Short-segment Barrett's Esophagus Research Articles

Epidemiology of Barrett Esophagus in a University Hospital Health Maintenance Organization

Introduction: Barrett esophagus (BE) is a complication of gastro-esophageal reflux disease (GERD) and subtantially increases the risk of esophageal adenocarcinoma. There are no direct data supporting screening among the general population or even in patients with chronic reflux symptoms but surveillance programmes for the detection of dysplasia and neoplasia are accepted. Issues related to clinical manifestations, diagnosis and malignant transformations have not been well stablished in our country. Aims: To assess the prevalence of endoscopic diagnosis, epidemiology and progress of BE in a population belonging to a health maintenance organization (HMO). Methods: Adult patients diagnosed with BE from January 2004 to August 2008 in a HMO were included. Age at onset, sex, symptoms, previous diagnosis of BE, endoscopic findings, histopatological results and surveillance were reviewed from their electronic medical records. Results: Among 147.109 individuals enrolled in the HMO, 110 patients were diagnosed as Barrett (estimated prevalence 74.8/100.000). Mean age at time of diagnosis was 67 years (30-90). The male: female ratio was 1.5: 1. Patients were initially refered because of symptoms associated with GERD (66%), dyspepsia (8%), others (13%) or because of BE control (13%). According to Prague criteria 37 patients had circumferential extent, 19 (51%) of them had long-segment BE (more than 3 cm) and 18 (49%) short-segment BE (less than 3 cm). On the other hand, 67 patients only had tongue like extent, of which 52 (78%) had long-segment BE and 15 (22%) short-segment BE. Four patients had both circumferencial and tongue like extents (1 short-segment BE and 3 long-segment BE) and 2 had esophageal stenosis. Most patients had concomitant endoscopic lessions: hiatus hernia (47%), erosive esophagitis (7%), both of them (24%), others (11%) and only 11% had no other finding but BE. At their first endoscopy 79 patients (72%) did not have dysplasia, 28 (25%) had low grade dysplasia (LGD), 1 (1%) had high grade dysplasia (HGD) and 2 (2%) had adenocarcinoma. Fifty seven patients underwent endoscopic surveillance with a total of 88 endoscopic procedures with biopses: in 65 dysplasia remained stable, in 14 dysplasia presented some kind of regression and in 9 metaplasia progressed (7 to LGD, 1 to HGD and 1 to adenocarcinoma). Conclusions: Prevalence of endoscopic diagnosis of BE in a HMO population from Argentina is lower than previous reports from other countries. The same occurs with male: female ratio although mean age is higher. We found more dysplasia than that reported in other series. However we should initiate a prospective study in order to corroborate these findings.

Marked Variability in the Endoscopic Diagnosis of Barrett's Esophagus Using Japanese and Western Criteria

Introduction: It is important to recognize and diagnose Barrett's esophagus (BE) with or without dysplasia, such that appropriate surveillance and interventions can be carried out. Recognition of the esophageal gastric junction (EGJ) is the basis for the diagnosis of BE. In Japan, the distal end of the lower esophageal palisade vessels (PV) is used to define the EGJ. However, in Western countries, the EGJ is defined as the proximal margin of the gastric folds (GF). We aimed to compare the endoscopic diagnosis of BE using the PV and the GF as a land mark of EGJ. Material and Method: We prospectively enrolled patients at a single US center who were referred for routine diagnostic esophagogastroduodenoendoscopy. Prior to the study initiation, a Japanese endoscopist formally demonstrated the endoscopic features of end of the palisade vessels and their detection technique. Six American endoscopists performed the endoscopic assessment, and recorded the location details of the PV, GF and BE. We assessed the recognition rates of the EGJ and the detection rates of BE, first by using the PV and later using the GF as a land mark of EGJ. Result: Over a six week period, we examined 82 patients. The mean patient age (SD) was 64.5 (14) years. The patients were primarily men (91%; n=73); with the majority (76%; n=62) being Caucasian and the minority (4%; n=3) Hispanic. Identification rate of EGJ was 87.8% (72/82) using PV and 97.5% (80/82) using GF. 28.0% (23/82) in cases were endocopically diagnosed as BE by PV (PV-BE cases) and 17.0% (14/82) by GF (GF-BE cases). The concordance rate for the detection of BE endoscopically was 68.3% (56/82). Reflux esophagitis was detected in 30.5% (25/82). We could not identify the EGJ due to esophagitis in 7 cases by using PV and in 2 cases using GF. BE (less than 1 cm) was identified in 73.9% (17/23 PV-BE cases) and 57.1% (8/14 GF-BE cases), respectively. Discussion: We showed different ratios in the endoscopic detection of BE based on the lack of a standard identification of EGJ. The difference in the prevalence rate of BE (especially short segment Barrett's esophagus (SSBE)) in Japan and Western countries may in part be attributed to differences in the endoscopic landmarks used to diagnose BE. As such, the actual risk for cancer in SSBE (especially less than 1 cm) based on Japanese criteria needs to be further investigated and clarified. A universal standard for identification of EGJ should be established.

