They defined the EGJ as the macroscopic junction between brown–red gastric mucosa and gray esophageal mucosa. The authors reported the detection of CG and oxyntocardiac glands in 97% of cases, with a mean length of 5 mm (range: 1–15 mm). They did not identify any case that showed a direct transition of gastric fundic oxyntic glands to the esophageal squamous mucosa. In addition, they also reported the findings

of the intra-esophageal presence of CG and oxyntocardiac glands above the deep esophageal glands and ducts in 25% of cases. However, in as much as 61% of cases in their report, there existed squamous islands among the CG or oxyntocardiac glands, which indicates that their analysis was actually Proteasome inhibitor in the tissues taken from the distal esophagus, not in the proximal stomach, since squamous islands are indicative of the esophagus.25,30 To contribute to the debate on the existence of gastric CG and CM, Marsman et al.22 conducted an endoscopic biopsy study in 63 of 198 unselected patients with biopsies at or immediately below the endoscopically-normal-appearing SCJ that was defined as the EGJ. They Tyrosine Kinase Inhibitor Library reported a uniform presence of the CM in the proximal stomach, including CG in 62% of cases and oxyntocardiac glands in 38%. Therefore,

they concluded that the CG and the CM were congenital, not acquired.22 Their conclusion was confirmed in a similar study of volunteer health-care workers in the USA.31 In summary, all studies showed a consistent presence of CG and Tolmetin the CM on the gastric side of the EGJ in most, but not all, patients, which is slightly different from that shown in fetuses and pediatric populations. The length of the CM in this transitional zone is short; approximately 5 mm on average. The absence of the CM in over 39% of adult Americans, as reported by the Chandrasoma groups, has not been confirmed. It should be noted that most studies used the SCJ as the landmark of the EGJ, which might potentially be the source of errors.25 In

contrast, recent studies on the distribution of CG in the EGJ region in adults from Japan and China show different results from those reported in Europe and North America. In Japan, Misumi et al. studied the relationship between the mucosal EGJ,32 which was defined as the distal end of esophageal longitudinal vessels, and CG in endoscopic biopsy patients without reflux esophagitis, ulcers, hiatal hernia, or tumors in the esophagus and stomach. They also systemically mapped CG in the entire EGJ region in additional, resected specimens for esophageal carcinoma and another cohort of resected specimens with cancers in either the lower esophagus or the proximal stomach. They reported the presence of CG in an area between 7.5 mm proximal and 13 mm distal to the EGJ. Histologically, the CM straddled the EGJ approximately 10 mm proximally and 20 mm distally.