Prevalence, histologic and clinical characteristics of heterotopic gastric mucosa in Chinese patients.

AIM: To determine the prevalence, demographic, clinical and histopathologic features of heterotopic gastric mucosa (HGM) in Chinese patients. METHODS: Patients referred to three endoscopy units were enrolled in this study. The macroscopic characteristics of HGM were documented. Biopsies were obtained and observed using hematoxylin and eosin staining. Helicobacter pylori colonization was examined by Whartin-Starry staining. RESULTS: HGM was observed in 420 Chinese patients, yielding a prevalence of 0.4%. The majority of patients had a single patch (300/420; 71.4%), while the remainder had two (84/420; 20%) or multiple patches (36/420; 8.6%). The size of the patches and the distance from the patch to the frontal incisor teeth varied significantly. The large majority of HGM patches were flat (393/420; 93.6%), whereas the remaining patches were slightly elevated. The primary histological characteristic was fundic-type (216/420; 51.4%) within the HGM patch, and antral- (43/420; 10.2%) and transitional-type (65/420; 15.5%) mucosa were also observed. The prevalence of intestinal metaplasia was 3.1% (13/420) and the prevalence of dysplasia was 1.4% (6/420), indicating the necessity for endoscopic follow-up in patients with HGM. Esophageal and extraesophageal complaints were also observed in patients with HGM. Dysphagia and epigastric discomfort (odds ratios: 6.836 and 115.826, respectively; Ps < 0.05) were independent risk factors for HGM. CONCLUSION: Clinical complaints should be considered to improve the detection rate of HMG. The prevalence of intestinal metaplasia and dysplasia also indicates a need for endoscopic follow-up.

[Ulcerating tumor of the esophagus as a primary manifestation of extrapulmonary tuberculosis]. / Ulzeröser Tumor der Speiseröhre als Erstmanifestation einer extrapulmonalen Tuberkulose.

HISTORY AND ADMISSION FINDINGS: The patient, a 36-year-old man from Somalia, who had moved to Germany a year before, was referred for a diagnostic work-up of an ulcerating tumour. He suffered from thoracic tightness for the last weeks albeit without any further symptoms. There were no pre-existing illnesses. No further pathological signs were found during a preliminary physical examination. INVESTIGATIONS: After ruling out any malignancies by means of an analysis of biopsy samples, further differential diagnostic measures were undertaken. Besides mechanical and chemical factors, an infectious genesis of the esophageal lesion was considered and investigated further through histological, immunohistochemical, laboratory and microbiological tests. DIAGNOSIS, TREATMENT AND COURSE: Mycobacterium tuberculosis was detected in cultures sampled from biopsy material. This strain turned out to be responsive to medical treatment. Further diagnostics regarding a potential primary pulmonary tuberculosis were negative. Histological analysis of a liver biopsy confirmed noncaseating epithelioid cellular granuloma as typically seen in granulomatous hepatitis without any direct evidence of mycobacteria. Thus, tuberculosis of the liver appeared most likely considering the differential diagnosis of a granulomatous hepatitis. The patient underwent standard treatment using antituberculous drugs over six months. Endoscopic control after two months showed a significant reduction of the ulcerating lesion. CONCLUSION: Ulcerating tumors of the esophagus are primarily classified as potential malignancies. Crohn's disease is an important differential diagnosis. Apart from mechanical and chemical causes, infectious diseases should be taken into consideration. However, tuberculosis is one of the most relevant differential diagnoses, particularly in patients immigrating from TB-prone countries, pre-existing immune deficiency or environmentally induced elevated infection risk.

Barrett's esophagus-related diseases remain uncommon in China.

Barrett's esophagus (BE)-related esophageal adenocarcinoma (EAC) has shown the fastest rise in incidence in Western countries; however, research data on BE-related diseases from China are inconclusive. We aimed to review and analyze the published results on these diseases in China. We searched PubMed and Chinese medical literature for key words: BE, EAC, Chinese and China. Relevant research papers along with the study results from our own groups were reviewed and analyzed. Using standardized criteria, columnar-lined esophagus (CLE) was found in as many as 29% of resection specimens in Chinese patients with proximal gastric cancer. However, BE with intestinal metaplasia was rare, ranging from 0.06% in the general population to <2% in referral patients. Risk factors included advancing age, hiatal hernia and probably gastroesophageal reflux disease and tobacco or alcohol abuse, but not male gender or obesity. At endoscopy, most CLE/BE were <2 cm in length, and appeared tongue-like and island-like. The long-segment BE was rare, especially in women. Population-based studies conducted in Taiwan and Hong Kong SAR, China showed that EAC was not only rare but also stable or had decreased in incidence over the past decade. By histopathology, EAC accounted for only 1% of all distal esophageal cancers and almost all gastroesophageal junction (GEJ) cancers were centered in the proximal stomach. BE-related diseases, except for CLE, are rare in China. The clinical significance and malignant potential of CLE in the Chinese population remain elusive. Further investigation on these diseases is in progress.

