Alfredo Barbosa

By Alfredo J. A. Barbosa and Camila G. Miranda

Part of the book: Gastrointestinal Endoscopy

By Alfredo J. A. Barbosa and Rivelle D. Pereira

The cardiac mucosa of the human stomach is composed mainly of branched PAS positive mucous glands that occupy the deep half of the mucosa thickness. This morphological pattern of the mucous glands present in endoscopic biopsies from the gastric fundus region or near the gastroesophageal junction (GEJ) serves as parameter for the histological diagnosis of gastric cardia. However, this morphological pattern is highly variable along the gastric part of the GEJ: in some areas these mucous glands are abundant and in others they are scarce, if not totally absent. Depending on the concept adopted for some, the cardiac mucosa would be a native structure attached to human GEJ, while for others it would have a metaplastic origin that would occur during the extra-uterine life. In cardiac mucosa the mixed glands (mucous/oxyntic glands) are almost always present in between mucous glands and in between oxyntic glands; such as the parietal cells which could also be detected in greater or lesser amounts. The aim of this work was to evaluate the presence of serotonin-immunoreactive cells (EC cells) in these different types of glands in both normal cardiac mucosa as well as in the Barrett´s esophagus. The main results concerning the endocrinology of gastric cardia allows to consider that the human cardia has exocrine and endocrine elements that together constitute its specific differential characteristic in relation to the gastric fundus and to the antropyloric regions of the stomach. On the other hand, the histologic and immunohistochemical analysis of endoscopic biopsies of 26 patients showed that 23 (88.5%) of them presented varying amounts of mucous glands associated with intestinal metaplasia in distal esophagus. Moreover, many of these patients presented a rich component of serotoninergic EC cells. The major population of serotonin-immunoreactive cells was found both in intestinal metaplasia as well as in its associated mucous glands. Among these patients, 16 (70%) presented foci of high concentration of serotoninergic EC cell in the distal esophagus. Whatever the neuroendocrine actions of serotonin in the GEJ, these actions should be enhanced in many patients who present a large population of EC cells in gastric cardia as well as in the areas of intestinal metaplasia of those with Barrett´s esophagus.

Part of the book: Endoscopy