Columnar Segment Research Articles

On the conditions for the occurrence of crystal avalanches during alloy solidification

Experimental studies on the solidification of ammonium-chloride-water alloys in relatively large containments reveal conditions that lead to the formation of numerous crystal avalanches. Columnar segments that occasionally slide downwards along a vertical mushy zone further fragmentate and so crystal multiplication occurs. As a condition for this phenomenon solidification-induced solutal buoyancy that leads to a rising interdendritic flow was identified for the present case. The interaction with sedimentation-induced downward flow ahead of a vertical columnar region results in a redirection of the interdendritic flow and thus, to local conditions that slow down further solidification or even lead to remelting. Gravity is then pulling loose segments downwards. In larger containment, the flow in the bulk melt is generally unsteady and even turbulent. Thus, the outlined flow-solidification/melting interplay happens frequently at numerous positions but in a stochastic manner.

Telomere lengths in Barrett's esophagus as a precancerous lesion.

We have reported that precancerous conditions and lesions invariably have shorter telomeres and associated chromosomal instability relative to normal tissue. Using the Q-FISH method and our original software, Tissue Telo, we estimated telomere lengths in cardiac- and intestinal-type mucosae in 48 cases of Barrett's esophagus (short-segment (SS) n = 18; long-segment (LS) n = 30). There were no significant differences in telomere length between the cardiac and intestinal types in any of the 48 cases, suggesting that the presence or absence of goblet cells in the columnar segments is unrelated to telomere-dependent chromosomal instability in Barrett's esophagus. In LS Barrett's esophagus, telomeres were shorter in cardiac-type than in intestinal-type mucosa, suggesting that the former may play a more important role than the latter as a precancerous lesion in LS. Telomeres in cardiac-type mucosa were longer in SS than in LS, supporting the possibility that cardiac-type LS may pose a higher risk as a precancerous lesion than cardiac-type SS. Although it has been considered that Barrett's carcinoma arises only from intestinal-type mucosa, our present findings support previous histogenetic studies suggesting that cardiac-type mucosa is more important as a precancerous condition in Barrett's esophagus than anticipated.

Thermal Cycling Behavior of Quasi-Columnar YSZ Coatings Deposited by PS-PVD

Columnar-structured thermal barrier coatings, owing to their high strain tolerance, are expected for their potential possibilities to substantially extend turbine lives and improve engine efficiencies. In this paper, plasma spray-physical vapor deposition (PS-PVD) process was used to deposit yttria partially stabilized zirconia (YSZ) coatings with quasi-columnar structures. Thermal cyclic tests on burner rigs and thermal shock tests by heating and water-quenching method were involved to evaluate the thermal cycling and thermal shock behaviors of such kind of structured thermal barrier coatings (TBCs). Evolution of the microstructures, phase composition, residual stresses and failure behaviors of quasi-columnar YSZ coatings before and after the thermal tests was investigated. The quasi-columnar coating obtained had an average life of around 623 cycles when the spallation area reached about 10% of the total coating surface during burner rig tests with the coating surface temperature of ~1250 °C. Failure of the coating is mainly due to the break and pull-out of center columnar segments.

SEGUIMIENTO ENDOSCÓPICO E HISTOLÓGICO POST ABLACIÓN CON ARGÓN PLASMA DEL ESÓFAGO DE BARRETT EXTENSO EN PACIENTES SOMETIDOS A TRATAMIENTO QUIRÚRGICO PREVIO

