As endoscopists have become more skilled in sampling the gastroesophageal junction, pathologists are being increasingly challenged to characterize previously unknown or neglected findings. One such example is the cardiac polyp. Originally described in the radiology literature as the sentinel fold, the first histologic descriptions of polyps at the gastroesophageal junction did not appear until less than a decade ago. Current clinicopathologic information is limited and somewhat conflicting. This study was designed to define the clinical, endoscopic, and histopathologic associations in patients with cardiac polyps. Using an electronic database, we extracted information on all patients who had a distal esophageal or esophagogastric junctional biopsy during a 24-month period. We then reviewed the slides of 330 adult patients diagnosed with a cardiac polyp and used semiquantitative or qualitative scales to score foveolar hyperplasia, inflammation, erosion or ulcers, epithelial type, and metaplasia. As controls we used 120,487 patients who had biopsies from the same anatomic sites during the same period, but were not diagnosed with a cardiac polyp. There were no significant differences among any clinical indications for esophagogastroduodenoscopy between study and control patients. Endoscopically, a polyp or nodule at the gastroesophageal junction was noted in 59.1% of the patients who had a histopathologic diagnosis of cardiac polyp. Histologically, Barrett mucosa, active esophagitis, and Helicobactor pylori gastritis were all significantly less common in patients with a cardiac polyp than in controls. Although relatively infrequent, synchronous hyperplastic polyps elsewhere in the stomach were significantly more common in patients than in controls. In conclusion, this large series suggests that cardiac polyps are rare but histologically distinct lesions. They are benign and are not uniquely associated with esophagitis, Barrett esophagus, gastroesophageal reflux disease, reactive gastropathy, or gastritis, with or without H. pylori.