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Takeda T, Asaoka D, Ueyama H, Abe D, Suzuki M, Inami Y, Uemura Y, Yamamoto M, Iwano T, Uchida R, Utsunomiya H, Oki S, Suzuki N, Ikeda A, Akazawa Y, Matsumoto K, Ueda K, Hojo M, Nojiri S, Tada T, Nagahara A. Development of an Artificial Intelligence Diagnostic System Using Linked Color Imaging for Barrett's Esophagus. J Clin Med 2024; 13:1990. [PMID: 38610762 PMCID: PMC11012507 DOI: 10.3390/jcm13071990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 03/21/2024] [Accepted: 03/26/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Barrett's esophagus and esophageal adenocarcinoma cases are increasing as gastroesophageal reflux disease increases. Using artificial intelligence (AI) and linked color imaging (LCI), our aim was to establish a method of diagnosis for short-segment Barrett's esophagus (SSBE). Methods: We retrospectively selected 624 consecutive patients in total at our hospital, treated between May 2017 and March 2020, who experienced an esophagogastroduodenoscopy with white light imaging (WLI) and LCI. Images were randomly chosen as data for learning from WLI: 542 (SSBE+/- 348/194) of 696 (SSBE+/- 444/252); and LCI: 643 (SSBE+/- 446/197) of 805 (SSBE+/- 543/262). Using a Vision Transformer (Vit-B/16-384) to diagnose SSBE, we established two AI systems for WLI and LCI. Finally, 126 WLI (SSBE+/- 77/49) and 137 LCI (SSBE+/- 81/56) images were used for verification purposes. The accuracy of six endoscopists in making diagnoses was compared to that of AI. Results: Study participants were 68.2 ± 12.3 years, M/F 330/294, SSBE+/- 409/215. The accuracy/sensitivity/specificity (%) of AI were 84.1/89.6/75.5 for WLI and 90.5/90.1/91.1/for LCI, and those of experts and trainees were 88.6/88.7/88.4, 85.7/87.0/83.7 for WLI and 93.4/92.6/94.6, 84.7/88.1/79.8 for LCI, respectively. Conclusions: Using AI to diagnose SSBE was similar in accuracy to using a specialist. Our finding may aid the diagnosis of SSBE in the clinic.
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Affiliation(s)
- Tsutomu Takeda
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo 113-8421, Japan; (H.U.); (D.A.); (Y.U.); (M.Y.); (T.I.); (R.U.); (H.U.); (S.O.); (N.S.); (A.I.); (Y.A.); (K.M.); (K.U.); (M.H.); (A.N.)
| | - Daisuke Asaoka
- Department of Gastroenterology, Juntendo Tokyo Koto Geriatric Medical Center, Tokyo 136-0075, Japan; (D.A.); (M.S.); (Y.I.)
| | - Hiroya Ueyama
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo 113-8421, Japan; (H.U.); (D.A.); (Y.U.); (M.Y.); (T.I.); (R.U.); (H.U.); (S.O.); (N.S.); (A.I.); (Y.A.); (K.M.); (K.U.); (M.H.); (A.N.)
| | - Daiki Abe
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo 113-8421, Japan; (H.U.); (D.A.); (Y.U.); (M.Y.); (T.I.); (R.U.); (H.U.); (S.O.); (N.S.); (A.I.); (Y.A.); (K.M.); (K.U.); (M.H.); (A.N.)
| | - Maiko Suzuki
- Department of Gastroenterology, Juntendo Tokyo Koto Geriatric Medical Center, Tokyo 136-0075, Japan; (D.A.); (M.S.); (Y.I.)
| | - Yoshihiro Inami
- Department of Gastroenterology, Juntendo Tokyo Koto Geriatric Medical Center, Tokyo 136-0075, Japan; (D.A.); (M.S.); (Y.I.)
| | - Yasuko Uemura
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo 113-8421, Japan; (H.U.); (D.A.); (Y.U.); (M.Y.); (T.I.); (R.U.); (H.U.); (S.O.); (N.S.); (A.I.); (Y.A.); (K.M.); (K.U.); (M.H.); (A.N.)
| | - Momoko Yamamoto
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo 113-8421, Japan; (H.U.); (D.A.); (Y.U.); (M.Y.); (T.I.); (R.U.); (H.U.); (S.O.); (N.S.); (A.I.); (Y.A.); (K.M.); (K.U.); (M.H.); (A.N.)
| | - Tomoyo Iwano
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo 113-8421, Japan; (H.U.); (D.A.); (Y.U.); (M.Y.); (T.I.); (R.U.); (H.U.); (S.O.); (N.S.); (A.I.); (Y.A.); (K.M.); (K.U.); (M.H.); (A.N.)
| | - Ryota Uchida
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo 113-8421, Japan; (H.U.); (D.A.); (Y.U.); (M.Y.); (T.I.); (R.U.); (H.U.); (S.O.); (N.S.); (A.I.); (Y.A.); (K.M.); (K.U.); (M.H.); (A.N.)
| | - Hisanori Utsunomiya
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo 113-8421, Japan; (H.U.); (D.A.); (Y.U.); (M.Y.); (T.I.); (R.U.); (H.U.); (S.O.); (N.S.); (A.I.); (Y.A.); (K.M.); (K.U.); (M.H.); (A.N.)
| | - Shotaro Oki
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo 113-8421, Japan; (H.U.); (D.A.); (Y.U.); (M.Y.); (T.I.); (R.U.); (H.U.); (S.O.); (N.S.); (A.I.); (Y.A.); (K.M.); (K.U.); (M.H.); (A.N.)
| | - Nobuyuki Suzuki
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo 113-8421, Japan; (H.U.); (D.A.); (Y.U.); (M.Y.); (T.I.); (R.U.); (H.U.); (S.O.); (N.S.); (A.I.); (Y.A.); (K.M.); (K.U.); (M.H.); (A.N.)
| | - Atsushi Ikeda
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo 113-8421, Japan; (H.U.); (D.A.); (Y.U.); (M.Y.); (T.I.); (R.U.); (H.U.); (S.O.); (N.S.); (A.I.); (Y.A.); (K.M.); (K.U.); (M.H.); (A.N.)
| | - Yoichi Akazawa
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo 113-8421, Japan; (H.U.); (D.A.); (Y.U.); (M.Y.); (T.I.); (R.U.); (H.U.); (S.O.); (N.S.); (A.I.); (Y.A.); (K.M.); (K.U.); (M.H.); (A.N.)
| | - Kohei Matsumoto
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo 113-8421, Japan; (H.U.); (D.A.); (Y.U.); (M.Y.); (T.I.); (R.U.); (H.U.); (S.O.); (N.S.); (A.I.); (Y.A.); (K.M.); (K.U.); (M.H.); (A.N.)
| | - Kumiko Ueda
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo 113-8421, Japan; (H.U.); (D.A.); (Y.U.); (M.Y.); (T.I.); (R.U.); (H.U.); (S.O.); (N.S.); (A.I.); (Y.A.); (K.M.); (K.U.); (M.H.); (A.N.)
| | - Mariko Hojo
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo 113-8421, Japan; (H.U.); (D.A.); (Y.U.); (M.Y.); (T.I.); (R.U.); (H.U.); (S.O.); (N.S.); (A.I.); (Y.A.); (K.M.); (K.U.); (M.H.); (A.N.)
| | - Shuko Nojiri
- Department of Medical Technology Innovation Center, Juntendo University School of Medicine, Tokyo 113-8421, Japan;
| | | | - Akihito Nagahara
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo 113-8421, Japan; (H.U.); (D.A.); (Y.U.); (M.Y.); (T.I.); (R.U.); (H.U.); (S.O.); (N.S.); (A.I.); (Y.A.); (K.M.); (K.U.); (M.H.); (A.N.)
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Westra WM, Straub D, Milano F, Buttar NS, Wang KK, Krishnadath KK. Inhibition of the BMP pathway prevents development of Barrett's-associated adenocarcinoma in a surgical rat model. Dis Esophagus 2021; 35:6412930. [PMID: 34718471 PMCID: PMC9113020 DOI: 10.1093/dote/doab072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 08/30/2021] [Accepted: 09/19/2021] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Esophageal adenocarcinoma (EAC) is an aggressive cancer, associated with reflux esophagitis and intestinal metaplasia (IM). One underlying biological mechanism, which possibly drives the development of EAC, is the dysregulated expression of Bone Morphogenetic Proteins (BMPs). AIM To investigate if local delivery of Noggin, a BMP antagonist, reduced EAC. METHODS After obtaining proof of principal on local delivery of a Noggin/Sucralfate substance, a randomized controlled trial to test the effects of Noggin on EAC development was performed in a surgical rat model. In the model, an esophago-jejunostomy leads to development of reflux-esophagitis, IM and eventually EAC. Rats were treated by Noggin/Sucralfate or Sucralfate alone. Treatment was administered from 26 to 29 weeks after the operation. RESULTS Of the 112 operated rats, 52 survived beyond 26 weeks. Finally, 25 rats treated with Noggin/Sucralfate and 21 with Sucralfate, were evaluated. At the end, 39 (85%) of the animals had IM while 28 (61%) developed cancer. There were significantly more cancers in the Noggin/Sucralfate arm (50%) versus the Sucralfate group (73%) (Chi square, P < 0.05). Most cancers were mucous producing T3 adenocarcinomas. There were no significant differences in the amount of IM, size or grade of the cancers, or expression of columnar and squamous markers between the two groups. CONCLUSION In this study, we demonstrated that inhibition of BMPs by Noggin reduced development of EAC in a surgical esophagitis-IM-EAC rat model. In future, effective targeting of the BMP pathway with selective BMP-inhibitors could become an important asset to improve EAC patient outcome.