Argon plasma ablation of extensive Barrett esophagus. Experience in 19 patients Background: Endoscopic argon plasma ablation of Barrett esophagus decreases the risk of future esophageal cancer development. aim: To assess the endoscopic regression of columnar epithelium and the presence of intestinal metaplasia among patients operated for Barrett esophagus and subjected to argon plasma ablation. Patients and methods: In 19 patients with extensive Barrett esophagus subjected to a nissen fundoplication, Barrett esophagus was endoscopically ablated with argon plasma. Patients were assessed 6 and 12 months after surgery to evaluate the regression of columnar epithelium and the presence of intestinal metaplasia. results: One, two and three ablation sessions were carried out in 10, three and six patients, respectively. Three patients had complications. The initial length of columnar epithelium segment was 52 ± 15.6 mm and decreased to 22.6 ± 10.6 mm (p < 0.05). In 12 patients, there was absence of intestinal metaplasia on follow up, in six it persisted (one of them with “buried cells”) and in one patient, dysplasia appeared. conclusions: Endoscopic argon plasma ablation may have a complementary therapeutic role for the regression of columnar epithelium in Barrett esophagus.

The Neo-Squamocolumnar Junction after Radiofrequency Ablation (RFA): Do We Need to Biopsy if Normal Appearing on Endoscopy?

Purpose: RFA is a safe and effective treatment for Barrett's esophagus (BE) with dysplasia and may decrease risk of progression to esophageal adenocarcinoma. Intestinal metaplasia (IM) of the gastro-esophageal junction (GEJ) has previously been shown to have a substantially lower cancer progression risk compared to BE. As a result, biopsy acquisition of an irregular z-line is discouraged. The proportion of patients with dysplasia or IM of the GEJ in the absence of endoscopic evidence of BE post-ablation is not known. AIM: We evaluated the proportion of post-RFA patients with IM or dysplasia of the GEJ who had no endoscopic evidence of BE. Methods: We reviewed all patients with BE and high grade dysplasia (HGD) who were referred for RFA at a tertiary care referral center between 3/2004 and 3/2012. The EGD reports of all patients following RFA were reviewed. Those patients who did not have any columnar metaplasia visualized in the esophagus and those with an irregular Z line, without tongues, islands or nodules, were assessed. Presence of an irregular z-line was defined as a columnar segment < 1 cm. The pathology from each GEJ biopsy was then reviewed for evidence of intestinal metaplasia or dysplasia. Results: Seventy three patients (63 male, age 64.3±10 years, BMI 29.9±5.4 kg/m2, all with entry histology of HGD and all without endoscopic evidence of BE) fulfilled the inclusion criteria. Patients were followed for a mean length of 25±19 months following initial RFA. Forty six patients (63%) had documented evidence of an irregular z-line on endoscopic evaluation. Fifteen patients (20.2%) were found to have either IM or dysplasia of the GEJ following a normal EGD post-RFA [5 (6.8%) with HGD, 5 (6.8%) with low-grade dysplasia, 1 (1.4%) indefinite for dysplasia and 4 (5.5%) with IM]. Univariate analysis did not show age (p=0.08), BMI (p=0.99), gender (p=0.96), number of RFA sessions (p=0.65) or presence of irregular z-line (p=0.36) to be associated with having an abnormal GEJ biopsy. On multivariate analysis, controlling for the presence of an irregular Z-line and number of RFA treatments; presence of hiatal hernia was found to increase the risk of IM or dysplasia of the GEJ [OR 1.45 (1.1-2.04), p=0.02]. Conclusion: In our cohort of patients, 20% had findings of dysplasia or IM of GEJ after RFA with no endoscopic evidence of BE. The rate of overall dysplasia (15%), especially HGD (7%), is higher than would be expected with IMGEJ patients (7% and 0%, respectively) found on population based screening by our group. Unlike IMGEJ in patients without a prior diagnosis of BE, we recommend routine biopsies of the GEJ in post-RFA patients with a normal appearing esophagus during surveillance endoscopy. Disclosure: Dr. Wang - Consultant: Covidien (Barrx), Ninepoint Medical Research, CDX Diagnostics, Pinnacle Biologics. Research: Covidien (Barrx), Fujinon, Ninepoint Medical. Lori Lutzke - Research: Covidien (Barrx), Fujinon, Ninepoint Medical. Dr. Iyer - Consultant: Takeda.

