Endocytoscopic findings of lymphomas of the stomach.

BACKGROUND: The gastric lesions of various lymphomas were observed at the cellular level using endocytoscopy. METHODS: Endocytoscopy and magnifying endoscopy with narrow band imaging (NBI) were performed in 17 patients with lymphomas of the stomach. The lesions consisted of 7 with low-grade mucosa-associated lymphoid tissue (MALT), 5 with gastric involvement by adult T-cell leukemia/lymphoma (ATLL), 4 with diffuse large B-cell lymphoma (DLBCL), and 1 with peripheral T-cell lymphoma. RESULTS: On conventional endoscopy, 9 were classified as having superficial spreading type, 7 were mass-forming type, and 1 was diffuse infiltrating type. Anti-H. pylori treatment was given in the 7 MALT lymphoma cases. NBI magnification endoscopy invariably showed dilatation or ballooning and destruction of gastric pits and elongation and distortion in microvessels. Endocytoscopy showed mucosal aggregation of interstitial cellular elements in almost all gastric lymphoma cases. The nuclear diversity in size and configuration was exclusively seen in gastric lymphomas other than MALT lymphoma, whereas the nuclei of MALT lymphoma cells were regular and small to moderate in size. Inter-glandular infiltration by lymphomatous cell elements was frequently observed in MALT lymphoma and DLBCL, but it was uncommon in peripheral gastric T-cell malignancies. Endocytoscopy could identify the disease-specific histology, the lymphoepithelial origin, as inter-glandular infiltration of cellular components in MALT lymphoma and the possibly related DLBCL cases. Complete regression (CR) was observed in 2 of the 7 MALT lymphoma patients. In the 2 patients with CR who underwent repeat endocytoscopy, the ultra-high magnification abnormalities returned to normal, while they were unchanged in those without tumor regression. CONCLUSIONS: On endocytoscopy, intra-glandular aggregation of cellular components was invariably identified in lymphomas of the stomach. Nuclear regularity in size and configuration may indicate the cytological grade, differentiating the indolent low-grade from aggressive lymphoproliferative diseases. The inter-glandular infiltration seen on endocytoscopy can indicate the lymphoepithelial lesions seen in MALT lymphoma and related DLBCL. Endocytoscopy would be applicable for virtual histopathological diagnosis of different lymphoproliferative disorders and their clinical assessment during ongoing endoscopy.

Usefulness of oral prednisolone in the treatment of esophageal stricture after endoscopic submucosal dissection for superficial esophageal squamous cell carcinoma.

BACKGROUND: Endoscopic submucosal dissection (ESD) permits en bloc removal of superficial esophageal squamous cell carcinoma. However, postprocedure stricture is common after ESD for extensive tumors, and multiple endoscopic balloon dilation (EBD) is required for recalcitrant cases. OBJECTIVE: To evaluate the effectiveness of oral prednisolone in controlling postprocedure esophageal stricture. DESIGN: Retrospective study. SETTING: Endoscopy department at a university hospital. PATIENTS: Patients who underwent complete circular or semicircular ESD for esophageal squamous cell carcinoma involving more than three fourths of the lumen were treated with either pre-emptive EBD or oral prednisolone. INTERVENTION: Preemptive EBD was started on the third day post-ESD and continued twice weekly for 8 weeks. Oral prednisolone was started at 30 mg/day on the third day post-ESD , tapered gradually, and then discontinued 8 weeks later. An additional EBD was performed on demand in both groups whenever dysphagia appeared. MAIN OUTCOME MEASUREMENT: The incidence of esophageal stricture and number of EBD sessions required to relieve dysphagia. RESULTS: Stricture at 3 months after ESD was found in 7 of 22 patients in the preemptive EBD group but only 1 of 19 in the oral prednisolone group (P < .05). The average number of EBD sessions required was 15.6 in the preemptive EBD group and 1.7 in the oral prednisolone group (P < .0001). After complete circular ESD, 32.7 EBD sessions were needed on average in the preemptive EBD group, whereas fewer were needed in the oral prednisolone group (P < .05). LIMITATIONS: Nonrandomized study. CONCLUSIONS: Post-ESD esophageal strictures were persistent even if treated preemptively with multiple EBD sessions, but oral prednisolone may offer a useful preventive option.