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Affiliation(s)
- Wytske M Westra
- Center for Experimental and Molecular Medicine (CEMM), AUMC, Amsterdam, The Netherlands,Department of Gastroenterology and Hepatology, Amsterdam UMC, Amsterdam, The Netherlands,Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Danielle Straub
- Center for Experimental and Molecular Medicine (CEMM), AUMC, Amsterdam, The Netherlands
| | - Francesca Milano
- Center for Experimental and Molecular Medicine (CEMM), AUMC, Amsterdam, The Netherlands
| | - Navtej S Buttar
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Kenneth K Wang
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Kausilia K Krishnadath
- Address correspondence to: Professor Kausilia K. Krishnadath, Department of Gastroenterology, University of Amsterdam Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. Tel: +31 20 5666703; Fax: +31 20 6917033;
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Lin EC, Holub J, Lieberman D, Hur C. Low Prevalence of Suspected Barrett's Esophagus in Patients With Gastroesophageal Reflux Disease Without Alarm Symptoms. Clin Gastroenterol Hepatol 2019; 17:857-863. [PMID: 30196157 PMCID: PMC6405322 DOI: 10.1016/j.cgh.2018.08.066] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 08/21/2018] [Accepted: 08/24/2018] [Indexed: 01/14/2023]
Abstract
BACKGROUND & AIMS Esophagogastroduodenoscopy (EGD) is frequently used to evaluate gastroesophageal reflux disease (GERD) without alarm symptoms, although the benefits are not clear. We aimed to determine the prevalence of uncomplicated GERD as an indication for EGD, the demographic characteristics of these patients, and the endoscopic outcomes of these procedures. METHODS We collected endoscopy data from a large national database of 543,103 EGDs performed at 82 sites from 2003 through 2014. We identified patients with GERD without alarm symptoms (dysphagia, bleeding, vomiting, or weight loss). Endpoints included the prevalence of endoscopically suspected Barrett's esophagus (sBE) and suspected long-segment BE (sLSBE), defined as ≥3 cm. RESULTS We found that 73,535 EGDs (13.5%) were performed for a primary indication of GERD without alarm symptoms: only 4122 patients (5.6%) had sBE, and of these, 24.2% had sLSBE. Significant risk factors for sBE and sLSBE included male sex, age, and white race. Other findings included peptic ulcers in 1337 patients (1.8%) and suspected tumors (47 esophageal, 42 gastric, 13 duodenal tumors, 2 others) in 101 patients. CONCLUSIONS In an analysis of a large cohort of patients undergoing EGD, uncomplicated GERD accounted for almost 14% of EGDs; within this population, only 23.6% were white men older than 50 years, who have an increased risk of BE and esophageal adenocarcinoma. The prevalence of sBE is lower than in prior time periods-this raises questions about the utility of EGD to detect BE in patients with uncomplicated GERD. Guidelines for management of uncomplicated GERD should account for these observations.
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Affiliation(s)
- Emery C Lin
- Division of Gastroenterology and Hepatology, Department of Medicine, Oregon Health Sciences University, 3181 SW Sam Jackson Park Road, Portland, OR 97239
| | - Jennifer Holub
- Division of Gastroenterology and Hepatology, Department of Medicine, Oregon Health Sciences University, 3181 SW Sam Jackson Park Road, Portland, OR 97239
| | - David Lieberman
- Division of Gastroenterology and Hepatology, Department of Medicine, Oregon Health Sciences University, Portland, Oregon.
| | - Chin Hur
- Division of Gastroenterology and Hepatology, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114
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Dysplasia discrimination in intestinal-type neoplasia of the esophagus and colon via digital image analysis. Virchows Arch 2016; 469:405-15. [PMID: 27492044 DOI: 10.1007/s00428-016-1999-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 07/06/2016] [Accepted: 07/25/2016] [Indexed: 01/26/2023]
Abstract
Determining gastrointestinal tract dysplasia level is clinically important but can be difficult, and given this challenge, we investigated colonic and esophageal dysplastic progression using digital image analysis (IA). Whole slide images were obtained for colonic normal mucosa (NCM), hyperplastic polyps (HP), conventional tubular adenomas (TA), and adenomas with high-grade dysplasia (HGD), and esophageal intestinal metaplasia negative for dysplasia (IM), indefinite for dysplasia (IFD), low-grade dysplasia (LGD), and HGD. Characteristic nuclei were circumscribed, and parameters discriminating groups included nuclear circumference (μm), area (μm(2)), and 15 positive pixel count (PPC) algorithm IA measurements. In colon polyps and esophageal lesions, average nuclear area and circumference ranged 30-108.6 μm(2) and 27.5-48.9 μm, respectively. Differences for average nuclear area and circumference met statistical significance (p < 0.05) between diagnostic groups in the esophagus and colon, except for IM versus IFD nuclear area. Pixel intensity (brightness) separated lesions within both groups with statistical significance except for colonic TAs versus HPs and esophageal LGD versus IM. HGD nuclei in both groups demonstrated more pixel staining heterogeneity than other lesions. Hierarchical clustering and principal component analysis demonstrated that lesions with similar diagnoses tended to cluster together on a low- to high-grade spectrum. Our results confirm that quantitative IA is an effective adjunct reflecting dysplasia in colon polyps and Barrett esophagus lesions. Nuclear area, circumference, and PPC algorithm findings distinguished lesions in a statistically significant manner. This suggests utility for future studies on similar methods, which may provide an adjunctive ancillary technique for pathologists and enhance patient care.
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Kagemoto K, Oka S, Tanaka S, Miwata T, Urabe Y, Sanomura Y, Yoshida S, Hiyama T, Arihiro K, Chayama K. Clinical outcomes of endoscopic submucosal dissection for superficial Barrett's adenocarcinoma. Gastrointest Endosc 2014; 80:239-45. [PMID: 24565073 DOI: 10.1016/j.gie.2014.01.022] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Accepted: 01/09/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND Advances in diagnostic techniques have allowed early stage detection of superficial Barrett's adenocarcinoma (SBA) as well as resection by endoscopic submucosal dissection (ESD). Few reports exist, however, on the safety and efficacy of ESD for SBA. OBJECTIVE To analyze outcomes of ESD for SBA in relation to clinicopathological features of the lesions. DESIGN Retrospective study. SETTING University hospital. PATIENTS Twenty-three patients (21 men, 2 women; mean age, 63 years) with 26 SBAs. INTERVENTION ESD MAIN OUTCOME MEASUREMENTS We examined outcomes of ESD in relation to the clinicopathological features of SBAs. The main outcomes assessed were en bloc resection rate, operation time, adverse event rates, additional resection rate, and time between ESD and any recurrence. RESULTS Twenty lesions (87%) derived from short-segment Barrett's esophagus, and 3 lesions (13%) derived from long-segment Barrett's esophagus. The majority of SBAs (54%) were located in the 0 to 3 o'clock circumferential quadrant. Median tumor size was 15 mm (range 5-60 mm). Macroscopic types were flat elevated (n = 13, 50%), depressed (n = 12, 46%), and protruded (n = 1, 4%). The SBAs appeared red (n = 23, 88%) or normally pale (n = 3, 12%). Under magnifying narrow-band imaging, all SBAs showed an irregular mucosal pattern and an irregular vascular pattern. The endoscopic en bloc resection rate was 100% (26/26), and the pathological en bloc resection rate was 85% (22/26). The median procedure time was 95 minutes (range, 30-210 minutes). Delayed bleeding occurred in 1 case, but there was no perforation. The SBAs were of the differentiated type (n = 25, 96%) or poorly differentiated type (n = 1, 4%). The tumor had invaded the superficial muscularis mucosa (n = 3, 12%), lamina propria mucosa (n = 5, 19%, deep muscularis mucosa (n = 9, 34%), SM1 (n = 3, 12%), and SM2 (n = 6, 23%). Additional surgical resection after ESD was performed in 9 cases, and there were no residual tumors, but 1 lymph node metastasis was found. There were no recurrent tumors; however, 1 metachronous adenocarcinoma was diagnosed 42 months after ESD. LIMITATIONS Single-center, retrospective study. CONCLUSIONS ESD appears to be a safe and effective treatment strategy for early stage SBA.
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Affiliation(s)
- Kenichi Kagemoto
- Department of Gastroenterology and Metabolism, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Shiro Oka
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Shinji Tanaka
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Tomohiro Miwata
- Department of Gastroenterology and Metabolism, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Yuji Urabe
- Department of Gastroenterology and Metabolism, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Yoji Sanomura
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Shigeto Yoshida
- Department of Gastroenterology and Metabolism, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Toru Hiyama
- Department of Health Service Center, Hiroshima University Hospital, Hiroshima, Japan
| | - Koji Arihiro
- Department of Pathology, Hiroshima University Hospital, Hiroshima, Japan
| | - Kazuaki Chayama
- Department of Gastroenterology and Metabolism, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
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Amir I, Konikoff FM, Oppenheim M, Gophna U, Half EE. Gastric microbiota is altered in oesophagitis and Barrett's oesophagus and further modified by proton pump inhibitors. Environ Microbiol 2013; 16:2905-14. [PMID: 24112768 DOI: 10.1111/1462-2920.12285] [Citation(s) in RCA: 129] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 09/07/2013] [Accepted: 09/10/2013] [Indexed: 12/17/2022]
Abstract
Gastro-oesophageal reflux can cause inflammation, metaplasia, dysplasia and cancer of the oesophagus. Despite the increased use of proton pump inhibitors (PPIs) to treat reflux, the incidence of oesophageal adenocarcinoma has increased rapidly in Europe and in the United States in the last 25 years. The reasons for this increase remain unclear. In this study, we aimed to determine whether the microbiota of the gastric refluxate and oesophageal biopsies differs between patients with heartburn and normal-appearing oesophageal mucosa versus patients with abnormal oesophageal mucosa [oesophagitis or Barrett's oesophagus (BE)] and to elucidate the effect of PPIs on the bacterial communities using 16S rRNA gene pyrosequencing. Significant differences in the composition of gastric fluid bacteria were found between patients with heartburn and normal oesophageal tissue versus patients with oesophagitis or BE, but in the oesophagus-associated microbiota differences were relatively modest. Notably, increased levels of Enterobacteriaceae were observed in the gastric fluid of oesophagitis and BE patients. In addition, treatment with PPIs had dramatic effects on microbial communities both in the gastric fluids and the oesophageal tissue. In conclusion, gastric fluid microbiota is modified in patients with oesophagitis and BE compared with heartburn patients with normal biopsies. Furthermore, PPI treatment markedly alters gastric and oesophageal microbial populations. Determining whether the changes in bacterial composition caused by PPIs are beneficial or harmful will require further investigation.