Effects of Dropping the Requirement for Goblet Cells From the Diagnosis of Barrett's Esophagus

The 2011 American Gastroenterological Association diagnostic criteria for Barrett's esophagus (BE) require the presence of goblet cells in biopsy specimens of columnar mucosa within the esophagus. In other countries, patients can be diagnosed with BE based on evidence of columnar epithelium, regardless of the presence of goblet cells. We examined the effects that a broader criteria would have on diagnoses of patients with endoscopically suspected BE. We also compared the clinical outcomes of patients with and without goblet cells in esophageal biopsy samples. We analyzed the University of Chicago Medical Center database to identify 690 patients with no previous history of BE who underwent endoscopic biopsy analysis for BE from 1987 to 2008. We collected endoscopy reports, histology results, and chart reviews. Of biopsy specimens analyzed, samples from 258 patients contained goblet cells and 379 did not (53 of the biopsy samples contained only squamous mucosa). Patients whose biopsy samples contained goblet cells had longer endoscopic columnar segments (mean, 4.6 cm) and more biopsy specimens taken (mean, 5 biopsy specimens) than those without (mean length, 1.6 cm; mean, 4 biopsy specimens). Of patients whose biopsy specimens did not contain goblet cells, 35% underwent additional endoscopy; goblet cells continued to be absent in 88% of these (mean follow-up time, 5.8 y; 2.8 additional procedures; mean total biopsy specimens, 12). Goblet cells were identified in only 19% of all patients with columnar mucosa less than 2 cm. No patient without goblet cells developed adenocarcinoma. Decreasing the requirement for goblet cells would increase the diagnosis of BE by 147%. Among patients with short columnar segments, subsequent endoscopy generally does not reveal goblet cells, so the columnar mucosa might represent proximal stomach. Decreasing the requirement for goblet cells would cause many patients to be inaccurately labeled as BE.

The Epidemiology and Natural History of Barrettʼs Esophagus and Intestinal Metaplasia of Gastroesophageal Junction in Korea

Purpose: The incidence of esophageal adenocarcinoma (EAC) is rapidly increasing in western countries. However, the diagnosis of EAC and Barrett's esophagus (BE), its precursor, in Asian countries are still uncommon in spite of increased western food pattern or obesity. There are few studies describing prevalence of EAC and BE in asymptomatic people who undergo endoscopy (EGD) for health check. However, no study has described the natural history of BE. We aimed to investigate the epidemiology and natural history of BE and intestinal metaplasia of gastroesophageal junction (IMGEJ) initially diagnosed during an asymptomatic health check EGD at a single center in South Korea. Methods: From 2001 to 2010, 180,087 asymptomatic people who underwent EGD for health check at a tertiary care center were identified. Their EGD report, photographs, and pathology were reviewed and BE (columnar segment ≥ 1 cm with specialized intestinal metaplasia, or IMGEJ (intestinal metaplasia in biopsies from the gastroesophageal junction) were identified. Serum Helicobacter pylori (HP) IgG antibody was checked in all subjects. Their subsequent EGD and pathology reports and medical records were reviewed. Results: A total of 126 subjects (M:F = 91:35, mean age = 51.9±10.3) were identified. 73 subjects (0.04%) were diagnosed with BE and 53 subjects (0.03%) with IMGEJ. The mean number of biopsies taken was 1.6±0.8. Of the 73 subjects with BE, 72 (98.6%) had short-segment BE (SSBE), and 1 (1.4%) had longsegment BE (LSBE). HP IgG antibody was positive in 35 (47.9%) of BE and 27 (50.9%) of IMGEJ. Erosive esophagitis was identified in 27 (37.0%) BE subjects (13 with grade A, 12 with grade B, and 2 with grade C using the Los Angeles classification system) and 25 (47.2%) IMGEJ subjects (12 with grade A, 4 grade B). Hiatal hernia was diagnosed in 11 (15.1%) BE and 9 (17.0%) IMGEJ subjects. Among the 126 subjects diagnosed with either BE or IMGEJ, 50 were lost to follow-up and 76 received endoscopic surveillance with a mean duration of follow-up of 3.4±2.1 years (range 0.3-8.5 years). No subject developed EAC or high-grade dysplasia, and all 76 subjects were alive in May 2011. Conclusion: The prevalence of BE in Korea is still low and when it occurs, it is almost exclusively SSBE. In this limited descriptive report of subjects with BE and IMGEJ in an asymptomatic cohort in Korea, no one developed EAC or highgrade dysplasia over 3 years follow-up. A prospective well-organized standardized protocol of consecutive persons undergoing EGD in Asia is warranted.

