Distinction between short-segment Barrett's esophageal and cardiac intestinal metaplasia

AIM： To investigate the roles of mucin histochemistry, cytokeratin 7/20 （CK7/20） immunoreactivity, clinical characteristics and endoscopy to distinguish short- segment Barrett＇s esophageal （SSBE） from cardiac intestinal metaplasia （CIM）. METHODS： High iron diamine/Alcian blue （HID/AB） mucin-histochemical staining and immunohistochemical staining were used to classify intestinal metaplasia （IN） and to determine CK7/20 immunoreactivity pattern in SSBE and CIM, respectively, and these results were compared with endoscopical diagnosis and the positive rate of gastroesophageal reflux disease （GERD） symptoms and H pylori infection. Long-segment Barrett＇ s esophageal and IM of gastric antrum were designed as control. RESULTS： The prevalence of type III IM was significantly higher in SSBE than in CIM （63.33% vs 23.08%, P〈0.005）. The CK7/20 immunoreactivity in SSBE showed mainly Barrett＇s pattern （76.66%）, and the GERD symptoms in most cases which showed Barrett＇ s pattern were positive, whereas H pylori infection was negative. However, the CK7/20 immunoreactivity in CIM was gastric pattern preponderantly （61.54%）, but there were 23.08% cases that showed Barrett＇s pattern. H pylori infection in all cases which showed gastric pattern was significantly higher than those which showed Barrett＇ s pattern （63.83% vs 19.30%, P〈0.005）, whereas the GERD symptoms in gastric pattern were significantly lower than that in Barrett＇s pattern （21.28% vs 85.96%,P〈O.O05）. CONCLUSION： Distinction of SSBE from CIM should not be based on a single method; however, the combination of clinical characteristics, histology, mucin histochemistry, CK7/20 immunoreactivity, and endoscopic biopsy should be applied. Type III IM, presence of GERD symptoms, and Barrett＇s CK7/20 immunoreactivity pattern may support the diagnosis of SSBE, whereas non-type III IM, positive H pylori infection, and gastric CK7/20 immunoreactivity pattern may imply CIM.

Magnifying endoscopy for the diagnosis of specialized intestinal metaplasia in short-segment Barrett's esophagus

AIM:To determine whether magnified observation of short-segment Barrett’s esophagus(BE)is useful for the detection of specialized intestinal metaplasia(SIM).METHODS:Thirty patients with suspected short-segment BE underwent magnifying endoscopy up to×80.The magnified images were analyzed with respect to their pit-patterns,which were simultaneously classified into five epithelial types[Ⅰ(small round),Ⅱ(straight),Ⅲ(long oval),Ⅳ(tubular),Ⅴ(villous)]by Endo’s classification.Then,a 0.5%solution of methylene blue(MB)was sprayed over columnar mucosa.The patterns of the magnified image and MB staining were analyzed.Biopsies were obtained from the regions previously observed by magnifying endoscopy and MB chromoendoscopy.RESULTS:Three of five patients with a typeⅤ(villous)epithelial pattern had SIM,whereas 21 patients with a non-typeⅤepithelial patterns did not have SIM.The sensitivity,specificity,accuracy,positive predictive value,and negative predictive value of pit-patterns in detecting SIM were 100%,91.3%,92.3%,60%and100%,respectively(P=0.004).Three of the 12 patients with positive MB staining had SIM,whereas 14patients with negative MB staining did not have SIM.The sensitivity,specificity,accuracy,positive predictive value,and negative predictive value of MB staining in detecting SIM were 100%,60.9%,65.4%,25%and100%,respectively(P=0.085).The specificity and accuracy of pit-pattern evaluation were significantly superior compared with MB staining for detecting SIM by comparison with the exact McNemar’s test(P=0.0391).CONCLUSION:The magnified observation of a shortsegment BE according to the mucosal pattern and its classification can be predictive of SIM.

Postprandial proximal gastric acid pocket and its association with gastroesophageal acid reflux in patients with short-segment Barrett’s esophagus

