Columnar-lined oesophagus without intestinal metaplasia: results from a cohort with a mean follow-up of 7 years

Background The definition of Barrett's oesophagus lacks consensus, particularly the requirement of intestinal metaplasia for diagnosis. Scarce information exists on the prevalence and natural history of columnar-lined oesophagus without intestinal metaplasia. Aim To evaluate the demographics and natural history of columnar-lined oesophagus without intestinal metaplasia =2 cm in length. Methods Patients with columnar-lined oesophagus =2 cm in length and no intestinal metaplasia in biopsy specimens from two consecutive endoscopies with at least a 1-year interval were prospectively followed. A cohort of Barrett's oesophagus patients was used as a control. Results Columnar-lined oesophagus without intestinal metaplasia (n = 15) had a similar gender distribution, reflux symptoms prevalence and length as those of Barrett's oesophagus (n = 205). Patients were significantly younger (28.6 vs. 60 years, P < 0.0001) and accounted for 48% of patients aged <40 years in the two cohorts, but only 1% of those aged >40 years (P < 0.001). Patient distribution in both cohorts in 5 age brackets (019, 2029, 3039, 4049, and >50 years) was significantly different, except for patients aged 4049 years. Intestinal metaplasia was documented in 60% of the cohort after a mean follow-up of 7.1 years. Conclusions Columnar-lined oesophagus without intestinal metaplasia =2 cm is infrequent in the setting of a systematic biopsy protocol, is associated with a younger age in comparison with Barrett's oesophagus, and appears to be an intermediate step between squamous and intestinal lining of the oesophagus.