Gastric (Foveolar) Dysplasia in Barrett's Esophagus: A Clinical, Molecular and Long-Term Outcome Study.

Abstract

Background and aims: The aim of this long-term progression study was to evaluate the clinical and pathologic features of gastric type dysplasia in Barrett's esophagus (BE).

Methods: Baseline biopsies from 208 BE patients from the Seattle prospective cohort were evaluated for the type and grade of dysplasia (gastric or intestinal). Twenty-seven patients progressed to cancer and 181 did not over the long term follow up period. Patients with gastric or intestinal dysplasia were compared to each other with regard to their flow cytometric DNA content abnormalities and progression rates to cancer.

Results: Of the 59 patients with dysplasia at baseline, 12 (20%) had gastric dysplasia only, 24 (41%) had mixed gastric and intestinal dysplasia, and 23 (39%) had intestinal dysplasia only. Patients with any gastric dysplasia component (alone or mixed with intestinal dysplasia) showed a significantly higher rate of high-grade dysplasia (72% vs 23%, P < 0.001) at baseline and cancer development (47% versus 22%, P = 0.05), and a significantly shorter time frame to cancer development (32 versus 64 months, P = 0.008), as well as a longer BE segment length (P = 0.05), and higher rate of aneuploidy (P = 0.04), compared to patients with pure intestinal dysplasia. By multivariable analysis, gastric dysplasia showed a higher hazard ratio of progression to cancer compared to intestinal dysplasia patients.

Conclusion: Gastric type dysplasia is common in BE. Our study suggests that this type of dysplasia may represent a more aggressive form of neoplastic precursor than conventional intestinal type dysplasia.