, Johansson KE, Granath F, et al. Risk factors for Barrett’s oesophagus: a population-based approach. Scand J Gastroenterol. 2007;42:148–56.

    Article  PubMed  Google Scholar 

  10. Miller LS. Endoscopy of the esophagus. In: Castell DO, editor. The esophagus. Boston: Little, Brown & Co; 1992. p. 89–142.

    Google Scholar 

  11. Armstrong D, Bennett JR, Blum AL, Dent J, De Dombal FT, Galmiche JP, et al. The endoscopic assessment of esophagitis: a progress report on observer agreement. Gastroenterol. 1996;111:85–92.

    Article  CAS  Google Scholar 

  12. Falk GW. Barrett’s esophagus. Gastroenterology. 2002;122:1569–91.

    Article  PubMed  Google Scholar 

  13. Lagergren J, Bergström R, Lindgren A, Nyrén O. Symptomatic gastroesophageal reflux as a risk factor for esophageal adenocarcinoma. N Engl J Med. 1999;340:825–31.

    Article  CAS  PubMed  Google Scholar 

  14. Kjellen G, Brudin L, Hakansson HO. Is scintigraphy of value in the diagnosis of gastrooesophageal reflux disease? Scand J Gastroenterol. 1991;26:425–30.

    Article  CAS  PubMed  Google Scholar 

  15. Johnsson F, Joelsson B, Isberg PE. Ambulatory 24 hour intraesophageal pH-monitoring in the diagnosis of gastroesophageal reflux disease. Gut. 1987;28:1145–50.

    Article  CAS  PubMed  Google Scholar 

  16. Bland M. An introduction to medical statistics. 3rd ed. Oxford: Oxford University Press; 2000.

    Google Scholar 

  17. Glickman JN, Fox V, Antonioli DA, Wang HH, Odze RD. Morphology of the cardia and significance of carditis in pediatric patients. Am J Surg Pathol. 2002;26:1032–9.

    Article  PubMed  Google Scholar 

  18. Malfertheiner P, Sipponen P, Naumann M, Moayyedi P, Megraud F, Xiao SD, et al. Helicobacter pylori eradication has the potential to prevent gastric cancer: a state-of-the-art critique. Am J Gastroenterol. 2005;100:2100–15.

    Article  PubMed  Google Scholar 

  19. Hagiwara T, Mukaisho K, Ling ZQ, Sugihara H, Hattori T. Development of pancreatic acinar cell metaplasia after successful administration of omeprazole for 6 months in rats. Dig Dis Sci. 2007;52:1219–24.

    Article  CAS  PubMed  Google Scholar 

  20. Spechler SJ. Intestinal metaplasia at the gastroesophageal junction. Gastroenterology. 2004;126:567–75.

    Article  PubMed  Google Scholar 

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Acknowledgments

This study was funded by a grant from the Swedish Cancer Society (4570-B01-01XAB), by the Health Research Council in the South-East of Sweden (F97-310 and F2001-334), by the Department of Surgery, Kalmar County Hospital and by Kalmar County Council Research and Development Committee, Sweden. We express our gratitude to Susanne Kjellin and Gun Olsén for coordination of the endoscopies, to Agneta Hansson for data input, to Joakim Vang for database design, and to Professor Anders Borgström and Dr. Erik Svartholm for valuable discussions during the planning and early phase of the study.

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Authors and Affiliations

  1. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, P.O. Box 281, 171 77, Stockholm, Sweden

    Johan Johansson & Olof Nyrén

  2. Department of Surgery, Kalmar County Hospital, Kalmar, Sweden

    Hans-Olof Håkansson

  3. Department of Pathology, Kalmar County Hospital, Kalmar, Sweden

    Lennart Mellblom

  4. Department of Oto-Rhino-Laryngology, Kalmar County Hospital, Kalmar, Sweden

    Gerhard Kjellén

  5. Department of Physiology, Kalmar County Hospital, Kalmar, Sweden

    Lars Brudin

  6. Department of Surgery, Växjö County Hospital, Växjö, Sweden

    Antti Kempas

  7. Department of Surgery, Linköping University Hospital, Linköping, Sweden

    Karl-Erik Johansson

  8. Unit of Clinical Epidemiology, Department of Medicine, Karolinska Institutet, University Hospital, Stockholm, Sweden

    Fredrik Granath

Authors
  1. Johan Johansson
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  2. Hans-Olof Håkansson
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  3. Lennart Mellblom
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  4. Antti Kempas
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  5. Gerhard Kjellén
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  6. Lars Brudin
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  7. Fredrik Granath
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  8. Karl-Erik Johansson
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  9. Olof Nyrén
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Corresponding author

Correspondence to Johan Johansson.

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Johansson, J., Håkansson, HO., Mellblom, L. et al. Pancreatic acinar metaplasia in the distal oesophagus and the gastric cardia: prevalence, predictors and relation to GORD. J Gastroenterol 45, 291–299 (2010). https://doi.org/10.1007/s00535-009-0161-4

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  • DOI: https://doi.org/10.1007/s00535-009-0161-4

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