Effect of hiatal hernia size and columnar segment length on the success of radiofrequency ablation for Barrett’s esophagus: A single-center, phase II clinical trial

Hiatal hernia is common in patients with Barrett's esophagus. We sought to evaluate the effect of hiatal hernia size and initial columnar segment length on the success of radiofrequency ablation of Barrett's esophagus. A phase II clinical trial was conducted aimed at evaluating the success of radiofrequency ablation in eradicating Barrett's esophagus. Success was defined as complete replacement of the columnar lining with squamous mucosa and lack of intestinal metaplasia using light microscopy. Hiatal hernia size and columnar segment length were measured endoscopically. Sixty-seven patients were accrued to the protocol. In the 55 patients who completed radiofrequency ablation (43 successes, 12 failures), the mean hiatal hernia size was 3.3 cm (range, 0-10 cm), and the mean columnar segment length was 5.4 cm (range, 1-18 cm). The median length of the columnar segment was 3 cm in the successful cases and 8.5 cm in the failed cases (P = .002). Although the median hiatal hernia size was identical in the successful and failed cases (3 cm, P = .38), the median hiatal hernia size was 7 cm (P = .001) in the 6 patients who experienced nonhealing after the initial ablation. Patients who were successfully ablated but had larger hiatal hernias and longer columnar segment lengths required significantly more radiofrequency ablation sessions than those with smaller hernias and shorter segments (P = .003 and P = .007, respectively). Patients with larger hiatal hernias and longer columnar segments are more likely to experience failure or nonhealing after radiofrequency ablation. These patients also require more radiofrequency ablation treatments to achieve successful eradication of Barrett's esophagus.

Epidemiology and Natural History of Intestinal Metaplasia of the Gastroesophageal Junction and Barrett's Esophagus: A Population-Based Study

Population-based data on the epidemiology and outcomes of subjects with intestinal metaplasia of the gastroesophageal junction (IMGEJ) and Barrett's esophagus (BE) are limited. The objectives of this study were to (i) estimate the incidence of IMGEJ and BE diagnosed from clinically indicated endoscopy in Olmsted County, MN, over three decades (1976-2006) and prevalence as of 1 January 2007, (ii) compare baseline characteristics of subjects with IMGEJ and BE, and (iii) study the natural history and survival of both cohorts. This was a population-based cohort study. The study setting was Olmsted County, MN. Patients with BE (columnar segment >1 cm with intestinal metaplasia) and IMGEJ (intestinal metaplasia in biopsies from the gastroesophageal junction) from 1976 to 2006 in Olmsted County, MN, were identified using Rochester Epidemiology Project resources. Demographic and clinical data were abstracted from medical records and pathology confirmed by gastrointestinal pathologists. The association of baseline characteristics with overall and progression-free survival was assessed using proportional hazards regression models. Outcome measures were baseline characteristics and overall survival of subjects with IMGEJ compared to those with BE. In all, 487 patients (401 with BE and 86 with IMGEJ) were identified and followed for a median interval of 7 (BE subjects) to 8 (IMGEJ subjects) years. Subjects with BE were older, heavier, reported reflux symptoms more often, and had higher prevalence of advanced neoplasia than those with IMGEJ. No patient with IMGEJ progressed to esophageal adenocarcinoma (EAC) in contrast to BE subjects who had a cumulative risk of progression of 7% at 10 years and increased risk of death from EAC (standardized mortality ratio 9.62). The overall survival of subjects with BE and IMGEJ did not differ from that expected in similar age- and sex-distributed white Minnesota populations. Subjects with IMGEJ appear to have distinct clinical characteristics and substantially lower cancer progression risk compared to those with BE.