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Affiliation(s)
- Itay Amir
- Department of Molecular Microbiology & Biotechnology, George S. Wise Faculty of Life Sciences, Tel-Aviv University, Tel-Aviv, 69978, Israel
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Estores D, Velanovich V. Barrett esophagus: epidemiology, pathogenesis, diagnosis, and management. Curr Probl Surg 2013; 50:192-226. [PMID: 23601575 DOI: 10.1067/j.cpsurg.2013.01.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Omae M, Fujisaki J, Shimizu T, Igarashi M, Yamamoto N. Magnifying endoscopy with narrow-band imaging findings in the diagnosis of Barrett's esophageal adenocarcinoma spreading below squamous epithelium. Dig Endosc 2013; 25 Suppl 2:162-7. [PMID: 23617670 DOI: 10.1111/den.12077] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Accepted: 02/01/2013] [Indexed: 02/08/2023]
Abstract
It has been described that most cases of Barrett's esophageal adenocarcinoma in Japan are cases of Barrett's esophageal adenocarcinoma on a background of short-segment Barrett's esophagus, frequently occurring rostrad to Barrett's epithelium, adjacent to the squamous epithelium of the right wall of the esophagogastric junction. Barrett's esophageal adenocarcinoma may spread below the squamous epithelium when the tumor is situated adjacent to the squamocolumnar junction, so that it is usually difficult to diagnose its presence and extent by conventional endoscopy alone. We have noted that the spread of Barrett's esophageal adenocarcinoma below the squamous epithelium is recognizable as annular vascular formations (AVF) by magnifying endoscopy with narrow-band imaging (ME-NBI), and have verified it by 3-D stereo-reconstruction using serial sections from a specimen of the same lesion. When horizontal cross-sections of the tissue were viewed from the surface, AVF emerged at a depth of approximately 100 μm from the surface and disappeared at a depth of approximately 300 μm. Therefore, it would be presumed to be difficult to visualize the characteristic structural features by ME-NBI if the carcinomatous glandular ducts were situated deeper than approximately 300 μm underneath a thick layer of squamous epithelium. Thickness of the overlying squamous epithelium may be a limiting factor for whether or not the characteristic structural features can be detected.
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Affiliation(s)
- Masami Omae
- Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
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Oryu M, Mori H, Kobara H, Nishiyama N, Fujihara S, Kobayashi M, Yasuda M, Masaki T. Differences in the Characteristics of Barrett's Esophagus and Barrett's Adenocarcinoma between the United States and Japan. ISRN GASTROENTEROLOGY 2013; 2013:840690. [PMID: 23606979 PMCID: PMC3625601 DOI: 10.1155/2013/840690] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Accepted: 03/10/2013] [Indexed: 12/12/2022]
Abstract
In Europe and the United States, the incidence of esophageal adenocarcinoma has increased 6-fold in the last 25 years and currently accounts for more than 50% of all esophageal cancers. Barrett's esophagus is the source of Barrett's adenocarcinoma and is characterized by the replacement of squamous epithelium with columnar epithelium in the lower esophagus due to chronic gastroesophageal reflux disease (GERD). Even though the prevalence of GERD has recently been increasing in Japan as well as in Europe and the United States, the clinical situation of Barrett's esophagus and Barrett's adenocarcinoma differs from that in Western countries. In this paper, we focus on specific differences in the background factors and pathophysiology of these lesions.
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Affiliation(s)
- Makoto Oryu
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Takamatsu, Kagawa 761-0793, Japan
| | - Hirohito Mori
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Takamatsu, Kagawa 761-0793, Japan
| | - Hideki Kobara
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Takamatsu, Kagawa 761-0793, Japan
| | - Noriko Nishiyama
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Takamatsu, Kagawa 761-0793, Japan
| | - Shintaro Fujihara
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Takamatsu, Kagawa 761-0793, Japan
| | - Mitsuyoshi Kobayashi
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Takamatsu, Kagawa 761-0793, Japan
| | - Mitsugu Yasuda
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Takamatsu, Kagawa 761-0793, Japan
| | - Tsutomu Masaki
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Takamatsu, Kagawa 761-0793, Japan
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Abstract
Barrett's esophagus is a pathologic change of the normal squamous epithelium of the esophagus to specialized columnar metaplasia. Barrett's esophagus is a result of prolonged exposure of the esophagus to gastroduodenal refluxate. Although Barrett's itself is not symptomatic, and, in fact, patients with Barrett's esophagus may be completely asymptomatic, it does identify patients at higher risk of developing esophageal adenocarcinoma. Traditionally, antireflux surgery was reserved for patients with symptoms, because it was believed that antireflux surgery did not eliminate Barrett's esophagus and reduce cancer risk. Rationale for the treatment of Barrett's esophagus beyond treating symptoms of gastroesophageal reflux disease stems from the hope to decrease, if not eliminate, the risk of adenocarcinoma. Treatment options ranged from medical acid suppression without surveillance to resection. Ablation, particularly endoscopic radio-frequency ablation, has become the standard of care for Barrett's esophagus with high-grade dysplasia. It role in nondysplastic or low-grade dysplastic Barrett's is less clear. Combined endoscopic mucosal resection with ablation is effective in nodular high-grade Barrett's esophagus. Resection should be reserved for patients with persistent high-grade dysplasia despite multiple attempts at endoscopic ablation or resection or for patients with evidence of carcinoma.
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Affiliation(s)
- Vic Velanovich
- Division of General Surgery, University of South Florida, Tampa, Florida
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Thekkek N, Maru DM, Polydorides AD, Bhutani MS, Anandasabapathy S, Richards-Kortum R. Pre-clinical evaluation of fluorescent deoxyglucose as a topical contrast agent for the detection of Barrett's-associated neoplasia during confocal imaging. Technol Cancer Res Treat 2012; 10:431-41. [PMID: 21895028 PMCID: PMC4527376 DOI: 10.7785/tcrt.2012.500220] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The availability of confocal endomicroscopy motivates the development of optical contrast agents that can delineate the morphologic and metabolic features of gastrointestinal neoplasia. This study evaluates 2-NBDG, a fluorescent deoxyglucose, the uptake of which is associated with increased metabolic activity, in the identification of Barrett’s-associated neoplasia. Surveillance biopsies from patients with varying pathologic grades of Barrett’s esophagus were incubated ex vivo at 37°C with 2-NBDG and imaged with a fluorescence confocal microscope. Images were categorized as neoplastic (high grade dysplasia, esophageal adenocarcinoma) or metaplastic (intestinal metaplasia, low grade dysplasia) based on the degree of glandular 2-NBDG uptake. Classification accuracy was assessed using histopathology as the gold standard. Forty-four biopsies were obtained from twenty-six patients; 206 sites were imaged. The glandular mean fluorescence intensity of neoplastic sites was significantly higher than that of metaplastic sites (p < 0.001). Chronic inflammation was associated with increased 2-NBDG uptake in the lamina propria but not in glandular epithelium. Sites could be classified as neoplastic or not with 96% sensitivity and 90% specificity based on glandular mean fluorescence intensity. Classification accuracy was not affected by the presence of inflammation. By delineating the metabolic and morphologic features of neoplasia, 2-NBDG shows promise as a topical contrast agent for confocal imaging. Further in vivo testing is needed to determine its performance in identifying neoplasia during confocal endomicroscopic imaging.
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Affiliation(s)
- N Thekkek
- Department of Bioengineering, Rice University, 6100 Main St., MS 142, Houston, TX 77005, USA
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12
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Dvorak K, Goldman A, Kong J, Lynch JP, Hutchinson L, Houghton JM, Chen H, Chen X, Krishnadath KK, Westra WM. Molecular mechanisms of Barrett's esophagus and adenocarcinoma. Ann N Y Acad Sci 2011; 1232:381-91. [PMID: 21950830 DOI: 10.1111/j.1749-6632.2011.06062.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The following on molecular mechanisms of Barrett's esophagus and adenocarcinoma contains commentaries on the mechanism of bile and gastric acid induced damage; the roles of BMP-4 and CDX-2 in the development of intestinal metaplasia; the transcription factors driving intestinalization in Barrett's esophagus; the contribution of bone marrow to metaplasia and adenocarcinoma; activation and inactivation of transcription factors; and a novel study design targeting molecular pathways in Barrett's esophagus.
