Shape of Barrett's epithelium is associated with prevalence of erosive esophagitis

AIM:To test the hypothesis that the shape and length of Barrett's epithelium are associated with prevalence of erosive esophagitis.METHODS:A total study population comprised 869 patients who underwent endoscopy during a health checkup at our hospital.The presence and extent of Barrett's epithelium were diagnosed based on the Prague C & M Criteria.We originally classified cases of Barrett's epithelium into two types based on its shape,namely,flamelike and lotus-like Barrett's epithelium,and into two groups based on its length,its C extent < 2 cm,and ≥ 2 cm.Correlation of shape and length of Barrett's epithelium with erosive esophagitis was examined.RESULTS:Barrett's epithelium was diagnosed in 374 cases(43%).Most of these were diagnosed as shortsegment Barrett's epithelium.The prevalence of erosive esophagitis was significantly higher in subjects with flame-like than lotus-like Barrett's epithelium,and in those with a C extent of ≥ 2 cm than < 2 cm.CONCLUSION:Flame-like rather than lotus-like Barrett's epithelium,and Barrett's epithelium with a longer segment were more strongly associated with erosive esophagitis.

Endoscopic mucosal resection of Barrett's esophagus detects high prevalence of subsquamous intestinal metaplasia

AIM:To report the prevalence of Subsquamous intestinal metaplasia(SSIM)in patients undergoing endoscopic mucosal resection(EMR)for staging of Barrett’s esophagus(BE).METHODS:Thirty-three patients with BE associated neoplasia underwent EMR at our institution between September 2009 and September 2011;22 of these patients met study inclusion criteria.EMR was targeted at focal abnormalities within the BE segment.EMR was performed in standardized fashion using a cap-assisted band ligation technique,and resection specimens were assessed for the presence of SSIM.Demographic and clinical data were analyzed to determine predictors of SSIM.RESULTS:SSIM was detected in 59%of patients.SSIM was detected in 73%of patients with short segment(<3 cm)BE,and in 45%of patients with longsegment(≥3 cm)BE(P=NS).There was no association between presence/absence of SSIM and age,gender,or stage of BE-associated neoplasia.CONCLUSION:EMR detects SSIM in a majority of patients with BE-associated neoplasia.While the longterm clinical significance of SSIM remains uncertain,these results highlight the importance of EMR as an optimal diagnostic tool for staging of BE and detection of SSIM,and should further limit concerns that SSIM is purely a post-ablation phenomenon.

Barrett食管的临床病理特征分析

目的探讨内镜下拟诊为Barrett食管(BE)患者的临床症状、内镜下表现类型和病理特征之间的关系。方法对184例内镜下拟诊为BE的患者进行临床症状评估,HE染色行病理组织学分析。并对临床症状、内镜下表现类型及病理特征之间的关系进行相关分析。结果内镜下拟诊184例BE患者,反酸33例次,反食7例次,烧心23例次,胸骨后疼痛13例次,上腹痛70例次,上腹胀38例次,其中10例患者有食管外症状(咳嗽、咽炎等);37例无明显症状。内镜表现类型岛型128例,环周型43例,舌型13例。活检证实有柱状上皮化生88例(占47.8%),其中有46例可见肠上皮化生,发现1例不典型增生。病理确诊的46例肠化BE和42例非肠化BE患者的反酸发生率明显高于非BE患者,其他临床症状比较无明显差异;内镜下拟诊的3种类型的BE患者临床主要症状比较无明显差异;内镜表现为环周型、岛型和舌型BE的柱状上皮化生和肠化生的检出率无明显差异。结论(1)病理确诊的BE患者反酸的发生率明显高于非BE患者。(2)BE患者内镜表现类型与症状无关。(3)内镜表现以岛状多见,柱状上皮化生和肠上皮化生在3型BE中检出率无差异。