Endoscopic Therapy for Barrett's Esophagus

Recent retrospective cohort data and a prospective randomized sham controlled trial have clearly documented the impact of endoscopic ablation therapy on dysplasia and Barrett's esophagus (BE). The clinical indications for ablation of BE includes high-grade dysplasia and intramucosal adenocarcinoma. The techniques of resection of mucosal irregularities and of ablation are reviewed, primarily thermal and photodynamic ablation. Ablation of BE with neoplasia has appropriately entered the clinical arena.

Latest Results (12–21 Years) of a Prospective Randomized Study Comparing Billroth II and Roux-en-Y Anastomosis After a Partial Gastrectomy Plus Vagotomy in Patients With Duodenal Ulcers

After a partial resection of the stomach, the continuity of the gastrointestinal tract can be restored either by a Billroth II gastrojejunal anastomosis or a Roux-en-Y gastrojejunostomy. Each procedure has its advantages and disadvantages. To determine through a prospective and random clinical trial, the clinical outcome and the endoscopic and histologic alterations of the distal esophagus and the gastric remnant in patients who received a partial distal gastrectomy due to duodenal ulcers and a Billroth II or Roux-en-Y reconstruction. In this prospective random trial, a total of 75 patients with duodenal ulcers were included. A bilateral selective vagotomy and partial distal gastrectomy were performed in all patients. A Billroth II or Roux-en-Y 60-cm-long loop was randomly used for reconstruction of the gastrointestinal tract. During the latest follow-up clinical evaluation, upper endoscopy and biopsy samples from the distal esophagus and gastric remnant were obtained. There was 1 operative mortality and 6 patients had some morbidity. The average follow-up period was 15.5 years (range, 11-21). Patients with Roux-en-Y gastrojejunostomy were significantly more asymptomatic and had greater Visick I grading than patients with Billroth II reconstruction (P < 0.001). In the distal esophagus, endoscopic findings were normal in 90% of the Roux-en-Y group, but only in 51% of the Billroth II group (P < 0.0009). Nearly 25% of the latter group had the appearance of a short-segment Barrett esophagus compared with 3% of the Roux-en-Y group (P < 0.0001). The gastric remnant endoscopic findings were normal in 100% of the Roux-en-Y group and in 18% of the Billroth II group (P < 0.02). Histologic analyses showed similar proportions of normal fundic mucosa and chronic active fundic gastritis. However, chronic atrophic fundic gastritis and intestinal metaplasia were significantly more frequent after Billroth II reconstruction (P < 0.008). Helicobacter pylorus was present in a similar proportion of patients. This prospective and random study showed that Roux-en-Y gastrojejunostomy is significantly better than a Billroth II reconstruction in patients with duodenal ulcers, through subjective and objective endoscopic and histologic evaluations during the latest follow-up evaluation.