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Affiliation(s)
- Katerina Dvorak
- Department of Cell Biology and Anatomy, College of Medicine, Tucson, Arizona, USA
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Manabe N, Haruma K, Imamura H, Kamada T, Kusunoki H, Inoue K, Shiotani A, Hata J. Does short-segment columnar-lined esophagus elongate during a mean follow-up period of 5.7 years? Dig Endosc 2011; 23:166-72. [PMID: 21429023 DOI: 10.1111/j.1443-1661.2010.01073.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND The length of Barrett's esophagus is considered to be important because it is associated with the risk of neoplasia. In Japan, there is a high prevalence of short-segment columnar-lined esophagus (SS-CLE). The natural history of SS-CLE is not fully understood, so the aim of the present study was to investigate the chronological changes of SS-CLE. METHODS The subjects were 500 consecutive patients with SS-CLE (327 men and 173 women; mean age: 64.0 years) diagnosed between January 2001 and July 2002 at our hospital based on the definition of SS-CLE proposed by the Japanese Society for Esophageal Diseases. Follow-up endoscopy was carried out annually for a mean period of 5.7 ± 1.2 years. The cumulative probability of SS-CLE showing elongation was estimated by the Kaplan-Meier method, and factors related to endoscopic findings making an independent contribution to elongation were determined with Cox's proportional hazard model. RESULTS Elongation of SS-CLE occurred in 29 patients (5.8%) during the follow-up period and the cumulative 5-year probability of elongation was 16.6%. There was no progression of SS-CLE to Barrett's adenocarcinoma. The absence of atrophic gastritis (adjusted odds ratio (aOR): 23.4; 95%CI [6.5, 83.8]), the presence of reflux esophagitis (aOR: 4.53; 95%CI [1.2, 16.4]), and the flame-shaped type of SS-CLE (aOR: 22.4; 95%CI [7.8, 64.0]) were found to be independent contributors to the elongation of SS-CLE. CONCLUSIONS The present study demonstrated that SS-CLE remains stable in length over time, especially in patients without atrophic gastritis, as well as in those with reflux esophagitis and/or flame-shaped SS-CLE at initial examination.
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Affiliation(s)
- Noriaki Manabe
- Division of Endoscopy and Ultrasonography, Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School, Kurashiki, Japan.
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Cavazzola LT, Rosa ARPD, Schirmer CC, Gurski RR, Telles JPB, Mielke F, Meurer L, Edelweiss MIA, Kruel CDP. Immunohistochemical evaluation for P53 and VEGF (Vascular Endothelial Growth Factor) is not prognostic for long term survival in end stage esophageal adenocarcinoma. Rev Col Bras Cir 2010; 36:24-34. [PMID: 20076865 DOI: 10.1590/s0100-69912009000100007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2008] [Accepted: 10/28/2008] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To correlate the expression of p53 protein and VEGF with the prognosis of patients submitted to curative resection to treat esophageal adenocarcinoma. METHODS Forty-six patients with esophageal adenocarcinoma, submitted to curative resection, were studied. The expressions of p53 protein and VEGF were assessed by immunohistochemistry in 52.2% and 47.8% of tumors, respectively. RESULTS P53 protein and VEGF expressions coincided in 26% of the cases, and no correlation between these expressions was observed. None of the clinicopathological factors showed a significant correlation with p53 protein or VEGF expressions. There was no significant association between p53 protein and VEGF expressions and long-term survival. CONCLUSION The expression of p53 protein and VEGF did not correlate with prognosis in esophageal adenocarcinoma patients submitted to curative resection.
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Abstract
BACKGROUND Cancer of the esophagus and gastro-esophageal junction is a disorder with a poor prognosis and increasing incidence. OBJECTIVE To provide a critical evaluation of current treatment strategies and new developments including targeted therapy for esophageal cancer. METHODS Published clinical trials as well as abstracts were selected regarding chemoradiation or targeted therapy for esophageal cancer. RESULTS/CONCLUSIONS Preoperative chemotherapy may offer a survival advantage compared to surgery alone, but the evidence is inconclusive. For preoperative chemoradiation, only 2 of 10 randomized trials showed advanced survival compared to surgery alone, and, therefore, more Phase III trials and, consequently, meta-analyses are needed. Until now, for palliative chemotherapy, no survival benefit has been shown. This is largely due to a lack of studies and difficulties in performing randomized trials. The application of targeted therapy is widespread and reported for several tumor types. For esophageal cancer, most studies have been performed with EGFR inhibitors, including cetuximab, gefitinib, erlotinib and trastuzumab. Limited experience is available with angiogenesis inhibitors, apoptosis inhibitors and COX-2 inhibitors. As yet, targeted therapies are proven to be safe often in combination with chemoradiation, but modestly effective for esophageal cancer. Phase III trials have not been published yet and, therefore, for targeted therapies also, possibly using new concepts, more studies are needed.
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Affiliation(s)
- Marjolein Y V Homs
- University Medical Center Utrecht, Department of Medical Oncology, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
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Leers JM, DeMeester SR, Chan N, Ayazi S, Oezcelik A, Abate E, Banki F, Lipham JC, Hagen JA, DeMeester TR. Clinical characteristics, biologic behavior, and survival after esophagectomy are similar for adenocarcinoma of the gastroesophageal junction and the distal esophagus. J Thorac Cardiovasc Surg 2009; 138:594-602; discussion 601-2. [PMID: 19698841 DOI: 10.1016/j.jtcvs.2009.05.039] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2008] [Revised: 04/16/2009] [Accepted: 05/22/2009] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The Siewert classification system differentiates between adenocarcinoma of the gastroesophageal junction and that of the distal esophagus. The purpose of this study was to evaluate whether there were differences in the location and prevalence of lymph node metastases, type of recurrence, and survival with these tumors that warrant distinguishing between them in clinical practice. METHODS Records of all patients who underwent resection for adenocarcinoma of the distal esophagus or gastroesophageal junction from 1987 to 2007 were retrospectively reviewed. Based on the endoscopic location of the epicenter of the tumor in relation to the gastroesophageal junction, tumors were categorized in 301 patients as being of the distal esophagus and in 208 as being of the gastroesophageal junction. RESULTS There were no significant differences in age, sex, or body mass index between patients with adenocarcinoma of the distal esophagus or gastroesophageal junction. Patients with adenocarcinoma of the distal esophagus were more likely to have reflux symptoms (75% vs 53%, P < .0001) and peritumoral intestinal metaplasia (73% vs 51%, P < .0001) and be in a surveillance program (54% vs 9%, P = .0005) compared with patients with adenocarcinoma of the gastroesophageal junction. However, the prevalence and location of nodal metastases was similar, and in node-positive patients mediastinal node involvement was present in more than 40% of the patients in each group (distal esophageal adenocarcinoma, 47%; gastroesophageal junction adenocarcinoma, 41%). Survival was similar (5 years: distal esophageal adenocarcinoma, 45%; gastroesophageal junction adenocarcinoma, 38%; P = .14), as was the prevalence and type of recurrence. CONCLUSION The prevalence and distribution of lymph node metastases in patients with adenocarcinoma of the distal esophagus and gastroesophageal junction were similar, and after esophagectomy, there was no difference in overall survival or recurrence. Efforts to differentiate between these tumors are unnecessary, and both are effectively treated with esophagectomy.
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Affiliation(s)
- Jessica M Leers
- Department of Surgery, the University of Southern California, Keck School of Medicine, Los Angeles, Calif, USA
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Eldaif SM, Lin E, Singh KA, Force SD, Miller DL. Radiofrequency ablation of Barrett's esophagus: short-term results. Ann Thorac Surg 2009; 87:405-10; discussion 410-1. [PMID: 19161747 DOI: 10.1016/j.athoracsur.2008.11.043] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2007] [Revised: 11/03/2008] [Accepted: 11/10/2008] [Indexed: 01/12/2023]
Abstract
BACKGROUND The presence of Barrett's esophagus (BE) increases the risk of esophageal cancer. Total regression of BE is uncommon with medication or laparoscopic fundoplication, and endoscopic techniques to obliterate BE have varied results. This study evaluated the early results of a balloon-based catheter radiofrequency ablation (RFA) system in patients with medically refractory reflux symptoms and biopsy-proven BE. METHODS The medical records of 27 consecutive patients who underwent RFA for BE from March 2005 through January 2007 were reviewed. Esophagogastroduodenoscopy was performed before ablation to document presence of BE and no cancer and at 8 weeks after the RFA to assess the presence of residual BE. RESULTS Mean patient age was 53.6 +/- 12.5 years; 16 (59%) were men. The average length of the Barrett segment treated was 4.6 +/- 4.7 cm. Two patients (7.4%) had low-grade dysplasia. No patient had high-grade dysplasia and cancer. There was no periprocedural morbidity or at follow-up, no postprocedure dysphagia or stricture. In all patients, the BE was completely replaced with normal squamous epithelium. Symptoms regressed in 16 patients (60%) with RFA and proton pump inhibitor therapy. Eleven required an antireflux procedure for persistent symptoms. CONCLUSIONS Short-term results show that RFA for BE is safe and achieves 100% replacement of intestinal metaplasia. RFA of BE combined with fundoplication may be offered to patients with BE and medically refractory reflux symptoms. Long-term endoscopic surveillance is needed to determine if the risk of cancer is reduced with this bimodality therapy.
