Acute GERD, Endoscopy, Prilosec, Glandular Mucosa With Minimal Chronic Inflammation, No Intestinal Metaplasia. Is It Normal?
I have had two months of new onset acute gerd which began after foreign travel and persisted. I had a endoscopy and the doc commented on a possible barretts toungue at 38cm. I went to see him after the results,and he said there is no barretts and the path results came back pretty much normal with the exception of some mild esophagitis and that there are no abnormal cells and recommended continue with prilosec 20mg BID x 6 weeks and repeat endscopy in one year.
Here are the biopsy results which seem a little scant:
irregular gastroesophageal Z line at 40cm, biopsy:
Glandular mucosa with minimal chronic inflammation and mild reactive epithelial changes. No intestinal metaplasia identified and alcian ble-pas stain is negative for goblet cells.
I am confused on this, for he identified the possible barrets toungue at 38 cm, but the biopsy is at 40 cm. Also, it mentions nothing of what type the cells where of the biopsy and was under the impression that if it is in the esophagus it needs to be all squamos cells,and that any glandular tissue is abnormal. So do I have abnormal cellular changes of the esophagus or not? Is having glandular mucosa the same as having columnar cells, for he stated I dont have that, but it doenst mention that in the biopsy.Is this pre-barretts? Could the biopsy represent the gastroesophageal junction and therefore contain the glandular cells from the stomach side. Does everybody have glandular mucosa at a z-line at 40cm
I would wish to explain some of these terms first
1) Barrets mucosa - An intestinal columnar type of mucosa with absorptive and or goblet cells interposed inbetween the squamous epithelium of the esophagus. This is now termed as Columnar lined esophagus. This is an histopathological diagnosis and occurs after prolonged period of uncontrolled and untreated reflux
2) Endoscopic finding suggestive of Barrets - when salmon coloured islands or tongues of mucosa are seen extending into the esophgus from the GE junction. This feature is only suggestive and can be due to either Barrets mucosa or cardiac gland metaplasia where the altered mucosa is of the gastric type. The cardiac metaplasia doesnot change to Barrets mucosa
Of these only a Barrets mucosa which is more than 3 cm in length has a higher risk of malignancy if left untreated.
Hence the reason for not finding barrets on biopsy is because either it represented only cardiac gland metaplasia or there was a sampling error
Hope this answers your concern