The characteristics of Barrett's esophagus: an analysis of 4120 cases in China

Our objective was to investigate the endoscopic and clinico-pathological characteristics in patients with Barrett's esophagus (BE) in China. Using the terms 'Barrett's esophagus' and 'Barrett's esophagus, China' as key words, literatures published in Chinese and English journals were searched in Chinese data banks, as well as PubMed and ISI Web of Science from 1989 to 2007. An analysis was carried out with the standard inclusion and exclusion criteria. A total of 4120 cases were included in this study. BE was found in 2.44% of patients undergoing endoscopy for various symptoms of upper gastrointestinal tract diseases; the male : female ratio was 2.09 : 1, the average age of detection of BE was 53.15 years old, and 51% of patients with BE had typical symptoms for gastroesophageal reflux disease (GERD). The island-type BE was predominant (56.80%), and the occurrence of BE with special intestinal metaplasia (SIM) was 36.58%, but SIM was more common in tongue-type BE than island-type and circumferential-type BE (both P < 0.001), as well as in long segment BE (LSBE) than in short segment BE (SSBE) (P < 0.001). A total of 46.39% of patients had Helicobacter pylori infection. The mean length of follow up was 2 years in 492 patients. The incidence of adenocarcinoma was 0.61% patient-years of total follow up. In China, the endoscopic prevalence of BE is lower, but the average age of diagnosis is younger; a high proportion of H. pylori infection is found in patients with BE, and about half of the patients have no typical symptoms of GERD; the tongue-type BE and the LSBE are apt to SIM.

Trends in Barrett's esophagus diagnosis in Southern Europe: implications for surveillance

The incidence of Barrett's esophagus (BE) and esophageal adenocarcinoma has increased in Western countries in recent decades. The aim of this study is to describe the changes in incidence and prevalence of BE diagnosis, dysplasia, and adenocarcinoma development in BE patients in a South-European Mediterranean area. Retrospective population-based analyses of endoscopy and pathology reports from 1976 to 2001 was performed. Data from patients with diagnosis of BE and/or esophageal carcinoma were collected. The study period was divided in four quartiles for statistical calculations; parametric and nonparametric tests were used. A 6.9-fold increase was found in the diagnosis of long-segment BE from the first to the fourth quartile, and a 9.3-fold increase in short-segment BE from 1995 to 2000, in contrast to a much smaller increase of 1.9-fold increase in the number of upper gastrointestinal endoscopies. The adjusted incidence of BE diagnosis increased from 0.73 to 9.73 cases/100,000 (first to fourth quartile, respectively) and the adjusted prevalence from 6.51 to 76.04 cases/100,000 (1985-2001). The incidence of dysplasia was 2.13% per year (95% confidence interval: 0.05-11.3%) - 1.78% for low-grade dysplasia and 0.36% for high-grade dysplasia - giving a total incidence of 1 per 47 patient-years. The incidence of adenocarcinoma during follow-up was 0.48% per year (95% confidence interval: 0.006-2.62%), for an incidence of 1 per 210 patient-years. Nineteen patients with BE (14 long-segment BE, 5 short-segment BE) were diagnosed with esophageal adenocarcinoma, with eight being diagnosed during endoscopic surveillance. Only 14 (8%) adenocarcinoma patients diagnosed during the study period had a history of BE. BE diagnosis has dramatically increased over recent decades in our population, unrelated to an increase in endoscopies. Progression to low-grade dysplasia and adenocarcinoma is rare. Surveillance may have a low impact on the survival of adenocarcinoma patients in Southern Europe.

Clinicopathologic Characteristics of Barrett's Cancer in Korea

The incidence of Barrett's cancer is increasing in Western countries, but there have been only a few case reports of this condition in Korea. The aim of this study was to elucidate the endoscopic and pathologic characteristics of Barrett's cancer in a single center in Korea. We retrospectively reviewed the demographic, endoscopic, and pathologic characteristics of six patients with Barrett's cancer, defined as a tumor centered above the esophagogastric junction and surrounded by Barrett's esophagus. All six patients were male, and three (50%) were symptomatic. Barrett's cancer had developed from short-segment Barrett's esophagus in all patients. All tumors were located on the right side of the lower esophagus and showed hyperemic mucosal changes. Three patients were treated surgically and three by endoscopic resection. All cases had pathologic evidence of Barrett's cancer. Early detection of Barrett's cancer requires meticulous endoscopic observations of subtle mucosal color and morphological changes around the esophagogastric junction.