Management of esophageal stricture after complete circular endoscopic submucosal dissection for superficial esophageal squamous cell carcinoma.

BACKGROUND: Endoscopic submucosal dissection (ESD) permits removal of esophageal epithelial neoplasms en bloc, but is associated with esophageal stenosis, particularly when ESD involves the entire circumference of the esophageal lumen. We examined the effectiveness of systemic steroid administration for control of postprocedural esophageal stricture after complete circular ESD. METHODS: Seven patients who underwent wholly circumferential ESD for superficially extended esophageal squamous cell carcinoma were enrolled in this study. In 3 patients, prophylactic endoscopic balloon dilatation (EBD) was started on the third post-ESD day and was performed twice a week for 8 weeks. In 4 patients, oral prednisolone was started with 30 mg daily on the third post-ESD day, tapered gradually (daily 30, 30, 25, 25, 20, 15, 10, 5 mg for 7 days each), and then discontinued at 8 weeks. EBD was used as needed whenever patients complained of dysphagia. RESULTS: En bloc ESD with tumor-free margins was safely achieved in all cases. Patients in the prophylactic EBD group required a mean of 32.7 EBD sessions; the postprocedural stricture was dilated up to 18 mm in diameter in these patients. On the other hand, systemic steroid administration substantially reduced or eliminated the need for EBD. Corticosteroid therapy was not associated with any adverse events. Post-ESD esophageal stricture after complete circular ESD was persistent, requiring multiple EBD sessions. CONCLUSIONS: Use of oral prednisolone administration may be an effective treatment strategy for reducing post-ESD esophageal stricture after complete circular ESD.

Effect of oral prednisolone on esophageal stricture after complete circular endoscopic submucosal dissection for superficial esophageal squamous cell carcinoma: a case report.

A 74-year-old man with nausea underwent upper gastrointestinal endoscopy, and a 0-IIb type tumor was found in the middle thoracic esophagus. Histological examination with endoscopic biopsies revealed squamous cell carcinoma (SCC), and chromoendoscopy with iodine staining revealed that the superficial SCC involved nearly the entire circumference of the esophageal lumen. There were neither nodal nor distant metastases. Complete circular endoscopic submucosal dissection (ESD) was successfully achieved with tumor-free margins in an en bloc fashion. The histopathological examination confirmed a diagnosis of intramucosal invasive carcinoma limited to the lamina propria mucosae without angiolymphatic invasion. Oral prednisolone was started with 0.5 mg/kg daily on the 3rd post-ESD day, tapered gradually, and then discontinued 8 weeks later without adverse effects. There were no complaints of dysphagia following ESD. On follow-up endoscopy with iodine staining, which was scheduled at 1, 3 and 6 months after ESD, there was no postprocedural esophageal stricture, and neither recurrent nor metachronous lesions were found. Thus, the patient required no sessions of endoscopic balloon dilatation. At the last outpatient clinic visit 7 months after ESD, he remained well without dysphagia. Oral prednisolone administration may offer an effective therapeutic strategy to prevent the post-ESD esophageal stricture after complete circular ESD.

Magnifying chromoendoscopic findings of early gastric cancer and gastric adenoma.

PURPOSE: In the field of colorectal cancer and adenoma, Kudo's classification of pit pattern with magnifying chromocolonoscopy using crystal violet (CV) staining is now accepted. Magnifying endoscopy using narrow band imaging has been used for the diagnosis of gastric carcinoma; the characteristic findings of microvascular patterns have been demonstrated. However, there was limited information on magnified endoscopic findings with CV staining for gastric neoplasms in terms of their pit patterns. METHODS: Magnifying chromoendoscopy with CV was performed in 175 patients with early gastric cancer and 18 with gastric adenoma, prior to treatment. Surface patterns of gastric tumors were classified into five types: (1) long tubular pit pattern, (2) irregular size pit pattern, (3) small round pit pattern, (4) destroyed pit pattern, and (5) non-structural pattern. RESULTS: Long tubular pit pattern was most common in gastric adenoma. Well differentiated adenocarcinoma and papillary adenocarcinoma tended to show different size of pit pattern or destroyed pit pattern. Small round pit pattern was most commonly seen in moderately differentiated adenocarcinoma. Non-structural pattern was most frequently observed in poorly differentiated adenocarcinoma and signet ring cell carcinoma (P < 0.0001). CONCLUSION: For gastric neoplasms, magnifying endoscopy may help predict histopathological type.

