Although the incidence of gastric adenocarcinoma in the U. S. is declining, the incidence of cancer localized to the gastric cardia has risen dramatically. It is not yet clear whether cancer of the gastric cardia arises from a premalignant lesion such as intestinal metaplasia (IM). The purpose of this study was to determine the prevalence of IM involving the cardia in patients presenting for elective EGD, and evaluate potential associated factors.During a 7 month period patients referred for elective EGD at the Tucson VA Medical Center were invited to participate in the study. Prior to EGD each patient was surveyed with regard to GERD symptoms and smoking and alcohol history. During EGD note was made of the presence of esophagitis, hiatus hernia, and Barrett's-appearing mucosa. The esophagogastric junction (EGJ) was defined as the end of the tubular esophagus coinciding with the proximal heads of the gastric folds. Seven biopsies were taken from specific sites in the antrum, angularis, cardia, and EGJ. Biopsy specimens were stained with a combination of H & E and Alcian blue at a pH of 2.5. Histologic evidence of IM was defined as columnar-type epithelium including goblet cells staining with Alcian blue. Patients were also evaluated for H. pylori infection by histologic and serologic examinations.There were 104 patients (99 male, 5 female) with a mean age of 61.6 years. Twenty-four (23%) were found to have IM involving the gastric cardia, although none of these had dysplasia. Eleven patients (11%) had Barrett's esophagus; however, only 2 of these had concomitant IM of the cardia. On the other hand, 9 of the 24 with IM of the cardia had concomitant IM elsewhere in the stomach. Forty-nine patients (47%) were found to be positive for H. pylori infection and there was a significant association between H. pylori infection and IM of the gastric cardia (p = 0.03).These data show that IM of the gastric cardia is a relatively common finding and is associated with H. pylori infection. Although dysplasia was not identified, long-term follow-up studies will be necessary to determine the incidence of dysplasia or adenocarcinoma developing from IM of the cardia.