Barrett’s esophagus in Japanese patients: its prevalence, form, and elongation

Barrett's esophagus is a well-known acquired condition resulting from gastroesophageal reflux disease (GERD). However, it is still unknown whether Barrett's esophagus develops gradually over time in patients with GERD. To address this issue, we investigated the change in the prevalence and length of short-segment Barrett's esophagus (SSBE) over time. From January 2005 to March 2007, we enrolled 5338 patients who received upper gastrointestinal endoscopy. Prevalence and length of endoscopically identified SSBE were evaluated within groups divided on the basis of 10-year age intervals. The factors possibly influencing SSBE length such as symptoms, antacid use, and endoscopic findings were also evaluated. Additionally, the length change in 236 patients with histologically confirmed Barrett's esophagus was evaluated over a 2-year follow-up. Of the 5338 enrolled patients, 1997 had SSBE. The prevalence of endoscopically identified SSBE was significantly higher and its length was significantly longer in elderly patients. Multiple regression analysis showed that age, presence of reflux esophagitis, reflux symptoms, and hiatal hernia were positively correlated with SSBE length. Analysis of the 2-year follow-up study of histologically confirmed SSBE revealed significant extension of Barrett's length in 28.0% of 236 patients. Presence of reflux symptoms and hiatal hernia were identified as positive predictors and proton pump inhibitor administration as a negative predictor of SSBE elongation. Positive predictors for the extension of SSBE were presence of hiatal hernia and reflux symptoms, but not age.

Risk Factors for the Progression of Endoscopic Barrett’s Epithelium in Japan: A Multivariate Analysis Based on the Prague C &amp; M Criteria

To determine the prevalence and progression of Barrett's epithelium and associated risk factors in Japan. The study population comprised 869 cases. Endoscopic Barrett's epithelium was diagnosed based on the Prague C & M Criteria. The correlations of clinical factors with the prevalence and progression of endoscopic Barrett's epithelium were examined. Endoscopic Barrett's epithelium was diagnosed in 374 cases (43%), in the majority of which the diagnosis was short-segment Barrett's esophagus. The progression of Barrett's epithelium was identified in 47 cases. In univariate and multiple logistic regression analyses, aging, smoking habit, and erosive esophagitis were significantly associated with the prevalence of Barrett's epithelium, whereas aging and erosive esophagitis, especially severe erosive esophagitis, were significant contributing factors to the progression of Barrett's epithelium. Forty-three percent of the total study population was diagnosed as having endoscopic Barrett's epithelium. During the follow-up period, 12.6% of the cases with Barrett's epithelium exhibited progression which was associated with aging and severe erosive esophagitis.

Prevalence and Clinical Characteristics of Barrett's Esophagus in a Chinese General Population

The prevalence of Barrett esophagus (BE) remains elusive in the general populations. The purpose of this study was to identify the prevalence and clinical characteristics of BE in a Chinese general population. Between June 2003 and December 2006, consecutive subjects were evaluated via upper gastrointestinal endoscopy during a routine health examination. Patients were evaluated for any abnormalities, including endoscopically suspected esophageal metaplasia (ESEM) and erosive esophagitis (EE). Biopsies were attained from patients with ESEM to confirm a diagnosis of BE. The demographic data and endoscopic findings were retrospectively analyzed. Of the 19,812 endoscopies performed, 56 patients (0.28%) were diagnosed with ESEM and 3129 patients (15.7%) with EE. Twelve of the 56 patients diagnosed with ESEM (0.06% of the total number of patients who underwent endoscopy) were confirmed to have BE after histologic analysis of the biopsies. Patients with BE were older than patients without BE (61.6 vs. 51.7 y), and only one of the 12 patients diagnosed with BE (8.3%) reported typical gastroesophageal reflux symptoms. A majority of the BE patients were categorized as short-segment BE (91.7%) and concomitant EE was found in 4 (33.3%). Smoking, alcohol, and metabolic disorders seemed to be associated with the presence of BE and EE. The prevalence of BE in a Chinese general population was lower than that in other reported studies, particularly in comparison with the studies originating from Western countries. Patients with advanced age and metabolic disorders are risk factors for developing BE.