Endoscopic submucosal dissection for colorectal epithelial neoplasms.

PURPOSE: Endoscopic submucosal dissection permits removal of colorectal epithelial neoplasms en bloc, but long-term clinical outcomes remain unknown. METHODS: Endoscopic submucosal dissection was performed in 282 patients having 296 colorectal tumors that fulfilled the inclusion criteria, which included lesions greater than 20 mm in size for which en bloc resection would be difficult with endoscopic mucosal resection, lesions with fibrotic scar due to previous endoscopic treatment or biopsies, locally residual lesions after endoscopic resection, or invasive carcinoma with slight submucosal penetration. En bloc or piecemeal resection, complete (en bloc with tumor-free lateral/basal margins) or incomplete resection, and complications were assessed, and factors related to each were analyzed using logistic regression. Patients with early colon cancer received endoscopic follow-up and metastatic surveys for a median of 34 months. RESULTS: En bloc resection was achieved in 89.2% (264/296) and 234 lesions (79.1%) were deemed to have undergone complete resection. A right-side colonic location was the significant contributor to incomplete resection. Perforation was seen in 24 cases (8.1%) in association with tumor size and the presence of fibrosis. There was 1 case of locally recurrent tumor with incomplete resection, whereas neither recurrence nor residual disease was observed in the complete resection group. Neither cancer-related nor cancer-unrelated death was observed. CONCLUSIONS: Precise assessment of curability with successful en bloc resection may reduce tumor recurrence after endoscopic submucosal dissection. The prognosis of early colorectal cancer in patients treated by endoscopic submucosal dissection is likely to be excellent, although further longer follow-up studies are warranted.

Endoscopic submucosal dissection for rectal carcinoid tumors.

BACKGROUND: Endoscopic submucosal dissection (ESD) has an advantage over endoscopic mucosa resection (EMR) by enabling removal of gastrointestinal neoplasms en bloc. The ESD procedure is the treatment of choice for rectal carcinoids that have classic histologic architecture with minimal cellular pleomorphism and sparse mitoses, but it has not been applied for such tumors. METHODS: The ESD procedure was performed for patients with colorectal tumors that fulfilled the inclusion criteria specifying tumor with a diameter of 10 mm or less, no muscular layer invasion, and no metastases to the lymph nodes or distal organs. The ESD procedure was performed for patients with rectal carcinoids but no node or distal metastasis. RESULTS: This study enrolled 20 rectal carcinoid tumors from 20 consecutive patients. The mean tumor size was 7.6 mm (range, 3-16 mm). En bloc removal was achieved for all the tumors, and the complete resection (en bloc with tumor-free lateral/basal margins) rate was 90% (18/20). The two cases in which the margins were not evaluable due to burn effects still are free of recurrence and metastasis at this writing. Perforation was seen in one case, which was managed nonsurgically. CONCLUSIONS: Precise histolopathogic assessment of the specimens resected en bloc by ESD may reduce tumor recurrence and metastasis after ESD. As the treatment of choice for small rectal carcinoids, ESD is associated with nominal risks of metastatic disease.

Endoscopic submucosal dissection for laterally spreading tumours of the colorectum in 200 consecutive cases.