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Affiliation(s)
- Shady M Eldaif
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
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18
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Exploring the association between elevated body mass index and Barrett's esophagus: a systematic review and meta-analysis. Ann Thorac Surg 2009; 87:655-62. [PMID: 19161814 DOI: 10.1016/j.athoracsur.2008.08.003] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2008] [Revised: 07/31/2008] [Accepted: 08/01/2008] [Indexed: 02/03/2023]
Abstract
We performed a systematic review and meta-analysis to study the association between elevated body mass index (BMI) and Barrett's esophagus (BE). Cross-sectional, case-control and cohort studies published through February 2008 that met strict inclusion and exclusion criteria were included. Summary estimates were calculated for the association between BE and being either overweight (BMI > or = 25 kg/m(2)) or obese (BMI > or = 30 kg/m(2)), or both. Based on 11 studies included in this analysis, there was a statistically significant relationship between increasing BMI and BE. Further studies are needed to evaluate if the presence of reflux attenuates the strength of this relationship, and if a particular pattern of obesity is more strongly associated with BE.
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Kusano C, Gotoda T, Khor CJ, Katai H, Kato H, Taniguchi H, Shimoda T. Changing trends in the proportion of adenocarcinoma of the esophagogastric junction in a large tertiary referral center in Japan. J Gastroenterol Hepatol 2008; 23:1662-5. [PMID: 19120859 DOI: 10.1111/j.1440-1746.2008.05572.x] [Citation(s) in RCA: 171] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION A dramatic increase in incidence of adenocarcinoma of the esophagogastric junction (EGJ) over the past two decades has been reported in the West. However, epidemiological data from Asian countries have not shown a similar trend. The aim of this study was to determine the incidence of adenocarcinoma of the EGJ in a cohort of consecutive patients operated on for gastric adenocarcinoma at a major cancer referral center in Japan. METHOD We reviewed pathological reports of all patients who underwent surgery for advanced gastric adenocarcinoma between 1962 and 2005 at the National Cancer Centre Hospital in Tokyo. Adenocarcinoma of the EGJ was defined from images recorded for each patient, in accordance with the classification of Siewert and Stein. The proportion of adenocarcinoma at the EGJ among operated gastric adenocarcinoma patients was compiled at five-year intervals and serial comparison made. RESULTS A total of 6953 patients with advanced gastric adenocarcinoma were operated on; adenocarcinoma of EGJ was found in 520 patients. The overall proportion of adenocarcinoma of the EGJ increased from 2.3% (1962-1965) to 10.0% (2001-2005). The proportion of Siewert Type II rose from 28.5% (1962-1965) to 57.3% (2001-2005), while that of Type I remained at around 1%. CONCLUSION An increasing trend of adenocarcinoma of EGJ is observed in this study of patients operated on for gastric adenocarcinoma from 1962 to 2005 in a large tertiary referral center in Japan.
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Affiliation(s)
- Chika Kusano
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.
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Muldoon TJ, Anandasabapathy S, Maru D, Richards-Kortum R. High-resolution imaging in Barrett's esophagus: a novel, low-cost endoscopic microscope. Gastrointest Endosc 2008; 68:737-44. [PMID: 18926182 PMCID: PMC2869299 DOI: 10.1016/j.gie.2008.05.018] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2008] [Accepted: 05/09/2008] [Indexed: 12/20/2022]
Abstract
BACKGROUND This report describes the clinical evaluation of a novel, low-cost, high-resolution endoscopic microscope for obtaining fluorescent images of the cellular morphology of the epithelium of regions of the esophagus with Barrett's metaplasia. This noninvasive point imaging system offers a method for obtaining real-time histologic information during endoscopy. OBJECTIVE The objective of this study was to compare images taken with the fiberoptic endoscopic microscope with standard histopathologic examination. DESIGN Feasibility study. SETTING The University of Texas M.D. Anderson Cancer Center Department of Gastroenterology. PATIENTS, INTERVENTIONS, AND MAIN OUTCOME MEASUREMENTS: The tissue samples studied in this report were obtained by endoscopic resection from patients with previous diagnoses of either high-grade dysplasia or esophageal adenocarcinoma. RESULTS Three distinct tissue types were observed ex vivo with the endoscopic microscope: normal squamous mucosa, Barrett's metaplasia, and high-grade dysplasia. Squamous tissue was identified by bright nuclei surrounded by dark cytoplasm in an ordered pattern. Barrett's metaplasia could be identified by large glandular structures with intact nuclear polarity. High-grade dysplasia was visualized as plentiful, irregular glandular structures and loss of nuclear polarity. Standard histopathologic examination of study samples confirmed the results obtained by the endoscopic microscope. LIMITATIONS The endoscopic microscope probe had to be placed into direct contact with tissue. CONCLUSIONS It was feasible to obtain high-resolution histopathologic information using the endoscopic microscope device. Future improvement and integration with widefield endoscopic techniques will aid in improving the sensitivity of detection of dysplasia and early cancer development in the esophagus.
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Affiliation(s)
| | | | | | - Rebecca Richards-Kortum
- Contact information for corresponding author: , Rice University, Department of Bioengineering, MS 142, 6100 Main St, Keck Hall #116, Houston, TX 77005
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Feber A, Xi L, Luketich JD, Pennathur A, Landreneau RJ, Wu M, Swanson SJ, Godfrey TE, Litle VR. MicroRNA expression profiles of esophageal cancer. J Thorac Cardiovasc Surg 2007; 135:255-60; discussion 260. [PMID: 18242245 DOI: 10.1016/j.jtcvs.2007.08.055] [Citation(s) in RCA: 301] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2007] [Revised: 08/12/2007] [Accepted: 08/15/2007] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Expression of microRNAs by array analysis provides unique profiles for classifying tissues and tumors. The purpose of our study was to examine microRNA expression in Barrett esophagus and esophageal cancer to identify potential markers for disease progression. METHODS MicroRNA was isolated from 35 frozen specimens (10 adenocarcinoma, 10 squamous cell carcinoma, 9 normal epithelium, 5 Barrett esophagus, and 1 high-grade dysplasia). MicroRNA expression was analyzed with Ambion bioarrays (Ambion, Austin, Tex) containing 328 human microRNA probes. RESULTS Unsupervised hierarchic clustering resulted in four major branches corresponding with four histologic groups. One branch consisted of 7 normal epithelium samples and 1 squamous cell carcinoma sample. The second branch consisted of 7 squamous cell carcinoma samples and 1 normal epithelium sample. The third branch contained 4 Barrett esophagus samples and 1 squamous cell carcinoma sample. The fourth contained all the adenocarcinoma samples and 1 sample each of Barrett esophagus, normal epithelium, squamous cell carcinoma, and high-grade dysplasia. Supervised classification with principal component analysis determined that the normal epithelium samples were more similar to the squamous cell carcinoma tumors, whereas the Barrett esophagus samples were more similar to adenocarcinoma. Pairwise comparisons between sample types revealed microRNAs that may be markers of tumor progression. Both mir_203 and mir_205 were expressed 2- to 10-fold lower in squamous cell carcinoma and adenocarcinomas than in normal epithelium. The mir_21 expression was 3- to 5-fold higher in both tumors than in normal epithelium. Prediction analysis of microarray classified 3 Barrett esophagus samples as Barrett esophagus, 1 as adenocarcinoma, and 1 as normal epithelium. CONCLUSION Expression profiles of miRNA distinguish esophageal tumor histology and can discriminate normal tissue from tumor. MicroRNA expression may prove useful for identifying patients with Barrett esophagus at high risk for progression to adenocarcinoma.
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Affiliation(s)
- Andrew Feber
- Department of Pathology, Mount Sinai Medical Center, New York, NY 10029, USA
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22
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Villwock MDM, Meurer L, Cavazzola LT, Gurski RR, Edelweiss MI, Schirmer CC. Prevalence of p21 immunohistochemical expression in esophageal adenocarcinoma. ARQUIVOS DE GASTROENTEROLOGIA 2007; 43:212-8. [PMID: 17160237 DOI: 10.1590/s0004-28032006000300011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2004] [Accepted: 03/29/2006] [Indexed: 11/21/2022]
Abstract
BACKGROUND In western societies, the prevalence of adenocarcinoma of the gastroesophageal junction has increased in recent years. It is commonly accepted today that esophageal adenocarcinoma develops from a premalignant lesion: Barrett's esophagus. This type of carcinoma is hardly diagnosed at early stages, which results in significant mortality. Molecular biology studies have shown that most malignant tumors originate from the interaction between inherited characteristics and external factors, which may cause genetic changes that interfere with the control over the differentiation and growth of cells in susceptible individuals. p21 (WAF1/CIP1) has a key role in the regulation of the cell cycle, and its immunohistochemical expression has been investigated in several tumors, showing that it influences the prognosis of various neoplasms. AIM To check the prevalence of p21 protein expression in patients with esophageal adenocarcinoma diagnosed in the last 5 years by the Group for Surgeries of the Esophagus and Stomach of "Hospital de Clínicas de Porto Alegre", RS, Brazil. METHODS The study population consisted of 42 patients with esophageal adenocarcinoma diagnosed by the Group for Surgeries of the Esophagus and Stomach between January 1998 and December 2002. The expression of p21 protein was determined by immunohistochemistry using primary antibody, p21, clone SX118, code M7202 (Dako), and assessed according to the immunoreactive scoring system. RESULTS Of 42 analyzed patients, 83.3% were male and older than 40 years. Among these, 56.2% were submitted to curative resection: total gastrectomy and transhiatal esophagogastrectomy. The remaining patients were submitted to palliative surgery or did not undergo any surgical treatment. Only five patients received adjuvant chemotherapy and radiation therapy, either alone or combined. Advanced disease (stages III and IV) was detected in 78.6% of the patients. Only nine patients were positive for p21, according to the immunoreactive scoring system. CONCLUSION p21 was expressed in 9 of 42 patients (21.4%) with esophageal adenocarcinoma diagnosed in the last 5 years by the Group for Surgeries of the Esophagus and Stomach of Hospital de Clínicas de Porto Alegre. In our patient population, the accumulation of p21 did not play a key role in the carcinogenesis of esophageal adenocarcinoma.
