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Effects of Dropping the Requirement for Goblet Cells from the Diagnosis of Barrett's Esophagus.
MedLine Citation:
PMID:  22642957     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND AND AIMS: The 2011 American Gastroenterological Association diagnostic criteria for Barrett's esophagus (BE) require the presence of goblet cells in biopsies of columnar mucosa within the esophagus. In other countries, patients can be diagnosed with BE based on evidence of columnar epithelium, regardless of the presence of goblet cells. We examined the effects that a broader criteria would have on diagnoses of patients with endoscopically suspected BE. We also compared the clinical outcomes of patients with and without goblet cells in esophageal biopsy samples. METHODS: We analyzed the University of Chicago Medical Center database to identify 690 patients with no previous history of BE history who underwent endoscopic biopsy analysis for BE, from 1987 to 2008. We collected endoscopy reports, histology results, and chart reviews. RESULTS: Of biopsies analyzed, samples from 258 patients contained goblet cells and 379 did not (53 of the biopsy samples contained only squamous mucosa). Patients whose biopsy samples contained goblet cells had longer endoscopic columnar segments (mean 4.6 cm) and more biopsies taken (mean 5 biopsies) than those without (mean length of 1.6 cm, mean 4 biopsies). Of patients whose biopsies did not contain goblet cells, 35% underwent additional endoscopy; goblet cells continued to be absent in 88% of these (mean follow-up time, 5.8 years; 2.8 additional procedures; 12 mean total biopsies). Goblet cells were identified in only 19% of all patients with columnar mucosa <2 cm. No patient without goblet cells developed adenocarcinoma. CONCLUSIONS: Dropping the requirement for goblet cells would increase the diagnosis of BE by 147%. Among patients with short columnar segments, subsequent endoscopy generally does not reveal goblet cells, so the columnar mucosa might represent proximal stomach. Dropping the requirement for goblet cells would cause many patients to be inaccurately labeled as BE.
Authors:
Maria Westerhoff; Lindsey Hovan; Christine Lee; John Hart
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-5-26
Journal Detail:
Title:  Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association     Volume:  -     ISSN:  1542-7714     ISO Abbreviation:  -     Publication Date:  2012 May 
Date Detail:
Created Date:  2012-5-30     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101160775     Medline TA:  Clin Gastroenterol Hepatol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2012 AGA Institute. Published by Elsevier Inc. All rights reserved.
Affiliation:
University of Washington Medical Center, 1959 NE Pacific Street, Seattle WA 98195.
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