Familial Barrettʼs Esophagus

Purpose: Barrett's Esophagus is seen in 3–12% of patients with chronic reflux symptoms. This is a study of three family members (father, son, and daughter) all of whom had long-segment Barrett's esophagus that rapidly progressed from low grade dysplasia (LGD) to high grade dysplasia (HGD) within a year. This study demonstrates that there is a genetic component to this disease, and that, in familial cases, there can be rapid histological progression suggesting that the biological behavior is distinct from that seen in sporadic cases of Barrett's esophagus. Methods: A 77 year old male with chronic acid reflux was found to have long-segment Barrett's esophagus with LGD that progressed to HGD within a year. A laparoscopic esophagectomy was performed with the finding of HGD. The pstient's son and daughter were both subsequently diagnosed with long-segment Barrett's esophagus that rapidly progressed from LGD to HGD within a year. Both son and daughter had laparoscopic esophagectomy with finding of HGD. The patient's grandson was found to have short segment Barrett's esophagus without dysplasia. The patient's wife has erosive esophagitis as does a granddaughter. Results: A 77 year old male, his daughter and son all were found to have long-segment Barrett's esophagus that rapidly progressed from LGD to HGD within a year. The patient's grandson was found to have short segment Barrett's esophagus without dysplasia and is under close surveillance. Conclusion: Barrett's esophagus is felt to be an acquired condition resulting from chronic acid reflux. This report suggests that there is a genetic component to this disease, and, where there are familial clusters, the biological behavior can be more aggressive with rapid progression to HGD emphasizing the need to consider some modification of endoscopic screening strategies for this group of patients. Early intervention with ablation of Barrett's tissue might be considered in patients with a strong family history of Barrett's esophagus.

Results of antireflux surgery in patients with Barrett's esophagus

BACKGROUND: Barrett's esophagus (BE) is defined as the presence of intestinal metaplasia with goblet cells, which replace the normal squamous epithelium of the distal esophagus. PURPOSE: To review the results of surgical treatment in patients with short- and long-segment BE. METHODS: Between 1980 and 2006, a total of 35 articles published in English literature dealing with surgical treatment of patients with BE were reviewed. Clinical success, stop of acid, and duodenal reflux into the distal esophagus, endoscopic and histologic evaluations and development of adenocarcinoma were the main issues included. RESULTS: The majority of publications include very few patients (less than 50), the follow-up is less than 5 years in 80% and classic antireflux surgery obtains clinical success before 5 years of follow-up in 81% of the patients, but this success deteriorates with the length of follow-up. Acid reflux before and after surgery was evaluated in few publications and duodeno-esophageal reflux in only 3 papers. The majority of reports include only 1 endoscopic evaluation after surgery while histologic analysis of Barrett's mucosa has shown regression of intestinal metaplasia in only 5%. Progression of adenocarcinoma has been reported in 3.8%, even in asymptomatic patients. On the contrary, the acid suppression and duodenal diversion procedure obtained 91% of clinical success at a late follow-up (8 to 10 years), permanent control of acid and duodenal reflux, regression of intestinal metaplasia to cardiac mucosa in 55% of the patients and no progression to high grade dysplasia or adenocarcinoma has been documented. Patients with short-segment BE have shown very good results after laparoscopic fundoplication. CONCLUSIONS: Antireflux surgery in patients with long-segment BE does not prevent the development of adenocarcinoma. Acid suppression and duodenal diversion procedure is an alternative procedure, specially in patients below 60 years of age.

