It remains unknown whether or not this discrepancy was due to typographic errors. In a recent histological study in Japan, Nakanishi et al.28 investigated the entire EGJ macroscopically and microscopically in surgically-resected specimens for upper and middle esophageal squamous cell carcinomas. They reported the existence of CG in the proximal stomach in all cases, and superficial esophageal check details CG in 95% of cases, with mean lengths of 13 mm and 4 mm, and ranges of 2–64 mm and 1–26 mm, respectively. The results clearly indicate the presence of both gastric and superficial esophageal CG and CM in almost all Japanese patients. The superficial esophageal CG are believed
to protect the squamous mucosa from acidic injury.7 Indeed, the Japanese Research Society of Gastric selleck products Cancer defines the gastric cardia as the region where the CG and the CM are located.33 However, the EGJ landmark used in that study was the angle of His. With this EGJ landmark, the authors could not confidently differentiate the mucosal EGJ from the columnar-lined esophagus that is not uncommon in the Japanese population.3 Recent endoscopic and
histological study results in Chinese patients are similar to those reported in Japanese patients. For example, Law et al. performed endoscopic biopsies at or immediately below the SCJ, which showed a normal appearance in 94% of cases, and none with the SCJ shifted proximally towards the esophagus.34 The authors reported the presence of CG in 73% of cases in the proximal stomach below the SCJ/EGJ line, but did not describe the status of oxyntocardiac glands.34 In another
histological study of the EGJ in 44 resected specimens for gastric cardiac cancer in Chinese patients, with 31 cases having the entire EGJ examined microscopically, Fan et al.5 used the most distal end of squamous mucosa, along with deep esophageal glands and ducts, as the landmarks of the EGJ to investigate the distribution of the CG.5,25 They found that the CG were distributed not only distally in the proximal stomach, with a mean length of 7 mm (range: 3–20 mm), but also proximally underneath the squamous mucosa into the distal superficial esophagus, with a mean length of 7 mm (range: 3–18 mm). In their report, chronic inflammation medchemexpress was present in 95% of cases, and 64% with Helicobacter pylori infection.5 The major limitations of their study included a small sample size and the potentially-confounding factor of cancer involvement in the tissues they studied. In summary, the results from recent studies in Japanese and Chinese populations show a universal presence of CG and the CM in the proximal stomach, and also in the distal superficial esophagus, with approximate lengths of 13 mm distally and 7 mm proximally from the EGJ, which differs substantially from the data reported in Europeans and Americans.