Prognostic factors in Barrett's esophagus: an immunohistochemical and morphometric study of 120 cases.

UNLABELLED: Barrett's esophagus is a condition in which the squamous mucosa that normally lines the distal esophagus is replaced by a columnar type of epithelium. Although it carries a clear risk of adenocarcinoma, the estimation of this risk and therefore the value of endoscopic screening remain highly controversial. AIM: To investigate more sensitive techniques to identify those patients who are at high risk of developing cancer and who need intensive endoscopic surveillance for early detection. METHODS: A morphologic, histochemical and morphometric study was performed on paraffin-embedded material from 120 patients with Barrett's esophagus and 18 with adenocarcinoma. In addition, each sample was analyzed immunohistochemically with proliferating cell nuclear antigen (PCNA), p53, c-erbB-2, CEA and EMA antibodies. RESULTS: In all zones of the glandular mucosa we found a higher percentage of PCNA-positive nuclei when the specialized epithelium was present. We saw PCNA expression in 75% of the patients with adenocarcinoma, and p53 expression in 15% of the patients without dysplasia, 37% of the patients with dysplasia and 44% of the patients with adenocarcinoma. Positivity for c-erbB-2 was found in 38% of the patients without dysplasia, 53% of those with dysplasia and 37% of those with adenocarcinoma. Aneuploidy was found in 70% of the patients with metaplasia or dysplasia and in all patients with adenocarcinoma. CONCLUSIONS: We conclude that p53, PCNA overexpression and aneuploidy are markers of risk for malignancy in Barrett's esophagus.

[A consensus on Helicobacter pylori and gastroduodenal pathology]. / Consenso sobre Helicobacter pylori y patología gastroduodenal.

The current debate involving Helicobacter pylori (H.p.) and its potential role as an etiological factor for some digestive diseases, as well as the recent discussion through different mass media of this bacterium, including the American N.I.H. Consensus, have lead to the discussion of the H.p. problem, in order to clarify its real importance in acid-related diseases. Thus we want, as gastroenterologists, to give an overview of the current status, so as to facilitate the general practitioner work when confronted with gastrointestinal diseases, particularly related to H.p. Our purpose is to provide a critical and objective view regarding the implications of H.p. infection, and explain when treatment is needed and how this treatment should be accomplished.

[Angiodysplasia of the colon and Crohn's disease. A study with vascular resin casts]. / Angiodisplasia de colon y enfermedad de Crohn. Estudio con moldes vasculares de resina.

All the previous studies which have associated arteriovenous malformations of the colon with chronic inflammatory disease have always been performed on a diseased intestine. This study, which uses the intravascular injection of resin, shows morphological evidence that angiodysplasia of the colon and intestinal inflammatory disease can coexist independently. This fact suggests that in cases of severe hemorrhage in a patient with inflammatory disease of the small intestine, it cannot simply be assumed that it originates in the macroscopically abnormal intestine, and that angiographic examination is a wise measure to rule out the possibility of arteriovenous malformations in the "normal" intestine.

Treatment of gastric pyrosis with almagate in patients with and without endoscopically demonstrable duodenal ulcer. A multicentre clinical trial.

An open multicentre trial of a new clinical antacid, almagate (hydrated aluminium-magnesium hydroxycarbonate, Al2Mg6(OH)14(CO3)2 X 4H2O, Almax) has been made in 169 patients suffering from gastric pyrosis (heartburn). Clinical and endoscopical exploration revealed that 104 of the patients had an active duodenal ulcer and 60 of these (group II) were treated with antisecretory drugs (cimetidine or ranitidine) plus Almax and 44 (group III) with Almax alone. Endoscopic exploration in the remaining 65 patients (group I) failed to reveal the presence of an ulcer and they were also treated with Almax alone. In all groups Almax proved to be very effective and the majority of patients were symptom free by the end of the two week trial. 79.5% of the ulcer patients in group III required doses of 6-8 g/d whereas only 21.7% of those in group II with concomitant treatment with antisecretory drugs took more than 4 g/d. The nonulcer patients of group I also used lower doses and only 29.3% needed to reach 6-8 g/d. There was a significant increase in daily bowel movements in all groups which was considered to be advantageous by most patients. Overall tolerance was excellent and side effects (diarrhoea 7 cases, nauseas 5 cases and constipation 1 case) were few and transient and 84.2% of the patients expressed a clear preference for Almax over their previous antacid treatment.