Endoscopic versus histological diagnosis of Barrett's esophagus: a cross-sectional survey.

CONTEXT: Barrett's esophagus is a common pathological condition in patients with gastro-esophageal reflux disease.

OBJECTIVE

The aim of this study was to compare endoscopic diagnosis versus histological confirmation.

DESIGN

Cross-sectional.

SETTING

Cancer Institute of the Imam Khomeini Hospital.

MATERIAL AND

METHODS

A total of 50 patients with a history of gastro-esophageal reflux were recruited and underwent upper endoscopy at this cross-sectional survey. Four-quadrant biopsy was taken from all suspected areas of intestinal metaplasia. Sections of blocks were stained with Mixed Alcian Blue (PH 2.5)/PAS and haematoxylin-eosin stainings for the diagnosis of intestinal metaplasia (complete vs. incomplete types) and goblet cell / columnar cell / dysplasia, respectively.

MAIN OUTCOME MEASURE: The presence of Helicobacter pylori was assessed by Giemsa staining.

RESULTS

There were 44 cases of short-segment Barrett's esophagus and 6 of long-segment Barretts esophagus by endoscopy. When examined by histologic examination, 12 patients with short-segment Barrett's esophagus and 4 with long-segment Barrett's esophagus had intestinal metaplasia. Haematoxylin-eosin staining diagnosed 12 cases of intestinal metaplasia, whereas mixed alcian blue/PAS was used to diagnose 16 cases (κ = 80%, p < 0.001). The positive predictive value in the diagnosis of goblet cell metaplasia and columnar cell metaplasia was 32% and 66%, respectively. Helicobacter pylori infection was observed in 10 cases of those with columnar cell metaplasia without goblet cells, while none of the patients with intestinal metaplasia were infected.

CONCLUSION

Our findings suggest that biopsy taking is necessary in all patients with gastro-esophageal reflux disease, whose results suggest columnar cell lining in distal esophagus in endoscopy.