BACKGROUND: Colorectal laterally spreading tumours (LSTs) are classified into granular (LST-G) and non-granular (LST-NG) type; each type was sub-grouped into LST-G-H (homogenous) and LST-G-M (nodular mixed) type or LST-NG-F (flat elevated) and LST-NG-FD (pseudodepressed) type, respectively. We assessed the clinicopathological factors associated with clinical outcomes of endoscopic submucosal dissection (ESD) for colorectal LSTs, and conducted follow-up after ESD. METHODS: ESD was performed in 196 patients with 204 LSTs that fulfilled the inclusion criteria for colorectal neoplasms. Clinical outcomes including resectability and curability of ESD and perforation were investigated, and factors related to the outcomes were analysed using logistic regression. One hundred thirty-eight patients received endoscopic follow-up for more than 12 months and metastatic surveys in 79 cases of cancerous LSTs. RESULTS: The incidence of submucosal cancer was lower in LST-G type. There were no significant differences in outcomes regarding LST macroscopic types. Overall en bloc, complete and curative resection, and perforation rates were 86.8%, 77.5%, 82.8% and 9.8%, respectively. Logistic regression analysis showed higher risk of non-curative resection in LST-G-M than in LST-G-H type. No other factors were associated with outcomes. During median follow-up of 35.5 months, no locally recurrent or metastatic tumours were observed, and overall survival was still 100%. CONCLUSIONS: ESD provides acceptable resectability for colorectal LSTs by facilitating en bloc resection, irrespective of macroscopic types. The relatively long-term outcomes may be excellent, but further evaluation is needed for appropriate treatment strategy for each type of LST.

Proximal extension of backwash ileitis in ulcerative-colitis - associated colon cancer.

BACKGROUND: Extension of the inflammatory process into the terminal ileum in ulcerative colitis is termed backwash ileitis. Ulcerative colitis patients with pancolitis and backwash ileitis may be at increased risk of colorectal carcinoma. A case of ulcerative colitis-associated cancer with backwash ileitis, which extended proximally over time, is described. CASE REPORT: A 67-year-old man was diagnosed with pancolitis; despite prednisolone and mesalazine treatment, he showed no improvement. Although initial endoscopic examination showed no abnormalities in the terminal ileum, a repeat colonoscopy 4 months later revealed erythema, absence of the vascular pattern, mucosal friability, and erosions within 30 cm of the terminal ileum in a continuous fashion from the cecum, and a flat, elevated lesion was found in the transverse colon. On histopathologic examination, the patient had nonspecific, active, chronic inflammation of the ileal mucosa, consistent with backwash ileitis, and colonic adenocarcinoma. Despite additional treatment with leukocytapheresis, the backwash ileitis progressed, with increased severity of mucosal inflammation and extensive erosions, 20 cm proximal to the primarily affected site of the ileum on repeat colonoscopy 2 months later. The patient underwent a proctocolectomy and excision of the terminal ileum with an ileostomy. CONCLUSIONS: Histopathology of the surgical specimen revealed marked backwash ileitis and submucosal, well-differentiated adenocarcinoma. The patient has remained well for 5 years after surgery.

Magnifying endoscopic observation with narrow band imaging for specialized intestinal metaplasia in barrett's esophagus with special reference to light blue crests.

AIM: Barrett's esophagus (BE) with specialized intestinal metaplasia (SIM) is at high risk of esophageal adenocarcinoma. Magnified endoscopy with narrow band imaging (ME-NBI) can be useful for detecting this condition. In addition to pit patterns, light blue crests (LBC), blue-whitish patchy areas on the metaplastic epithelia of the stomach, can predict SIM in BE under ME-NBI observation. METHODS: A total of 54 patients with BE underwent ME-NBI to identify IM pits (tubular and villous pits) and LBC. Biopsy samples were taken for histological evaluation of IM, immunohistochemical staining for CD10, MUC2 and MUC5AC antigen, transmission electron microscopy and real-time polymerase chain reaction (RT-PCR) analysis of CD10 mRNA expression. RESULTS: IM pit pattern with ME-NBI for the diagnosis of IM yielded acceptable sensitivity, specificity and accuracy at 92%, 77% and 83%, respectively. However, the sensitivity, specificity and accuracy of LBC with ME-NBI for IM were comparably high at 79%, 97% and 89%, respectively. Upon immunohistochemistry, all 19 metaplastic epithelia of LBC-positive BE showed immunoreactivity against anti-MUC2 antibody, whereas CD10 antigen was identified in 11 of the 19 LBC-positive BE. Brush borders were seen on IM epithelia using electron microscopy. On real-time PCR analysis, CD10 mRNA levels in the LBC-positive BE were higher compared to those in the LBC-negative BE. CONCLUSION: The appearance of LBC can be an accurate sign to predict SIM in BE and may be associated with high CD10 expression, possibly along with brush borders.