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Affiliation(s)
- Maitê de Mello Villwock
- Division of General Surgery, Hospital de Clínicas, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil.
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Gockel I, Sultanov FS, Domeyer M, Goenner U, Junginger T. Developments in esophageal surgery for adenocarcinoma: a comparison of two decades. BMC Cancer 2007; 7:114. [PMID: 17603896 PMCID: PMC1914077 DOI: 10.1186/1471-2407-7-114] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2007] [Accepted: 06/29/2007] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The objective of this study was to examine outcomes in patients undergoing esophageal resection for adenocarcinoma at our institution during a 20-year period and, in particular, to address temporal trends in long-term survival. METHODS Out of 470 patients who underwent esophagectomy for malignancy between September 1985 and September 2005, a total number of 175 patients presented with esophageal adenocarcinoma. Patients enrolled in this study included AEG (adenocarcinoma of the esophagogastric junction) type I tumors only. Time trends were studied comparing two decades, 9/1985 to 9/1995 (DI) and 10/1995 to 9/2005 (DII). RESULTS The overall survival was significantly more favourable in patients undergoing esophageal resection for adenocarcinoma in the recent time period (DII, 10/1995 to 9/2005) as compared to the early time period (DI, 9/1985 to 9/1995) (log rank test: p = 0.0329). Significant differences in the recent decade were seen based on lower ASA-classifications, earlier tumor stages, and the operative procedure with a higher frequency of transhiatal resections (p < 0.05). 30-day mortality improved from 8.3% to 3.1% during the 20-year time-interval, thus without statistical significance. CONCLUSION Based on our experience, overall survival is improving over time for adenocarcinoma of the esophagus. Factors that may play an important role in this trend include early diagnosis and improved patient selection through better preoperative staging, improved surgical technique with a tailored approach carefully evaluated by physiologic patient status, comorbidity and tumor extent.
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Affiliation(s)
- I Gockel
- Department of General and Abdominal Surgery, Johannes Gutenberg-University of Mainz, Mainz, Germany
| | - FS Sultanov
- Department of General and Abdominal Surgery, Johannes Gutenberg-University of Mainz, Mainz, Germany
| | - M Domeyer
- Department of General and Abdominal Surgery, Johannes Gutenberg-University of Mainz, Mainz, Germany
| | - U Goenner
- Department of General and Abdominal Surgery, Johannes Gutenberg-University of Mainz, Mainz, Germany
| | - Th Junginger
- Department of General and Abdominal Surgery, Johannes Gutenberg-University of Mainz, Mainz, Germany
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Anandasabapathy S, Jhamb J, Davila M, Wei C, Morris J, Bresalier R. Clinical and endoscopic factors predict higher pathologic grades of Barrett dysplasia. Cancer 2007; 109:668-74. [PMID: 17211862 DOI: 10.1002/cncr.22451] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Barrett esophagus is highly prevalent in the Western world; however, only a minority of affected individuals progress to esophageal adenocarcinoma. Whereas many studies have examined risk factors for development of Barrett metaplasia, few data are available on risk factors for progression to neoplasia. Identifying simple, reliable, clinical, and endoscopic predictors of high-grade dysplasia and adenocarcinoma would be helpful for risk stratification in screening and surveillance programs. METHODS Clinical, endoscopic, and histologic data were reviewed for patients with a new Barrett diagnosis between 2002 and 2005. Patients were classified, by an expert gastrointestinal pathologist, as having intestinal metaplasia, indefinite-for-dysplasia, low-grade dysplasia, high-grade dysplasia, and esophageal adenocarcinoma. Gender, age, race, ethnicity, hiatal hernia presence and size, Barrett segment length, H. pylori status, alcohol, smoking, proton pump inhibitor (PPI) use and duration, and reflux symptom duration were evaluated by logistic regression analysis for their association with dysplasia severity. RESULTS In all, 109 patients (26 women, 83 men, mean age: 58.8) were newly diagnosed with Barrett metaplasia (n = 39), indefinite/low-grade dysplasia (n = 35), and high-grade dysplasia/esophageal adenocarcinoma (n = 35) over a 3-year period. On logistic regression analysis, duration of reflux symptoms for >or=20 years (odds ratio [OR]: 5.66, P = .012), longer Barrett segment length (OR for 3-6 cm vs. <3 cm: 9.05, P < .0001; OR for >or=6 cm: 8.374, P < .0001), hernia size >or=4 cm (OR: 10.63, P = .014), and male gender (OR: 4.03, P = .0019) were associated with higher pathologic grade. Duration of reflux symptoms and Barrett length were significant as both discrete and continuous variables. Absence of H. pylori (OR: 2.731, P = .060) approached significance in predicting dysplasia severity. In bivariate models, gender and Barrett length (continuous form) were significantly associated with grade when considered together (OR: 2.52, P = .0490 and OR: 1.30, P < .0001), as were gender and hernia size >4 cm (OR: 4.64, P = .0049 and OR: 12.18, P = .0197). CONCLUSIONS Male gender, longstanding gastroesophageal reflux disease, hiatal hernia size, and segment length are strongly associated with higher grades of dysplasia at index diagnosis. These factors along with H. pylori status warrant further prospective evaluation as predictors of risk for development of high-grade dysplasia and esophageal adenocarcinoma.
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Affiliation(s)
- Sharmila Anandasabapathy
- Department of Gastroenterology, University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
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Jeon J, Luebeck EG, Moolgavkar SH. Age effects and temporal trends in adenocarcinoma of the esophagus and gastric cardia (United States). Cancer Causes Control 2006; 17:971-81. [PMID: 16841264 DOI: 10.1007/s10552-006-0037-3] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2006] [Accepted: 04/24/2006] [Indexed: 12/12/2022]
Abstract
A number of hypotheses have been advanced to explain the rapid increase of the incidence of esophageal adenocarcinoma in the US. A major problem in identifying and understanding the nature of this increase is the difficulty in untangling age effects from temporal trends due to cohort and period effects. To address this problem, we have developed multi-stage carcinogenesis models that describe the age-specific incidence of adenocarcinoma of the esophagus and of the gastric cardia with separate adjustments for temporal trends. These models explicitly incorporate important features of the cancers, such as the metaplastic conversion of normal esophagus to Barrett's esophagus (BE). We fit these models separately to the incidence of adenocarcinoma of the esophagus and of the gastric cardia reported in the Surveillance Epidemiology and End Results (SEER) registry over the period 1973-2000. We conclude that the incidence of both cancers is consistent with a sequence that posits a tissue conversion step in the target organ followed by a multi-stage process with three rate-limiting events, the first two leading to an initiated cell that can expand clonally into a premalignant lesion, and the third converting an initiated cell into a malignant cell. Temporal trends in the incidence of both cancers are dominated by dramatically increasing period effects.
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Affiliation(s)
- Jihyoun Jeon
- Department of Applied Mathematics, University of Washington, Seattle, WA 98195, USA
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Abstract
The incidence of adenocarcinoma of the esophagogastric junction has increased rapidly in the later half of the twentieth century in the United States and most western countries. Although squamous cell carcinoma of the esophagus used to predominate, adenocarcinoma of the distal esophagus and esophagogastric junction now accounts for more than half of new diagnoses in western countries. There also has been a shift from the development of distal gastric cancers to ones in a more proximal location. These recent epidemiologic shifts have led to controversy regarding the etiology and treatment of adenocarcinoma of the esophagogastric junction. Uncertainty still exists with regards to nomenclature and classification, risk factors, treatment, and screening and surveillance of esophagogastric adenocarcinoma. This article examines the epidemiology and etiologies of adenocarcinoma of the esophagogastric junction.
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Affiliation(s)
- Scott Keeney
- Department of Surgery, Christiana Care Health System, 4735 Ogletown-Stanton Road, Newark, DE 19713, USA
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Wang S, Zhan M, Yin J, Abraham JM, Mori Y, Sato F, Xu Y, Olaru A, Berki AT, Li H, Schulmann K, Kan T, Hamilton JP, Paun B, Yu MM, Jin Z, Cheng Y, Ito T, Mantzur C, Greenwald BD, Meltzer SJ. Transcriptional profiling suggests that Barrett's metaplasia is an early intermediate stage in esophageal adenocarcinogenesis. Oncogene 2006; 25:3346-56. [PMID: 16449976 DOI: 10.1038/sj.onc.1209357] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
To investigate the relationship between Barrett's esophagus (BE) and esophageal adenocarcinoma (EAC), we determined gene expression profiles of discrete pathological stages of esophageal neoplasia using a sequence-verified human cDNA microarray. Fifty one RNAs, comprising 24 normal esophagi (NE), 18 BEs, and nine EACs were hybridized to cDNA microarrays. Five statistical analyses were used for the data analysis. Genes showing significantly different expression levels among the three sample groups were identified. Genes were grouped into functional categories based on the Gene Ontology Consortium. Surprisingly, the expression pattern of BE was significantly more similar to EAC than to NE, notwithstanding the known histopathologic differences between BE and EAC. The pattern of NE was clearly distinct from that of EAC. Thirty-six genes were the most differentially modulated, according to these microarray data, in BE-associated neoplastic progression. Twelve genes were significantly differentially expressed in cancer-associated BE's plus EAC (as a single combined tissue group) vs noncancer-associated BE's. These genes represent potential biomarkers to diagnose EAC at its early stages. Our results demonstrate that molecular events at the transcriptional level in BE are remarkably similar to BE's-associated adenocarcinoma of the esophagus. This finding alarmingly implies that BE is biologically closer to cancer than to normal esophagus, and that the cancer risk of BE is perhaps higher than we had imagined. These findings suggest that changes modulated at the molecular biologic level supervene earlier than histologic changes, and that BE is an early intermediate stage in the process of EAC.