Association Between Goblet Cell Density and Intraluminal pH in Patients with Long Segment Barrettʼs Esophagus

Purpose: Barrett's esophagus (BE) develops in the setting of longstanding gastroesophageal reflux disease (GERD). The histology of BE has been defined, with goblet cells always located proximally with variable distribution distally. The aim of this prospective study was to measure the gradient of esophageal pH in normal subjects and patients with long segment BE, and to correlate esophageal pH with goblet cell density in patients with Barrett's esophagus. Methods: A novel 6 channel pH catheter was positioned with the most distal channel in the stomach with the remaining sensors located 1 cm below and at 1, 3, 5 and 8 cm above the manometrically determined upper border of the lower esophageal sphincter in 5 normal subjects and 6 patients with long segment Barrett's esophagus [length of BE: median 8 (6-9) cm]. Patients with Barrett's esophagus also underwent endoscopy and had four quadrant biopsies at levels corresponding to the location of the pH sensors. Goblet cell density was graded by a single experienced pathologist using a scale of 0-3 with 3 being the greatest density and 0 representing absence of goblet cells. The mean score at each level was calculated and scores from different levels were compared using the Kruskal-Wallis test. The median pH over the 24 hour recording period was calculated for each pH sensor location. Results: In normal subjects, the median esophageal pH was > 5 at all levels with no gradient evident. In patients with BE, a pH gradient was present in the esophagus ranging from 2.8 at the gastroesophageal junction (GEJ) to 4.7, at the sensor located 8 cm above the GEJ (Figure). The median pH was significantly lower at all pH sensor levels in patients with Barrett's esophagus compared to normal subjects. There was a significant difference in goblet cell density along the Barrett's segment with the highest density at the top, corresponding to the highest median pH in the Barrett's segment [Goblet cell density grading (median): 3 at proximal, 2 at mid and 1 at distal, p=0.007].FigureConclusion: In contrast to normal subjects, patients with Barrett's esophagus have a pH gradient in the esophagus. The density of goblet cells in the columnar segment inversely correlates with esophageal acid exposure suggesting that promoters of goblet cell differentiation are pH sensitive.

Response to Dr. Keltyet al.

TO THE EDITOR: We appreciate the comments of Dr. Kelty and are aware of his retrospective study. The points raised by Dr. Kelty are addressed in the guidelines as we acknowledge that there is a lack of consensus on the diagnosis of Barrett's esophagus. The guidelines state that a recent retrospective study has found that if eight biopsies are taken in a columnar esophageal segment, 68% of patients can be found to have goblet cells versus only 35% of those with that had only four biopsies (1, 2). The retrospective study of Dr. Kelty's had a median of only four biopsies in both the intestinal metaplasia and glandular mucosa group, which raised questions in our minds on the ability of this study to answer the question of the cancer risk in those with and without goblet cells given that up to half of those classified as not having intestinal metaplasia may well have had goblet cells (3). Furthermore, retrospective studies based on histology have clearly found that the presence of intestinal metaplasia correlates with risk of progression to dysplasia as opposed to those glandular mucosal without intestinal metaplasia (4).