Large Hiatal Hernia Is Associated with An Increased Frequency of Long Segment Versus Short Segment Barrett's Esophagus

Introduction: Hiatal hernia (HH) occurs commonly in Barrett's esophagus (BE). Long segment Barrett's esophagus (LSBE) is associated with increased dysplasia risk compared to short segment Barrett's esophagus (SSBE). The association of HH and length of BE is not clear. Methods: Endsocopies from 2003-2007 with both endoscopic appearance of BE and histologic confirmation of specialized intestinal metaplasia in patients over 18 years old were reviewed. HH was measured from diaphragmatic pinch to top of the gastric folds. HH was defined as “large” (greater than 3 cm length) or “moderate” (between 2 to 3 cm). Length of BE was measured from the top of the gastric folds to the most proximal point of abnormal characteristic appearing mucosa. LSBE was defined as 3 cm or greater. Statistical signifance was determined by two-tailed chi-square analysis. Patients with histopathology consistent with intestinal metaplasia but without characteristic “salmon-colored” abnormal appearing endoscopic mucosa were excluded. Results: BE was present in 88 patients. LSBE was present in 29/88 (33%) and SSBE in 59/88 (67%) of BE patients. Amongst all BE patients, the presence of any HH (2 cm or greater) was 74/88 (84%). HH was present in LSBE in 27/29 (93%) and in SSBE 47/59 (80%) of patients. The presence of a large HH in LSBE patients was 15/29 (52%) and in SSBE patients was 14/59 (24%). The presence of LSBE versus SSBE was associated with an increased frequency of large HH (p = 0.008). In LSBE patients, 23/29 (79%) were male while in SSBE 32/59 (54%) were men. Amongst LSBE patients, 20/29 (69%)were over the age of 60 years old. Amongst SSBE patients, 35/59 (59%)were over age 60. In LSBE patients, 21/29 (72%) were caucasian. In SSBE patients, 36/59 (61%) were caucasian. Age over 60, race and gender were all not predictive of the presence of LSBE. Dysplasia was present in LSBE in 5/29(17%)and in 3/59 (5%) with SSBE. The presence of dysplasia in LSBE versus SSBE approached statistical significance (p = 0.11). Amongst LSBE patients with dysplasia, all 5/5 had HH and 3/5 had a large HH. Conclusions: The majority of patients with BE (84%) had a HH. Large HH (>3 cm) was seen in 29/88 (33%) of BE patients. Patients with LSBE were more likely have a large HH (52%) versus patients with SSBE (24%). Conversely, the presence of LSBE versus SSBE was not associated with age over 60, male gender or caucasian race. LSBE has been associated with increased risk of dysplasia in prior studies. Here, LSBE has been shown to be associated with HH >3 cm. Further studies should address how HH size impacts dysplasia risk and dysplasia progression.

Adenocarcinoma of the Esophagogastric Junction May Arise From Short-Segment Barrett's Esophagus

Adenocarcinoma of the Esophagogastric Junction May Arise From Short-Segment Barrett's Esophagus

Adenocarcinoma developing in short-segment Barrett's esophagus: analysis of 5 patients and review of the literature

BACKGROUND: The endoscopic findings of short-segment Barrett's esophagus (SSBE) is a frequent diagnosis among patients with a long-standing history of gastroesophageal reflux. PURPOSE: To describe the clinical and pathologic findings in a small group of patients with SSBE, who developed an Adenocarcinoma. METHODS: Five patients were included in this study, 3 of them from a prospective endoscopic follow-up of patients with SSBE. A complete clinical, radiological and endoscopic evaluation was performed, and 24-h pH monitoring and esophageal manometry were also performed. Surgical procedure consisted in all of a transhiatal videoassisted esophagectomy with gastric pull up and cervical anastomosis and two-field lymphadenectomy. RESULTS: Four patients were men and 1 a woman with a mean age of 58 years. Symptoms of gastroesophageal reflux were present with a mean of 9 years. Radiological studies revealed the existence of a carcinoma in only one patient (20%). Endoscopic evaluation demonstrated a small carcinoma on the SSBE in 60%. In 3 patients 24 h pH monitoring revealed a severe acid reflux. All tumours corresponded to a tubular adenocarcinoma of the intestinal type. One patient had a mucosal carcinoma, 2 up to the muscularis propria and 2 had an advanced carcinoma. Lymph node metastases were absent in one patient. There was no operative mortality and postoperative morbidity corresponded to 3 leakages of the cervical anastomosis. Two patients had an associated renal carcinoma. One patient died 10 months after surgery due to recurrence of renal carcinoma and one died 62 months after surgery due to heart infarction. Only 1 patient died due to recurrence 38 months after surgery. Two patients are alive 18 and 40 months after operation. CONCLUSIONS: Patients with SSBE may develop an adenocarcinoma during their natural evolution. Therefore, an endoscopic surveillance during chronic medical treatment is mandatory.