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Affiliation(s)
- S Wang
- Division of Gastroenterology, Department of Medicine, University of Maryland School of Medicine, Baltimore, USA
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DeMeester SR. Adenocarcinoma of the esophagus and cardia: a review of the disease and its treatment. Ann Surg Oncol 2006; 13:12-30. [PMID: 16378161 DOI: 10.1245/aso.2005.12.025] [Citation(s) in RCA: 167] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2004] [Accepted: 07/20/2005] [Indexed: 02/06/2023]
Abstract
BACKGROUND Over the past 50 years there has been a remarkable change in the epidemiology of esophageal cancer. Previously rare, adenocarcinoma of the esophagus and gastroesophageal junction is now the most common esophageal cancer, and in the United States the incidence is increasing faster than that of any other malignancy. Surveillance in patients with Barrett's esophagus is identifying adenocarcinoma at an earlier, more curable stage in many patients, and at the same time new endoscopic and surgical options are available for the therapy of these localized tumors. METHODS This article is a review of the epidemiology, diagnosis, staging, and treatment options for esophageal and gastroesophageal junction adenocarcinoma. RESULTS The epidemiology, prognosis, patterns of lymphatic metastasis, and survival for esophageal and gastroesophageal junction adenocarcinoma suggest that these tumors are similar. New options for therapy, as well as the results of surgical resection with and without chemoradiotherapy, are reviewed. CONCLUSIONS Surveillance programs for Barrett's are identifying patients with early, curable adenocarcinoma of the esophagus or gastroesophageal junction. Therapy for more advanced tumors hinges on local control of the disease and the eradication of systemic metastases.
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Affiliation(s)
- Steven R DeMeester
- Department of Cardiothoracic Surgery, The University of Southern California, Keck School of Medicine, 1510 San Pablo Street, Suite 514, Los Angeles, California, 90033, USA.
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Stein DJ, El-Serag HB, Kuczynski J, Kramer JR, Sampliner RE. The association of body mass index with Barrett's oesophagus. Aliment Pharmacol Ther 2005; 22:1005-10. [PMID: 16268976 DOI: 10.1111/j.1365-2036.2005.02674.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Obesity has been linked to gastro-oesophageal reflux disease symptoms and oesophageal adenocarcinoma; however, there is no published evidence for an association with Barrett's oesophagus. AIM To investigate the association between obesity and Barrett's oesophagus. METHODS We conducted a retrospective cross-sectional study of patients who underwent upper endoscopy at the Southern Arizona Veteran's Affairs Healthcare System between 1998 and 2004. We examined male patients without malignancy, with available information on weight and height. Based on endoscopic and histological findings, patients were classified as cases with Barrett's oesophagus or non-cases without Barrett's oesophagus. Multivariable logistic regression analysis was conducted to examine the association of body mass index and obesity with Barrett's oesophagus and Barrett's oesophagus length while adjusting for age and race. RESULTS There were 65 cases with Barrett's oesophagus and 385 non-cases without Barrett's oesophagus. The mean body mass index was significantly higher in cases than in non-cases (29.8 vs. 28.0, P = 0.03). Cases had significantly greater mean weight than controls (206 lb vs. 190,P = 0.005). The proportions of cases with body mass index 25-30 and body mass index > or =30 were greater than those in non-cases (44.6% vs. 37.7%) and (40.0% vs. 33.5%), respectively (P = 0.08). In the multivariable logistic regression model adjusting for race and age, when compared with body mass index < 25, the odds ratio was 2.43 (95% confidence interval: 1.12-5.31) for body mass index 25-30 and 2.46 (1.11-5.44) for body mass index > or =30. When examined as a continuous variable the adjusted odd ratio for each five-point increase in body mass index was 1.35 (95% confidence interval: 1.06-1.71, P = 0.01). The association between weight and Barrett's oesophagus was also statistically significant (adjusted odd ratio for each 10 pound increase = 1.10, 1.03-1.17, P =0.002). Among the 65 cases of Barrett's oesophagus, there was no correlation between the length of Barrett's oesophagus at the time of diagnosis and the body mass index (correlation coefficient = 0.03, P = 0.79). CONCLUSION This retrospective cross-sectional study in male veterans shows that overweight is associated with a two-and-half-fold increased risk of Barrett's oesophagus. Larger studies of the underlying mechanism are warranted to better understand how and why obese patients are at greater risk for Barrett's oesophagus.
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Affiliation(s)
- D J Stein
- Southern Arizona VA Healthcare System and University of Arizona Health Science Center, Tucson, USA
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Gyõrffy H, Holczbauer A, Nagy P, Szabó Z, Kupcsulik P, Páska C, Papp J, Schaff Z, Kiss A. Claudin expression in Barrett's esophagus and adenocarcinoma. Virchows Arch 2005; 447:961-8. [PMID: 16133365 DOI: 10.1007/s00428-005-0045-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2005] [Accepted: 07/18/2005] [Indexed: 11/28/2022]
Abstract
Claudins (CLDNs) are key molecules in cell adhesion, polarity, and control of paracellular solute transport. Several studies suggested that changes in claudin pattern have a role in cancer development. This study aimed to detect alterations in CLDN 1, 2, 3, 4, and 7 expression patterns in Barrett's esophagus (BE) and adenocarcinoma (ACC) compared with that in foveolar epithelium (FOV), normal squamous epithelium (SQ), and squamous cell carcinoma (SQCC). One hundred twenty five surgically or endoscopically removed, paraffin-embedded cases were studied by immunohistochemistry and analyzed statistically. BE, ACC, and FOV were dissected from 30 paraffin-embedded samples for further mRNA expression analysis. CLDN 7 was the dominating type in all epithelia and carcinomas, but its expression did not differ in normal and altered tissues. CLDN 1 expression was significantly increased in SQCC compared with that in SQ. CLDNs 3 and 4 were significantly elevated both in BE and ACC compared with that in FOV. CLDN 2 expression increased significantly in ACCs compared with that in BE. This is the first report proving similarities and differences regarding claudin expression pattern in BE and ACC compared with that in FOV and SQ. Our data prove a close link in CLDN pattern between BE and ACC, adding further evidence that BE is an alteration preceding esophageal ACC.
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Affiliation(s)
- Hajnalka Gyõrffy
- 2nd Department of Pathology, Semmelweis Medical University, Ullõi út 93, 1091 Budapest, Hungary
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Kudo M, Gutierrez O, El-Zimaity HMT, Cardona H, Nurgalieva ZZ, Wu J, Graham DY. CagA in Barrett's oesophagus in Colombia, a country with a high prevalence of gastric cancer. J Clin Pathol 2005; 58:259-62. [PMID: 15735156 PMCID: PMC1770586 DOI: 10.1136/jcp.2004.022251] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND In the USA, atrophic gastritis and gastric cancer are rare, whereas gastro-oesophageal reflux disease (GERD) is common. Infection with Helicobacter pylori, especially a CagA positive strain, is unusual in patients with GERD/Barrett's oesophagus in the USA. AIM To examine the relation between Barrett's oesophagus and CagA positive H pylori in Colombia, a country with a high prevalence of CagA positive H pylori associated atrophic gastritis and gastric cancer. METHODS Helicobacter pylori and CagA status was determined among Colombian patients with long segment Barrett's oesophagus and a control group with simple H pylori gastritis. Helicobacter pylori status was determined using a triple stain and CagA status was determined by immunohistochemistry using a specific rabbit anti-CagA serum. RESULTS Gastric and oesophageal mucosal biopsies were obtained from 51 patients--39 men (mean age, 57.8 years; SD, 13.1) and 12 women (mean age, 51.8 years; SD, 14.4)--with documented long segment Barrett's oesophagus. The results were compared with 24 Colombian patients with H pylori gastritis without oesophageal disease. Thirty two patients with Barrett's oesophagus had active H pylori infection. CagA status was evaluated in a subset of 23 H pylori infected patients with Barrett's oesophagus, and was positive in eight of these patients compared with 19 of 24 controls (p = 0.01). CONCLUSIONS Although most Colombian patients with Barrett's oesophagus had H pylori infection, CagA positive infections were unusual. These data illustrate how consistent corpus inflammation reduces acid secretion, which prevents Barrett's oesophagus among those with abnormal gastro-oesophageal reflux barriers.