Histologic and clinical outcome after laparoscopic Nissen fundoplication for gastroesophageal reflux disease and Barrett’s esophagus

The effectiveness of laparoscopic Nissen fundoplication for the regression of Barrett's esophagus in gastroesophageal reflux disease remains controversial. The aim of this study, therefore, was to review endoscopic findings and clinical changes after laparoscopic Nissen fundoplication for gastroesophageal reflux disease, particularly for patients with Barrett's esophagus. From September 1995 through June 2004, 127 patients with gastroesophageal reflux disease underwent laparoscopic Nissen fundoplication. All the patients had clinical and endoscopic follow-up evaluation. We further analyzed the course of 37 consecutive patients with Barrett's esophagus (29% of all laparoscopic fundoplications performed in our institution) using endoscopic surveillance with appropriate biopsies and histologic evaluation. The median follow-up period for all the patients after fundoplication was 34 months (range, 3-108 months). The median follow-up period for the patients with Barrett's esophagus was 19 months (range, 3-76 months). During the 9-year period, 70 women (55 %) and 57 (45%) men were treated with laparoscopic Nissen fundoplication. The median age of these patients was 42 years (range, 7-81 years). The clinical results were considered excellent for 67 patients (53%), good for 51 patients (40%), fair for 7 patients (6%), and poor for 2 patients (1%). Endoscopic surveillance showed regression of the macroscopic columnar segment in 23 patients with Barrett's esophagus (62%). Regression at a histopathologic level occurred for 15 patients (40%). The histopathology remained unchanged for 14 patients with Barrett's esophagus (38%). Laparoscopic Nissen fundoplication effectively controls intestinal metaplasia and clinical symptoms in the majority of patients with Barrett's esophagus.

Stem cell factor and c-Kit in human primordial germ cells and fetal ovaries

The distribution of the tyrosine kinase receptor c-Kit and its ligand stem cell factor (SCF) was evaluated by immunohistochemistry in primordial germ cells (PGCs) and human embryonic gonads during weeks 5–8 of prenatal life, and fetal ovaries during weeks 9–36 of prenatal life. Distinct c-Kit and SCF staining was present in primordial germ cells in the wall of the hindgut and in the dorsal mesentery, particularly on level with the 10th thoracic columnar segment. Several PGCs were in close contact with c-Kit-negative but SCF-positive autonomic nerve fibers of the dorsal mesentery. Many fibroblasts and mesothelial cells of the dorsal mesentery were clearly stained for SCF, but not for c-Kit. Prominent c-Kit and SCF staining was present in germ cells of the embryonic gonadal anlage and in oogonia during further ovarian development. However, oocytes were either unstained or faintly stained for SCF. Oocytes not yet enclosed in follicles or present in primordial follicles were either unstained or exhibited faint cytoplasmic c-Kit staining, whereas oocytes of growing preantral follicles again showed distinct cell membrane staining which decreased during further follicular growth. Theca cells did not stain for c-Kit. Some pregranulosa cells and the first formed granulosa cells of primordial follicles were c-Kit stained. Granulosa cells of other follicles were not c-Kit stained. In the inner part of the cortex, SCF immunolabeling was detected in some pregranulosa cells surrounding cords containing germ cells and involved in formation of primordial follicles. Granulosa cells of primordial and growing follicles, including medium-sized antral follicles also revealed SCF staining. In conclusion, this first report on SCF in human PGCs and embryonic and fetal ovaries together with the c-Kit data lend substantial countenance to the notion that c-Kit and SCF play important roles during ascent of primordial germ cells towards the gonadal anlage, and during oogenesis and folliculogenesis in the human fetal ovary. We suggest that both autocrine and paracrine mechanisms are involved in the proposed anti-apoptotic effect of the c-Kit/SCF duet while PGCs are present in the dorsal mesentery. The SCF-positive autonomic nerve fibers of the dorsal mesentery, mesothelial cells and fibroblasts may nurse and perhaps guide PGCs during their ascent.