Hallazgos endoscópicos en poblaciones chilenas aisladas: Isla de Pascua y Chile Chico / Endoscopic findings in isolated chilean populations: Isla de Pascua (easter island) and Chile Chico

Chile is a country with high incidence of gastrointestinal diseases, but there are Chilean populations without access to an expeditious endoscopic diagnosis. Easter Island (3.791 inhabitants) and Chile Chico (3.042 inhabitants). Objective: To describe and compare the endoscopic findings in two subgroups of Chilean population of Easter Island (Isla de Pascua) and Chile Chico. Methods: Endoscopic procedures were performed on selected subgroups from Isla de Pascua and Chile Chico during October 2008 and March 2009, in the context of health operations conducted by our hospital. Results: Seventy two patients were evaluated in Isla de Pascua and 52 in Chile Chico. The most frequent endoscopic indications in Isla de Pascua were epigastric pain (22%), heartburn (18.2%), and gastroesophageal reflux (16.2%) and in Chile Chico: gastroesophageal reflux and pirosis (36,5%), epigastric pain (19,3%), and previous gastric ulcer (5.7%). Endoscopic findings in Isla de Pascua and Chile Chico were: gastritis, 26 patients (36.1%) and 5 (9.6%); peptic ulcer 2 (2.7%) and 9 (17.2%); esophagitis 10 (13.8%) and 6 (11.5%); hiatal hernia, 9 (12.5%) and 11 (21%); and endoscopy without lesions 20 (27%) and 13 (25%), respectively. Comparing the findings in both groups the occurrence of two advanced cancers stands out (gastric and esophageal) in the population of Chile Chico; no neoplastic diseases were found in Isla de Pascua. Conclusion: The endoscopic findings in a subgroup of Chileans belonging to isolated populations are described. Differences in the type of digestive diseases suggest that these are different populations despite sharing the same nationality. Future operations will provide a better understanding of these conditions.

Introducción: Chile es un país con alta incidencia de patología digestiva, sin embargo, existen poblaciones chilenas que por situación geográfica no cuentan con acceso expedito a un diagnóstico endoscópico. Objetivo: Describir los hallazgos endoscópicos en dos subgrupos de población chilena de Isla de Pascua y Chile Chico y compararlos entre sí. Métodos: Se realizaron procedimientos endoscópicos a subgrupos seleccionados en Isla de Pascua y Chile Chico en los meses de octubre de 2008 y marzo de 2009, en el marco de los operativos de salud realizados por nuestro Hospital. Resultados: Se evaluaron 72 pacientes en Isla de Pascua y 52 en Chile Chico. Las indicaciones endoscópicas más frecuentes en Isla de Pascua son epigastralgia (22%), pirosis (18,2%) y control de reflujo gastroesofágico (16,2%) y en Chile Chico: reflujo gastroesofágico y pirosis (36,5%), epigastralgia (19,3%) y antecedente de úlcera gástrica (5,7%). Los hallazgos endoscópicos en Isla de Pascua y Chile Chico respectivamente son: gastritis 26 pacientes (36,1%) y 5 (9,6%), úlcera péptica 2 (2,7%) y 9 (17,2%), esofagitis 10 (13,8%) y 6 (11,5%), hernia hiatal 9 (12,5%) y 11 (21%), sin lesiones 20 (27%) y 13 (25%). Al comparar los hallazgos en ambos grupos destaca la presencia de dos cánceres avanzados (gástrico y esofágico) en la población de Chile Chico, sin encontrarse patología neoplásica en Isla de Pascua. Conclusión: Se describen los hallazgos endoscópicos en un subgrupo de chilenos pertenecientes a poblaciones más aisladas. Las diferencias en el tipo de patologías pesquisadas sugiere que se trata de poblaciones diferentes pese a compartir una misma nacionalidad. La realización de futuros operativos permitirá obtener un mayor conocimiento de las patologías más prevalentes en dichas poblaciones y evaluar la influencia de las...

Associations between different forms of gastro-oesophageal reflux disease.

