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

INTRODUCTION: 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 patients with BE from the Seattle prospective cohort were evaluated for the type (gastric or intestinal) and grade of dysplasia. 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 with each other regarding their flow cytometric DNA content abnormalities and progression rates to cancer. RESULTS: Of the 59 patients with dysplasia at baseline, 12 (20%) had gastric-type dysplasia only, 24 (41%) had mixed gastric- and intestinal-type dysplasia, and 23 (39%) had intestinal-type dysplasia only. Patients with any gastric-type dysplasia component (alone or mixed with intestinal-type dysplasia) showed a significantly higher rate of high-grade dysplasia (72% vs 23%, P < 0.001) at baseline and cancer development (47% vs 22%, P = 0.05), and a significantly shorter time frame to cancer development (32 vs 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 with patients with pure intestinal dysplasia. By multivariable analysis, gastric-type dysplasia showed a higher hazard ratio of progression to cancer compared with patients with intestinal-type dysplasia. DISCUSSION: 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.