Capsule Endoscopy for Screening for Short-Segment Barrett's Esophagus

The rise in the incidence of esophageal adenocarcinoma has led to the development of new methods to screen for the precursor lesion, Barrett's esophagus. To evaluate the potential role of esophageal capsule endoscopy in identifying the presence of short-segment Barrett's esophagus. Patients with biopsy-proven short-segment Barrett's esophagus underwent esophageal capsule endoscopy. The images were reviewed by two expert observers with no knowledge of the purpose of the study. The data collected included transit time, quality of image, presence or absence of Z-line, Schatzki's ring, hiatal hernia, and Barrett's esophagus (long or short, definite or suspected). Twenty patients were studied; in 18, the capsule passed into the stomach. Barrett's esophagus was identified or suspected in eight cases (44%) by one observer and three (16%) by the second (P= 0.14). Although the Z-line was seen in the 18 cases that were qualified by both observers, there was an agreement in only six cases as to whether it was regular or irregular. Erosive gastroesophageal reflux disease (GERD) was scored as present in three and absent in six patients by both readers. Nonexisting feline esophagus, varices, and distal esophageal stricture were suspected in one patient each. Esophageal capsule endoscopy had a high interobserver variability and a low yield for short-segment Barrett's esophagus. Esophageal capsule endoscopy cannot be recommended for screening for short-segment Barrett's esophagus.

Is There a Difference in the Prevalence of Helicobacter pylori Infection between Short-Segment and Long-Segment Barrettʼs Esophagus?

Purpose: Recent studies suggest that the length of Barrett's esophagus (BE) is a risk factor for neoplastic progression. Patients with long-segment Barrett's esophagus (LSBE) are at higher risk for development of dysplasia and adenocarcinoma of the esophagus when compared with short-segment Barrett's esophagus (SSBE), which suggests that different pathophysiological mechanisms may be involved in SSBE and LSBE. To date, the role of H. pylori infection in the development of BE is still unclear. We aimed to investigate by meta-analysis if any difference exists in the prevalence of H. pylori infection between SSBE and LSBE. Methods: Observational studies comparing the prevalence of H. pylori infection or cagA+ H. pylori strains in patients with SSBE (length < 3 cm) and LSBE (length ≥ 3 cm) conducted in adult populations and published in all languages were identified through MEDLINE, EMBASE and Cochrane database searches until week 21, 2007. H. pylori infection required confirmation by histology and/or serology and/or RUT and/or culture. Primary outcome was the prevalence of H. pylori infection in SSBE and LSBE. Secondary outcome was the prevalence of cagA+ H. pylori strains in SSBE and LSBE. Studies were excluded if lacking raw data for outcome of interest or were duplicate publications. Summary effect size was calculated as odds ratios (OR) and 95% confidence intervals (CI) by the random-effects model using Review Manager 4.2.8. Results: Of 458 citations, 13 studies met inclusion criteria. 825 patients with SSBE and 470 with LSBE were included for analysis. The prevalence of H. pylori infection was significantly higher in SSBE than in LSBE [39.6% (327/825) and 29.6% (139/470) respectively, OR = 1.49, 95% CI 1.02–2.18, P= 0.04], and homogeneity was seen between studies (P= 0.14). The results from 4 studies in H. pylori positive patients showed no difference in cagA+ H. pylori strains between SSBE and LSBE [36.7% (18/49) and 37.8% (14/37) respectively, OR = 0.51, 95% CI 0.08–3.04, P= 0.46], with homogeneity (P= 0.14). Conclusion: The prevalence of H. pylori infection in LSBE is significantly lower than in SSBE, which suggests that H. pylori infection plays a different role, if any, in these two subtypes of BE and does not “protect” in patients with SSBE. Current evidence does not confirm a role for cagA+ in subtypes of BE although the sample size was small. Large prospective studies are needed to confirm these results in the future.

