Gastroesophageal reflux disease (GERD) is a common condition which, if left untreated, may result in intestinal metaplasia, a premalignant condition that occurs in the upper gastrointestinal tract.
Intestinal metaplasia (IM) is a form of metaplastic change that can occur in the stomach and the oesophagus (Barrett’s oesophagus). It can only be diagnosed by histological examination, and the presence of acid mucin-containing goblet cells is the hallmark of the condition. Studies suggest that IM of both the stomach and oesophagus may be a risk factor for the development adenocarcinoma at these sites. However, IM is present in about 20% of all gastric biopsies and few of these patients will progress to adenocarcinoma of the stomach. Thus. its specificity as a marker is actually too low to be used in surveillance for cancer.
Consequently, in an attempt to improve the specificity of IM, its subtypes have been examined. Conventionally, three main subtypes (I, II and III) have been recognised and some studies reveal that there may be a strong link between type III IM and both adenocarcinoma of the oesophagus and intestinal-type gastric adenocarcinoma.
The subtypes of IM have been characterised according to their mucin content and morphology (Table I). Discrimination between type I IM and the other two subtypes is easily made using the alcian blue/periodic acid–Schiff (AB/PAS) technique, as the latter two subtypes express acid mucins in the metaplastic columnar cells, whereas the former type contains no cellular mucin. However, this technique does not allow discrimination between types II and III IM.
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