[A case of sacroiliitis complicated with ulcerative colitis which was treated with leukocytapheresis].

A 51-year-old woman was admitted to our hospital because of fever and pain in the right buttock. She had ulcerative colitis. She was given a diagnosis of sacroiliitis complicated with ulcerative colitis, based on a physical examination and magnetic resonance imaging (MRI) . Her sacroiliitis was successfully treated by leukocytapheresis (LCAP) . Sacroiliitis complicated with ulcerative colitis is rare in Japan, and its treatment and pathogenesis remain unclear. We report an unusual case of sacroiliitis complicated with ulcerative colitis, which was successfully treated by LCAP.

Clinical outcomes of endoscopic submucosal dissection for early gastric cancer by indication criteria.

BACKGROUND AND STUDY AIMS: Endoscopic submucosal dissection (ESD) can remove early gastric cancer (EGC) en bloc. We sought to assess the feasibility and efficacy of ESD and the clinical outcomes based on the indication criteria. PATIENTS AND METHODS: 551 patients with 589 EGC lesions were divided into the guideline criteria group (elevated lesion < or =20 mm in diameter and depressed lesion < or =10 mm without ulceration) and the expanded criteria group (mucosal cancer without ulcer findings irrespective of tumor size; mucosal cancer with ulcer findings < or =3 cm in diameter; and minute submucosal invasive cancer < or =3 cm in size). RESULTS: En bloc, complete and curative resection were achieved in 98.6 and 93.0, 95.1 and 88.5, and 97.1 and 91.1%, for the guideline and expanded criteria lesions, respectively; the differences between the 2 groups were significant for each. The expanded criteria lesions were at significantly higher risk of ESD-associated bleeding and perforation. Overall survival was adequate irrespective of the indications, and the disease-specific survival rates were 100% in both. CONCLUSION: ESD for EGCs that met the expanded criteria was acceptable, though the resection rates and safety were decreased compared to those for the guideline criteria lesions.

Factors related to the curability of early gastric cancer with endoscopic submucosal dissection.

BACKGROUND: Endoscopic submucosal dissection (ESD) yields substantially high rates for curative resection of early gastric cancer (EGC). It is suggested that larger, ulcerative, or upper EGCs may prevent successful ESD. A detailed analysis of factors associated with the curability of ESD was performed. METHODS: Endoscopic submucosal dissection was performed for patients with EGC that fulfilled the expanded criteria, which specified mucosal cancer without ulcer findings irrespective of tumor size, mucosal cancer with ulcers 3 cm in diameter or smaller, and minute submucosal invasive cancer 3 cm or smaller. Resectability (en bloc or by piecemeal resection), curability (curative or non-curative), and complications were assessed, and logistic regression analysis was used to analyze the related factors. RESULTS: Ulcerative EGCs showed a significantly higher risk associated with ESD on multivariate analysis. When the risk factors (tumor size, location, and ulcer findings) were combined, the larger EGCs (>30 mm) located in the upper third or ulcerative tumors located in the upper and middle portion of the stomach were at significantly higher risk of non-curative resection. Such lesions also were associated with increased risk of procedure-related perforation. CONCLUSIONS: When risk factors including positive ulcer findings and larger size and upper location of tumors are combined, ESD should be performed more carefully.

Pneumatosis intestinalis in ulcerative colitis.

BACKGROUND: UC patients are considered to be at risk for pneumatosis intestinalis (PI). CASE REPORT: A 50-year-old man who had been treated with prednisolone for left-sided ulcerative colitis (UC) underwent follow-up colonoscopy. In addition to active colitis in the left colon, some cystic lesions were found in the unaffected ascending colon. Endoscopic ultrasonography and computed tomography confirmed the presence of intramural air, consistent with PI. Since corticosteroid use might contribute to the development of PI, the patient was successfully treated with leukocytapheresis. At the last follow-up colonoscopy the UC was still in remission and the pneumatic cysts were resolving. CONCLUSIONS: It is important to determine the clinical significance of PI in each patient to ensure appropriate therapy.