Distribution and significance of the oesophageal and gastric cardiac mucosae: a study of 131 operation specimens

To clarify the distribution and significance of the oesophageal and gastric cardiac mucosae at the oesophago-gastric junction (EGJ). Oesophagectomy specimens from 131 consecutive patients with middle and upper thoracic oesophageal cancer were examined. The surgically resected specimens including the EGJ were cut into 5 mm thick serial sections and examined histopathologically for the length of the oesophageal and gastric cardiac mucosae and the incidence of columnar epithelial islands (CEIs). We also determined the presence of short-segment Barrett's oesophagus (SSBE) and goblet cell metaplasia in SSBE. Oesophageal cardiac mucosa was found in 125 cases (95%) and gastric cardiac mucosa was found in all cases. The mean length of the oesophageal and gastric cardiac mucosa was 4 mm (range 1-26 mm) and 13 mm (range 2-64 mm), respectively. CEIs were found in 75 cases (57%). SSBE was found in 70 cases (53%), among which goblet cell metaplasia was found in 28 cases (21%). No long-segment Barrett's oesophagus was found. The mean length of oesophageal cardiac mucosa (6 mm) and gastric cardiac mucosa (17 mm) in SSBE was significantly greater than that (3 mm and 8 mm, respectively) in non-SSBE cases (P < 0.0001 and P < 0.0001). The incidence (69%) of CEIs in SSBE was significantly higher than that (44%) in non-SSBE cases (P = 0.005). Oesophageal and gastric cardiac mucosae were found frequently. Oesophageal cardiac glands and CEIs might play an important role in the development of SSBE.

Capsule Endoscopy for Screening for Short Segment Barrett's Esophagus

Background: Barrett's esophagus (BE) is a premalignant condition develops that develops in up to 15% of patients with chronic GERD. The rise in the incidence of esophageal adenocarcinoma has led to debate regarding the need for mass screening for BE. Esophageal capsule endoscopy (ECE) offers a relatively non-invasive and quick method for evaluating the esophageal mucosa. Its role in short segment BE (SSBE) remains unclear. Aim: To evaluate esophageal capsule endoscopy for the diagnosis of short segment Barrett's esophagus.

The Use of Cytokeratin Stain to Distinguish Barrett’s Esophagus from Contiguous Tissues: A Systematic Review

Our objective was to systematically review the existing literature regarding the use of cytokeratin (CK) stain in differentiating Barrett's esophagus (BE) from tissues of the gastric cardia, corpus, or antrum, with or without intestinal metaplasia (IM). Pubmed was searched for full publications in English (1983-2005) addressing the use of CK for differentiation of BE from contiguous tissues. Information was collected on the study sample, blinding, the methods used for CK staining, and for defining and applying the gold standard tests. Test characteristics were obtained or calculated. Sixteen studies (containing 46 comparisons) met the inclusion and exclusion criteria. Immunostaining for CK 7 and 20 was generally highly specific in distinguishing long-segment BE from antrum IM, fundus IM, or noncardiac gastric IM; 27 comparisons showed statistically significant differences. However, only 8 of 15 comparisons (6 of 12 studies) reported significant differences in CK staining patterns between BE and gastric cardia IM with a high sensitivity (89%-100%) and specificity (83%-100%) for long-segment BE and lower estimates for short-segment BE, while the other seven comparisons showed no significant differences and a very low sensitivity. Examination by a blinded pathologist was reported in five of six positive studies and in only one of six of the negative studies. In addition, variation in the patient populations, use of surgical resection versus endoscopic biopsies, and biopsy sampling technique in endoscopic studies may have accounted for these differences. Finally, two studies did not find significant differences in CK staining patterns between BE and normal cardiac mucosa. In conclusions, CK immunostaining has not performed well in differentiating BE, especially short-segment BE, from cardia IM. There seems to be a spectrum bias where the accuracy varies with different tested populations. CK immunostaining distinguished well between BE and IM in noncardiac segments of the stomach; however, these comparisons are not clinically relevant.