AIMS: To study the epidemiology and natural history of gastro-oesophageal reflux disease (GORD). METHODS: Retrospective cohort study involving all 172 hospitals of the Department of Veterans Affairs. A total of 194,527 patients with GORD were followed between 1981 and 1994. Distribution of oesophagitis, oesophageal ulcer, oesophageal stricture, strictured hiatus hernia, hiatus hernia, and pyrosis by age, sex, and ethnicity were determined. The comorbid occurrence of various forms of GORD in identical patients was analysed by an age and race standardised morbidity ratio. The population of all hospitalised veterans was used for comparison. RESULTS: Severe forms of GORD associated with oesophageal erosions, ulcers, or strictures, affected elderly, white, male patients more often than their corresponding opposite demographic group. All forms of GORD clustered in the same patient population; on average, any form of GORD was 10 times more likely to occur in a patient with another form of GORD than without. The highest morbidity ratio (22) was found in oesophageal ulcer and stricture. About one third of all patients with oesophageal erosions, ulcers, or strictures also had hiatus hernia; 46% of patients with hiatus hernia were diagnosed as having other forms of GORD. While one third of all oesophageal strictures appeared in patients without other forms of GORD diagnosed at any time, oesophageal ulcers were always associated with some other form of GORD. No clear cut progression in different forms of GORD was found. CONCLUSIONS: Older age, male sex, and white ethnicity are risk factors in the development of severe forms of GORD. The most severe grade of GORD is reached at the onset of the disease.

Upper gastrointestinal endoscopy in central Australian aborigines.

OBJECTIVES: To examine the upper gastrointestinal endoscopic findings in Australian Aborigines in central Australia; to determine if peptic ulceration occurs in this group; and to discover whether this population shares Helicobacter pylori as a risk factor for peptic ulceration. METHODS: A retrospective analysis of the records of all Aboriginal patients undergoing endoscopy at a general hospital over a two-year period. RESULTS: Eighty-five endoscopies were performed in 64 patients. Haematemesis and melaena was the indication for 24 patients (more commonly in men) and a cause was identified in 83% of these patients; varices were the cause in 17%. Pain was an indication for 25 patients (more commonly in females) and abnormalities were detected in 64%. Peptic ulceration was found in nine patients and a further 23 had gastritis or duodenitis. Cases of oesophageal, gastric and duodenal malignancy were seen, as well as late complications of simple diseases, including gastric outlet obstruction, oesophageal stricture and cholecystoduodenal fistula formation. Of 17 gastric biopsies with evidence of inflammation, H. pylori was found in 15 (88%). CONCLUSION: This, the first study of upper gastrointestinal endoscopy in Aborigines, shows its usefulness in the investigation of their gastrointestinal complaints. Oesophageal varices were found to be an important cause of bleeding. Peptic ulceration associated with H. pylori was found to be common.

Asian endoscopies: is there a difference?

In 1988 2062 adults had their first oesophagogastroduodenoscopy at Leicester General Hospital, of whom 224 (10.9%) were Asian. A greater proportion of the Asian patients were less than 45 years old (46% vs 24%), which reflects the age distribution of the local population. When the findings at oesophagogastroduodenoscopy were analysed in two age groups (less than or older than 45) there were no differences between the races in the younger group. However, in the older group duodenal disease was significantly more common in the Asians (P less than 0.001) whereas gastric disease was more common in Caucasians (P less than 0.05). The incidence of cancer was much lower in the Asians.

Melanocytes and melanosis of the oesophagus in Japanese subjects--analysis of factors effecting their increase.

Normal oesophagus specimens taken from 65 autopsy cases and surgical specimens from 127 oesophageal carcinoma cases were examined histopathologically to determine melanocyte incidence and distribution. Melanocytes were found in the epithelio-stromal junction in 7.7% of normal oesophagus specimens examined at autopsy, and in 29.9% of surgical cases with oesophageal carcinoma. Positive specimens in the latter groups, especially from pre-operatively irradiated individuals, showed a more remarkable increase of melanocytes than was evident in any of the normal oesophageal samples. There were no significant differences in incidence between males and females, or between age groups. In cases where the cancer invaded into deeper stroma, the melanocytes were mainly observed in the normal epithelium around the carcinomas. Epithelial and stromal elements of the melanotic mucosa commonly showed hyperplastic changes such as acanthosis or basal cell hyperplasia, and chronic oesophagitis. Melanocytes were observed most commonly in the lower part of the oesophagus, the site where malignant melanoma of the oesophagus, most often originates. These results strongly suggest that the melanocyte increase observed in areas of hyperplastic epithelium and chronic oesophagitis may play an important role as a precursor lesion for malignant melanoma in the oesophagus.

Adenocarcinoma of the lower esophagus. A disease primarily of white men with Barrett's esophagus.

Sex and racial predilection, social history, and histology were analyzed in a biopsy-proven adenocarcinoma of the lower esophagus/esophagogastric junction collected over a 5-year period in two teaching institutions with different patient populations. Adenocarcinoma occurred in 11% of patients with biopsy-proven esophageal cancer. The disease occurred only in males at one center, and in a 7:1 ratio of males to females at the other center. Clear racial predilection was seen, since 12 of 13 patients with adenocarcinoma of the esophagus were white, whereas less than 20% of patients with squamous carcinoma of the esophagus were white. The finding of Barrett's epithelium in eight of the 13 cases strongly supports the theory that in white males, Barrett's epithelium is a precursor lesion of adenocarcinoma of the esophagus/esophagogastric junction.