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Affiliation(s)
- M Kudo
- Michael E DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX 77030, USA
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Ronkainen J, Aro P, Storskrubb T, Johansson SE, Lind T, Bolling-Sternevald E, Graffner H, Vieth M, Stolte M, Engstrand L, Talley NJ, Agréus L. High prevalence of gastroesophageal reflux symptoms and esophagitis with or without symptoms in the general adult Swedish population: a Kalixanda study report. Scand J Gastroenterol 2005; 40:275-85. [PMID: 15932168 DOI: 10.1080/00365520510011579] [Citation(s) in RCA: 295] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Gastroesophageal reflux disease has been reported to be a common burden on health-care resources in the Western world, but its manifestations in the general population are as yet unclear. The aim of this study was to estimate the prevalence of, and to identify the risk factors for gastroesophageal reflux symptoms (GERS) and erosive esophagitis (EE) in the adult population of two Swedish municipalities. MATERIAL AND METHODS A random sample (n =3000) of the adult population (20-81 years of age) of two Swedish municipalities (n =21,610) was surveyed using a validated postal questionnaire assessing gastrointestinal symptoms. The response rate was 74%. A subsample (n = 1000) of the responders was subsequently invited, in random order, for esophago-gastro-duodenoscopy with evaluation of GERS, risk factors and tests for Helicobacter pylori. RESULTS GERS were reported by 40.0% and EE was found in 15.5% of the population that had undergone endoscopy. Of those with GERS, 24.5% had EE while 36.8% of those with EE reported no GERS. Hiatus hernia and obesity remained significant risk factors for GERS and/or EE, with or without symptoms in a main effect model (OR up to 14 at EE). Those with active H. pylori infection had a higher risk of GERS without EE than those without H. pylori infection (OR = 1.71 (1.23 2.38)). CONCLUSIONS GERS and EE (of which one-third is asymptomatic) are highly prevalent in the Swedish adult population. H. pylori infection seems to play a role in the manifestations of gastroesophageal reflux.
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Affiliation(s)
- Jukka Ronkainen
- Centre for Family Medicine, Karolinska Institutet, Stockholm, Sweden.
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Sampliner RE. Epidemiology, pathophysiology, and treatment of Barrett's esophagus: reducing mortality from esophageal adenocarcinoma. Med Clin North Am 2005; 89:293-312. [PMID: 15656928 DOI: 10.1016/j.mcna.2004.08.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The definition of BE has evolved over time. BE is the key premalignant lesion for developing EAC. The epidemiology and pathophysiology of BE is outlined, and risk factors for BE and EAC are reviewed. GERD plays a crucial role in the pathophysiology and the clinical identification of BE. Endoscopy with biopsy is the best tool for diagnosing and surveying patients with BE. Detection of early neoplasia is the present approach to reduce EAC mortality. Novel technology should assist in the early detection of dysplasia to enable targeted therapy. Effective chemopreventive strategies may reduce the risk of progression to EAC.
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Affiliation(s)
- Richard E Sampliner
- Section of Gastroenterology, Southern Arizona Veterans Affairs Health Care System, 3601 South 6th Avenue, Tucson, AZ 85723, USA.
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Photodynamic therapy and photodiagnosis for Barrett's oesophagus and early oesophageal carcinoma. Photodiagnosis Photodyn Ther 2004; 1:319-34. [DOI: 10.1016/s1572-1000(05)00009-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2004] [Revised: 02/07/2005] [Accepted: 02/07/2005] [Indexed: 01/14/2023]
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Sharma P, McQuaid K, Dent J, Fennerty MB, Sampliner R, Spechler S, Cameron A, Corley D, Falk G, Goldblum J, Hunter J, Jankowski J, Lundell L, Reid B, Shaheen NJ, Sonnenberg A, Wang K, Weinstein W. A critical review of the diagnosis and management of Barrett's esophagus: the AGA Chicago Workshop. Gastroenterology 2004; 127:310-30. [PMID: 15236196 DOI: 10.1053/j.gastro.2004.04.010] [Citation(s) in RCA: 411] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND & AIMS The diagnosis and management of Barrett's esophagus (BE) are controversial. We conducted a critical review of the literature in BE to provide guidance on clinically relevant issues. METHODS A multidisciplinary group of 18 participants evaluated the strength and the grade of evidence for 42 statements pertaining to the diagnosis, screening, surveillance, and treatment of BE. Each member anonymously voted to accept or reject statements based on the strength of evidence and his own expert opinion. RESULTS There was strong consensus on most statements for acceptance or rejection. Members rejected statements that screening for BE has been shown to improve mortality from adenocarcinoma or to be cost-effective. Contrary to published clinical guidelines, they did not feel that screening should be recommended for adults over age 50, regardless of age or duration of heartburn. Members were divided on whether surveillance prolongs survival, although the majority agreed that it detects curable neoplasia and can be cost-effective in selected patients. The majority did not feel that acid-reduction therapy reduces the risk of esophageal adenocarcinoma but did agree that nonsteroidal antiinflammatory drugs are associated with a cancer risk reduction and are of promising (but unproven) value. Participants rejected the notion that mucosal ablation with acid suppression prevents adenocarcinoma in BE but agreed that this may be an appropriate strategy in a subgroup of patients with high-grade dysplasia. CONCLUSIONS Based on this review of BE, the opinions of workshop members on issues pertaining to screening and surveillance are at variance with published clinical guidelines.
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Affiliation(s)
- Prateek Sharma
- University of Kansas School of Medicine and VA Medical Center, Kansas City, Missouri 64128-2295, USA.
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Abstract
Barrett's oesophagus is a pre-malignant condition affecting 1% of the population in the West. Even though most patients with Barrett's will not develop oesophageal cancer, the incidence of adenocarcinoma is 0.45-1%, conferring a 40-fold increased risk compared with the general population. The risk rises to 40-50% within 5 years for those with high grade dysplasia. Currently, the only strategies available to diminish adenocarcinoma rates are surveillance endoscopy, endoscopic thermal or photodynamic ablation or tissue resection. The latter options are reserved for those who already have dysplasia. 10-50% of patients undergoing oesophagectomy for high grade dysplasia have been shown to have adenocarcinoma. Therefore approaches are needed to be that either remove or prevent stimuli propelling patients down the dysplasia-adenocarcinoma pathway. Both gastric acid and bile acids have been reported as potential insults involved in the pathogenesis of Barrett's oesophagus. This is thought to be mediated by a range of molecules including cyclo-oxygenase-2, c-myc and mitogen-activated protein kinase signalling. Proton pump inhibitors not only suppress acid but also bile reflux, although symptom control is a poor guide as to adequacy of acid suppression. There is some evidence that proton pump inhibitors cause partial regression in Barrett's oesophagus length, although the data is contradictory. Proton pump inhibitors have also been shown to increase cell differentiation and apoptosis, reduce proliferation and COX-2 levels, with the supposition that this may diminish cancer risk. However this role in decreasing cancer risk has not yet been evaluated. The use of NSAIDS and aspirin, most likely via inhibition of COX-2 and other inflammatory pathways, is associated with a reduction of adenocarcinoma rates. Both PPIs and NSAIDs/Aspirin may therefore be potential chemopreventative agents but further studies are required to appraise their use.
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Affiliation(s)
- Anita Raj
- Digestive Diseases Centre, Leicester Royal Infirmary, Leicester, UK
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Caygill CP, Watson A, Reed PI, Hill MJ. Characteristics and regional variations of patients with Barrett's oesophagus in the UK. Eur J Gastroenterol Hepatol 2003; 15:1217-22. [PMID: 14560156 DOI: 10.1097/00042737-200311000-00011] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To establish the patient characteristics and regional variation of Barrett's oesophagus in the UK in a large number (5717) of subjects. Barrett's oesophagus is a precursor lesion of oesophageal adenocarcinoma, the incidence of which is rising more rapidly than any other solid tumour. METHODS Demographic data of 5717 Barrett's oesophagus patients from 27 UK centres, each registering at least 50 patients, with UK National Barrett's Oesophagus Registry, were analysed. RESULTS Centres registering patients were distributed evenly throughout the UK. There was an excess of males, with a male to female ratio of 1.7. Mean age at diagnosis was 62.0 years for males and 67.5 years for females. In Scotland, the mean and peak age at diagnosis for males was lower than for the remainder of the UK. In contrast, there was no regional variation in mean and peak age of diagnosis for females. In 3880 Barrett's oesophagus patients with complete data, adenocarcinoma developed in 136 (3.5%). Adenocarcinoma prevalence was 4.0% in males and 2.5% in females. The male/female ratio of patients with adenocarcinoma was 3.0, twice that of Barrett's oesophagus (1.7). The mean age was 64.7 years for males and 74.0 years for females. CONCLUSIONS These data demonstrate that Barrett's oesophagus occurs with a higher frequency in males, with progression to adenocarcinoma being even more biased towards men in the UK, in contrast to the USA. There are significant regional variations in age of diagnosis of Barrett's oesophagus, especially in younger male patients in Scotland. Studies to identify genetic and environmental determinants of Barrett's oesophagus and cancer risk are needed.
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Affiliation(s)
- Christine P Caygill
- UK National Barrett's Oesophagus Registry (UKBOR), University Department of Surgery, Royal Free and University College Medical School, London, UK.
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Abstract
The alarming rise in the incidence of esophageal adenocarcinomas in the Western world has focused interest on so-called Barrett's esophagus. Barrett's esophagus is characterized by specialized intestinal epithelium replacing the normal squamous epithelium in the distal esophagus and is considered a consequence of long-lasting and severe gastroesophageal reflux disease. A metaplasia-dysplasia-carcinoma sequence links Barrett's esophagus with adenocarcinoma of the distal esophagus (Barrett's cancer). Despite intensive research, many questions concerning the pathogenesis, diagnosis, and treatment of Barrett's esophagus and associated adenocarcinoma are still unanswered. Based on current data, the malignant progression of Barrett's esophagus cannot be substantially prevented by medical or surgical therapy for reflux. Although no firm data are available to show that surveillance strategies can reduce overall mortality from Barrett's cancer, early detection and cure are possible. Management of Barrett's esophagus and carcinoma is reviewed with reference to the sequence of disease from metaplasia to carcinoma.
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Affiliation(s)
- Burkhard H A von Rahden
- Chirurgische Klinik und Poliklinik, Klinikum rechts der Isar der TU München, Ismaningerstr 22, 81675 München, Germany
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