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Dr. Andrew Rynne

Family Physician

Exp 50 years

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Is the presence of columnar cells in the esophagus indicative of a risk of Barrett's esophagus in the future?

Answered by
Dr.
Dr. Ramesh Kumar

Gastroenterologist

Practicing since :1986

Answered : 1985 Questions

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Posted on Thu, 6 Dec 2018 in Digestion and Bowels
Question: Good Afternoon,I just had another upper GI Endoscopy, and I am confused by my biopsy report. It says the following:

Brush Biopsy Results: Z-Line 40cm: Benign Squamous and Columnar epithelium : Goblet cells are not identified either by modified Pap/H&E/Alcian-blue-PAS staining or by immunochemistry. negative for dysplasia. The cell block shows benign Squamous and Columnar epithelial fragments. Alcian-blue-PAS stain is negative for goblet cells (PAS staining only) negative for fungal organisms. Immunohistochemistry shows: negative MUC2 staining: negative CDX2 staining, 1+ weakly positive p53 staining, in columnar epithelium. And negative for AMACR staining. No dysplasia or carcinoma is seen.

Forceps Biopsy Results:Top of the Z-line at 40cm Biopsy1. Cardio-Oxyntic mucosa with minimal chronic inflammation
2. Squamos mucosa with no diagnostic abnormality
3. No Intestinal metaplasia or dysplasia is identified

I'm confused...is it normal for columnar epithelium to be at this location (top of the z line 40cm)....do these results suggest that Barretts esophagus may be coming soon?
doctor
Answered by Dr. Ramesh Kumar 2 hours later
Brief Answer:

Normal report.Its not suggestive of any pathological change.

Detailed Answer:

Hi!

As it clearly indicated that in the above Z line no goblet cells etc are there (Basically these cells are there in columnar epithelium of stomach).

Clinically this biopsy is perfectly normal. Its clearly written that there is no metaplasia or dysplasia seen. This means that cell on either side of Z line are normal.
Its clinically normal. It's not barrett.

Hope I have answered your question. Let me know if I can assist you further.

Regards,

Dr. Ramesh Kumar
Gastroenterologist
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Ramesh Kumar 14 minutes later
I understand that there is no barretts...my question is...is it normal for columnar cells to be in this location, or does it mean that Barretts is more likely to happen in the near future? My concern is that I'm unsure if this report shows columnar cells in the esophagus, or if they are in a normal place. And I am also insure if it is normal for Cardio-Oxyntic mucosa to be in this location...basically, I am just trying to learn if these results mean that Barretts is likely to happen in the future. I hope this clarifies my question. Thanks you
doctor
Answered by Dr. Ramesh Kumar 25 minutes later
Brief Answer:

Follow up.

Detailed Answer:

Hello again!

Barett esophagus is classified into three categories.

Divide esophagus in 3 equal part. If only lower one third is involved its mild, if mid section is also involved its moderate, and if complete esophagus is involved its severe.

It clearly writes that cardi oxyntic mucosa is there with inflammation. Cardiac is the first part of stomach and it contains oxyntic cells. But its common to have mild layer of cardio oxyntic cell above Z line.

Z line is a fictitious line and is assumed that below it the stomach starts but mild variations can be there.

Yes chances of future Barrett's esophagus if no proper treatment is taken for years are more as compared to a normal person. However if you follow proper therapy nothing is going to happen.

Rx
Take PPIs daily.
Follow up endoscopy after a year.

Hope I have answered your question. Let me know if I can assist you further.

Regards,

Dr. Ramesh Kumar
Gastroenterologist

Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Ramesh Kumar 17 minutes later
Ok...yes that helps alot, I appreciate your clarity and compassion...just so I understand correctly...mild variations of the Z line are common in people with reflux...since I have reflux, that makes me more likely to have Barretts in the future, but my results don't suggest that happens anytime soon. This would take years to happen from where my results are now...but most people with reflux that don't have Barretts would have results identical to mine. When you say higher chances than a normal person, you mean higher than a person without reflux...is that all correct?
doctor
Answered by Dr. Ramesh Kumar 16 hours later
Brief Answer:

Follow up

Detailed Answer:

Hello again!

Yes that is all correct.

If you will follow proper therapy then it would never happen.

Yes chances are a bit high if you compare to a person with normal gut but if medications and proper life style is followed it would never progress to Barett.

Hope I was helpful.

Just relax and enjoy life you are fine.

Regards,

Dr. Ramesh Kumar
Gastroenterologist

Above answer was peer-reviewed by : Dr. Kampana
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