Squamous islands in Barrett's esophagus: What lies underneath?

Prateek Sharma, Thomas G. Morales, Achyut K Bhattacharyya, Harinder S. Garewal, Richard E. Sampliner

Research output: Contribution to journalArticle

103 Citations (Scopus)

Abstract

Objective: Squamous islands are frequently visualized at the time of upper endoscopy in patients with Barrett's esophagus, especially those on proton pump inhibitor therapy (PPI). The significance of these islands is not clearly understood. The aim of this study was to systematically biopsy macroscopic squamous islands and to examine their histologic characteristics. Methods: Patients with Barrett's esophagus undergoing surveillance had squamous islands documented and biopsied at the time of endoscopy. Barrett's esophagus was defined as the presence of a columnar lined esophagus on endoscopy with intestinal metaplasia on biopsy. All biopsies were obtained by a single senior endoscopist and were stained with alcian blue at pH 2.5. Biopsy samples with inadequate tissue quantity were not included in the study. Results: A total of 39 biopsies were obtained from 22 patients. Twenty of the 22 patients were male, with a mean age of 65.4 yr (range 47-80 yr). The mean length of Barrett's mucosa was 5.6 cm (range 1-11 cm). Eleven of 22 patients were on omeprazole (mean dose 29.1 mg/day), whereas seven patients were on lansoprazole (60 mg/day). The mean duration of PPI therapy was 2.3 yr (range 9-71 months) at the time of biopsy of the squamous islands. Three patients were on H2-blocker therapy whereas the remaining patient had not been started on acid suppression therapy. On histology, 24 biopsy specimens (61.5%) revealed only squamous epithelium; whereas 15 (38.5%) showed the presence of intestinal metaplasia underlying the squamous epithelium. There was no significant difference between the patients with and without underlying intestinal metaplasia in regard to age, Barrett's length, dose, and duration of PPI therapy. Conclusion: In more than one-third of biopsies of macroscopic squamous islands within Barrett's esophagus, microscopic intestinal metaplasia is detected. The presence of squamous islands should not be equated with regression of Barrett's esophagus or with decreased cancer risk.

Original languageEnglish (US)
Pages (from-to)332-335
Number of pages4
JournalAmerican Journal of Gastroenterology
Volume93
Issue number3
DOIs
StatePublished - Mar 1998

Fingerprint

Barrett Esophagus
Islands
Biopsy
Metaplasia
Proton Pump Inhibitors
Endoscopy
Therapeutics
Epithelium
Lansoprazole
Alcian Blue
Omeprazole
Esophagus
Histology
Mucous Membrane
Acids

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Squamous islands in Barrett's esophagus : What lies underneath? / Sharma, Prateek; Morales, Thomas G.; Bhattacharyya, Achyut K; Garewal, Harinder S.; Sampliner, Richard E.

In: American Journal of Gastroenterology, Vol. 93, No. 3, 03.1998, p. 332-335.

Research output: Contribution to journalArticle

Sharma, Prateek ; Morales, Thomas G. ; Bhattacharyya, Achyut K ; Garewal, Harinder S. ; Sampliner, Richard E. / Squamous islands in Barrett's esophagus : What lies underneath?. In: American Journal of Gastroenterology. 1998 ; Vol. 93, No. 3. pp. 332-335.
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