Characteristics of patients with columnar-lined Barrett’s esophagus and risk factors for progression to esophageal adenocarcinoma

To determine the risk factors for the development of esophageal adenocarcinoma in these patients with columnar-lined esophagus (CLE). Data collected retrospectively on 597 consecutive patients diagnosed at endoscopy and histology to have CLE at Leeds General Infirmary between 1984 and 1995 were analyzed. Factors evaluated included age, sex, length of columnar segment, smoking, and drinking habits, history of non-steroidal ingestion, presence of endoscopic esophagitis, ulceration or benign strictures and presence of Helicobacter pylori in esophageal biopsies. Univariate and multivariate analyses were performed to identify risk factors for the development of adenocarcinoma. Forty-four patients presented or developed esophageal adenocarcinoma during follow-up. Independent risk factors for the development of adenocarcinoma in patients with CLE were males (OR 5.12, 95%CI 2.04-12.84, P=0.0005), and benign esophageal stricture (OR 4.37, 95%CI 2.02-9.45, P=0.0002). Male subjects and patients who developed benign esophageal stricture constituted 86% (n=38) of all patients who presented or developed esophageal adenocarcinoma. The presence of esophagitis was associated with a significant reduction in the development of esophageal carcinoma (OR 0.28, 95%CI 0.13-0.57, P=0.0006). No other clinical characteristics differentiate between the non-malignant and malignant group. In patients with CLE, endoscopic surveillance for the early detection of adenocarcinoma may be restricted to male subjects, as well as patients who develop benign esophageal strictures.

Epidemiological, clinical, and histological characteristics of intestinal metaplasia at the oesophagogastric junction compared to short segments of columnar-lined oesophagus.

Intestinal metaplasia (IM) close to the oesophagogastric junction (OGJ) has become a focus of research interest against a background of the rising incidence of malignancies in that area. Studies have focused on the presence of IM in short columnar segments (0-3 cm). Recently it has been suggested that IM at the OGJ and IM in short columnar segments may represent different entities. The objective of this current study was to determine the prevalence of IM in these areas and to assess clinical characteristics in order to test the hypothesis that IM at the OGJ and IM in short columnar segments are different entities. Six hundred and fifty-eight patients referred for gastroscopy, in whom a columnar lining of 0-3 cm was found, participated in the study. Endoscopic oesophagitis was graded, distances to endoscopic landmarks were measured, and biopsies (antrum, corpus, 'cardia', and immediately distal to the squamocolumnar junction) were taken. Biopsies were stained with haematoxylin & eosin, Alcian Blue (pH 2.5), modified Giemsa for Helicobacter pylori (Hp), and immunohistochemistry in cases of a negative Giemsa. According to endoscopy, patients were categorized as having a normal OGJ (0-1 cm) or having a short columnar segment (1 -3 cm, tongues >1 cm). In this study 77.7% of patients had a normal OGJ (IM-positive 15.1%), and 22.3% had a short columnar segment (IM-positive 29.3%). In the first group, IM was correlated with Hp (P = 0.003) and antral IM (P = 0.002), in the second IM was associated with the presence of a hiatal hernia (P < 0.001) and reflux oesophagitis (P = 0.023). These findings suggest that IM at the OGJ is not the same entity as IM in short columnar segments.

Does carditis have two different etiologies?

Carditis has become the subject of much study and discussion, although its etiology is still controversial. We wished to study the prevalence and possible pathogenetic mechanisms of carditis in a well-defined group of patients. In 664 patients biopsies were taken distal to the squamocolumnar junction (SCJ) and from the endoscopically defined cardia (2 cm below proximal margin of gastric folds). Specimens were stained with hematoxylin and eosin, Alcian blue, and modified Giemsa. Type of mucosa, inflammatory and metaplastic changes, and presence of Helicobacter pylori (Hp) were graded. Most of the patients had a normal appearing SCJ on endoscopy; 19.3% had short columnar segments (1-3 cm). In the first group cardiac/mixed mucosa was found in 71.9% of SCJ biopsies, and carditis (90.6%) was associated with Hp. In the second group, cardiac/mixed mucosa was present in 80.5%. There was a trend for an association between carditis (87.4%) and reflux esophagitis and hiatal hernia. Biopsies from the endoscopically defined cardia rarely contained cardiac/mixed mucosa (12.6%). These findings suggest two etiologies for carditis. In a normal-appearing SCJ carditis is associated with Hp, whereas in an irregular SCJ with short columnar segments/tongues carditis is associated with features of gastroesophageal reflux.

