Histology of the gastroesophageal junction: An autopsy study

Parakrama T. Chandrasoma, Roger Der, Yanling Ma, Patricia Dalton, Mark Taira

Research output: Contribution to journalArticle

186 Scopus citations

Abstract

Current diagnostic criteria for reflux disease and Barrett's esophagus are based on the belief that the gastroesophageal junction normally contains 2 cm of cardiac mucosa composed of mucous glands devoid of parietal cells. This autopsy study disproves this belief. Even when the entire circumference of the gastroesophageal junction is examined, pure cardiac mucosa was completely absent in 56% of patients. All patients had oxyntocardiac mucosa, in which glands contained a mixture of mucous and parietal cells. Cardiac and oxyntocardiac mucosae were present only in part of the circumference of the junction in 50% of patients. The measured maximum length of cardiac plus oxyntocardiac mucosa was less than 0.5 cm in 76% of patients. There was a tendency for the presence and extent of cardiac mucosa to increase with age. Cardiac mucosa at the junction is therefore frequently absent, has considerable individual variation, is very small in extent when present, is commonly absent from some part of the circumference of the junction, and increases in prevalence and length with age. These characteristics of cardiac mucosa make it highly unlikely that it is a normal structure. We develop the hypothesis that cardiac mucosa represents an early histologic manifestation of gastroesophageal reflux.

Original languageEnglish (US)
Pages (from-to)402-409
Number of pages8
JournalAmerican Journal of Surgical Pathology
Volume24
Issue number3
DOIs
StatePublished - Mar 1 2000

Keywords

  • Barrett's esophagus
  • Cardiac mucosa
  • Gastroesophageal junction
  • Gastroesophageal reflux disease
  • Histology
  • Reflux esophagitis

ASJC Scopus subject areas

  • Anatomy
  • Surgery
  • Pathology and Forensic Medicine

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