Objective:To determine the characteristics of postprandial proximal gastric acid pockets(PPGAPs)and their association with gastroesophageal acid reflux in patients with Barrett’s esophagus(BE).Methods:Fifteen patients with BE(defined by columnar lined esophagus of≥1 cm)and 15 healthy individuals that were matched for age,gender,and body mass index,were recruited.The fasting intragastric p H and the appearance time,length,lowest p H,and mean p H of the PPGAP were determined using a single p H electrode pull-through experiment.For BE patients,a gastroesophageal reflux disease questionnaire(Gerd Q)was completed and esophageal 24-h p H monitoring was carried out.Results:The PPGAP was significantly longer(5(3,5)cm vs.2(1,2)cm)and the lowest p H(1.1(0.8,1.5)vs.1.6(1.4,1.9))was significantly lower in patients with short-segment BE than in healthy individuals.The PPGAP started to appear proximally from the gastroesophageal p H step-up point to the esophageal lumen.The acidity of the PPGAP was higher in the distal segment than in the proximal segment.In short-segment BE patients,there were significant correlations between the acidity and the appearance time and length of the PPGAP.The length and acidity of the PPGAP were positively associated with gastroesophageal acid reflux episodes.The acidity of the PPGAP was associated with the De Meester scores,the Gerd Q scores,and the fasting intragastric p H.Conclusions:In patients with short-segment BE,a PPGAP is commonly seen.Its length and acidity of PPGAP are associated with gastroesophageal acid reflux,the De Meester score,and the Gerd Q score in patients with short-segment BE.

Effect of Elbow Position on Short-segment Nerve Conduction Study in Cubital Tunnel Syndrome

Background： The appropriate elbow position of short-segment nerve conduction study （SSNCS） to diagnose cubital tunnel syndrome （CubTS） is still controversial. The goal of this study was to determine the effect of different elbow positions at full extension and 70° flexion on SSNCS in CubTS. Methods： In this cross-sectional study, the clinical data of seventy elbows from 59 CubTS patients between September, 2011 and December, 2014 in the Peking University First Hospital were included as CubTS group. Moreover, thirty healthy volunteers were included as the healthy group. SSNCS were conducted in all subjects at elbow fhll extension and 70° elbow flexion. Paired nonparametric test, bivariate correlation, Bland-Altman, and Chi-squared test analysis were used to compare the effectiveness of elbow full extension and 70° flexion elbow positions on SSNCS in CubTS patients. Results： Data of upper limit was calculated from healthy group, and abnormal latency was judged accordingly. CubTS group＇s latency and compound muscle action potential （CMAP） of each segment at 70° elbow flexion by SSNCS was compared with lull extension position, no statistically significant difference were found （all P 〉 0.05）. Latency and CMAP of each segment at elbow full extension and 70° flexion were correlated （all P 〈 0 elbow （P - 0.43）, and the latency （P = 0.15） and the CMAP （P = 01）, except the latency of segment of 4 cm to 6 cm above 0.06） of segment of 2 cm to 4 cm below elbow. Bivariate correlation and Bland-Altman analysis proved the correlation between elbow full extension and 70° flexion. Especially in segments across the elbow （2 cm above the elbow and 2 cm below it）, latency at elbow full extension and 70° flexion were strong direct associated（r=0.83, P〈0.01;r=0.55, P〈0.01）,andsodidtheCMAP（r 0.49, P〈0.01;r=0.72, P〈0.01）.Therewasno statistically significant difference in abnormality of each segment at full extension as measured by SSNCS compared with that at 70° flexion （P 〉 0.05, respectively）. Conclusions： There was no statistically significant difference in the diagnosis of CubTS with the elbow at full extension compared with that at 70° flexion during SSNCS. We suggest that elbow positon at full extension can also be used during SSNCS.

Preliminary Study on the Lesion Location and Prognosis of Cubital Tunnel Syndrome by Motor Nerve Conduction Studies

Background：To study lesions＇ location and prognosis of cubital tunnel syndrome （CubTS） by routine motor nerve conduction studies （MNCSs） and short-segment nerve conduction studies （SSNCSs,inching test）.Methods：Thirty healthy subjects were included and 60 ulnar nerves were studied by inching studies for normal values.Sixty-six patients who diagnosed CubTS clinically were performed bilaterally by routine MNCSs and SSNCSs.Follow-up for 1-year,the information of brief complaints,clinical symptoms,and physical examination were collected.Results：Sixty-six patients were included,88 of nerves was abnormal by MNCS,while 105 was abnormal by the inching studies.Medial epicondyle to 2 cm above medial epicondyle is the most common segment to be detected abnormally （59.09％）,P ＜ 0.01.Twenty-two patients were followed-up,17 patients＇ symptoms were improved.Most of the patients were treated with drugs and modification of bad habits.Conclusions：（1） SSNCSs can detect lesions of compressive neuropathy in CubTS more precisely than the routine motor conduction studies.（2） SSNCSs can diagnose CubTS more sensitively than routine motor conduction studies.（3） In this study,we found that medial epicondyle to 2 cm above the medial epicondyle is the most vulnerable place that the ulnar nerve compressed.（4） The patients had a better prognosis who were abnormal in motor nerve conduction time only,but not amplitude in compressed lesions than those who were abnormal both in velocity and amplitude.Our study suggests that SSNCSs is a practical method in detecting ulnar nerve compressed neuropathy,and sensitive in diagnosing CubTS.The compound muscle action potentials by SSNCSs may predict prognosis of CubTS.