Comparative study of intestinal metaplasia and mucin staining at the cardia and esophagogastric junction in 225 symptomatic patients presenting for diagnostic open-access gastroscopy

Objective: Adenocarcinoma around the esophagogastric junction (EGJ) is increasing in incidence, and is frequently associated with areas of macroscopic or microscopic intestinal metaplasia (IM). The aim of this study was to define the incidence and type of metaplastic changes in the cardia and at the EGJ in symptomatic patients in whom there was no endoscopic columnar segment. Methods: Patients attending for open-access gastroscopy had three sets of endoscopic biopsies taken at 3-cm intervals, from cardia, EGJ, and distal esophagus. Hematoxylin and eosin, Alcian blue/PAS (AB/PAS), and high-iron diamine/Alcian blue (AB/HID) were used to define and characterize IM. Results: Of 225 patients, eight (4%) had carcinoma, eight (4%) had conventional long-segment Barrett’s esophagus, 15 (7%) showed endoscopic short-segment Barrett’s change, with no endoscopic Barrett’s in 194 (86.2%). Of the latter, 34 (17.5%) had IM at the EGJ, and nine (4.6%) had IM at the cardia on hematoxylin and eosin. Acid mucin stains were positive at the EGJ in 135 (69.6%) and at the cardia in 75 (38.7%). Metaplasia at the EGJ was associated with sulphomucins ( p < 0.0001) and involved the surface glandular epithelium ( p < 0.0001) more frequently than the cardia. Metaplasia was not related to reflux symptoms, hiatus hernia, or endoscopic esophageal inflammation. Ninety percent of those with IM detectable by hematoxylin and eosin were taking acid suppression, compared with 72.8% overall. Conclusions: Intestinal metaplasia is very common at the esophagogastric junction and gastric cardia, with marked differences in incidence and characteristics of mucin staining between the two sites. The relationship of intestinal metaplasia to the development of carcinoma is yet to be determined.

Characteristics of the columnar-cell lined (Barrett's) esophagus

During a 6-month period, endoscopy in 203 patients established a diagnosis of Barrett's esophagus in 8 (4%). Esophagitis was present in the squamous-lined segment of the esophagus in 7 of these patients. Three patients had strictures, and 3 had esophageal ulcers, 2 of which were in the columnar segment distal to the squamocolumnar junction. During endoscopic examination an iodine-containing solution was instilled to better define the areas of squamous epithelium. This technique revealed islands of squamous epithelium in the columnar segment in 2 patients which were not visible before dye instillation. In the 2 patients with ulcers in the columnar segment, squamous epithelium was identified at the ulcer edge. By manometry, lower esophageal sphincter pressure was decreased in 6 patients and motility in the body of the esophagus was abnormal in 6. Acid perfusion tests were positive in 3 of 5 patients. Acid reflux and acid clearing were abnormal in all patients tested.

Anisotropy of magnetic susceptibility variations in Icelandic columnar basalts

The anisotropy of magnetic susceptibility (AMS) has been determined for 81 samples from eleven horizontal columnar segments from two Icelandic near-vertical dikes. Near-vertical orientation of short AMS axes and corresponding long-axis horizontal orientations in most columns represents alignments consistent with compactive effects due to vertically directed forces exerted by overlying columns. These data are inconsistent with primary orientations resulting from thermal contractive stresses, but such stresses may be responsible for the secondary orientations observed.