Magnified endoscopic observation using narrow-band imaging of periampullary adenoma in a patient with familial adenomatous polyposis.

BACKGROUND: Adenoma of the major papilla carries a relatively high risk of malignant transformation to carcinoma, the leading cause of death in patients with familiar adenomatous polyposis (FAP) after colectomy. CASE REPORT: A 35-year-old man had undergone prophylactic colectomy for FAP 3 years earlier. On the forward-viewing and side-viewing endoscopy done for surveillance, the overlying mucosa of the major papilla showed even granularity. On magnifying duodenoscopy using a narrow-band system (NBI), which uses modified optical filters and yields clear images of fine surface structures on the mucosal layer, a compact formation of round pits was seen in the affected ampulla. The microvascular architecture on NBI magnification showed no abnormalities, such as dilated, tortuous or network-like vessels, suggestive of malignancy. On endoscopic retrograde pancreaticocholangiography there was no intraductal growth, and endoscopic ultrasonography showed confinement to the mucosal layer. The ampullary lesion was completely resected using endoscopic snare papillectomy. Histopathological examination of the removed specimen showed tubular adenoma without malignant foci. The patient's post-treatment course was uneventful and without complications, and no local recurrence was noted on repeat endoscopy. CONCLUSIONS: Thus, endoscopic surveillance and removal of ampullary adenomas appear to be justified.

Endoscopic submucosal dissection of a minute intramucosal adenocarcinoma in Barrett's esophagus.

A 73-year-old man with short segmental Barrett's esophagus underwent esophagoscopy, and a slightly depressed, discolored lesion was found on the anterior wall of the lower esophagus. Under a provisional diagnosis of differentiated adenocarcinoma without local lymph node metastasis, endoscopic submucosal dissection (ESD) was carried out. En bloc resection with tumor-free lateral/basal margins was accomplished without complication. The resected area was 12 x 15 mm in size, whereas the neoplastic lesion was 4 x 4 mm. Histopathological examination confirmed intramucosal well-differentiated tubular adenocarcinoma without angiolymphatic invasion adjacent to the muscularis mucosae. Repeated esophagoscopy 6 months after ESD showed neither locally recurrent nor metachronous lesions. Considering that Barrett's esophagus is a precancerous condition, one may recommend eradication of both the neoplastic and non-neoplastic lesion with using ESD.

A new thin endoscopic method of transanal drainage tube insertion for acute colonic obstruction due to colorectal cancer.

AIM: Insertion of a transanal drainage tube is effective in the management of obstructing colorectal cancer. We devised a new method of inserting the transanal drainage tube safely and quickly using a thin endoscope. METHODS: Sixteen patients (seven men and nine women) with obstructive left-sided colorectal cancer were treated by inserting a transanal drainage tube using a thin endoscope. We inserted a transanal drainage tube for 32 patients (21 men and 11 women) with left-sided colorectal cancer using the conventional method. RESULTS: Drainage tube placement by the conventional method was successful in 29 (90.6%) of 32 patients, while via the new method, it was successful in all 16 patients without major complications. Moreover, median insertion time was significantly shortened (34 minutes for the new method compared with 42 minutes for the conventional method). CONCLUSION: Management of acute colorectal obstruction by transanal drainage tube insertion using the thin endoscope was effective and safe.

A case of Cronkhite-Canada syndrome: remission after treatment with anti-Helicobacter pylori regimen.

A 67-year-old man with nausea, appetite loss, frequent diarrhea and severe weight loss presented with alopecia, skin hyperpigmentation and onychodystrophy. Laboratory investigations showed mild anemia, hypoproteinemia and hypoalbuminemia. Colonoscopy identified the numerous, hyperemic and sessile polyps with mucous exudation of various sizes throughout the colorectum. The ileocecal valve was substantially swollen. Magnified chromoendoscopy revealed sparsely distributed crypt openings with widening of the preicryptal space without destruction in the affected lesions. Upper gastrointestinal endoscopy revealed multiple small, reddish, and sessile polyps in the duodenum and Helicobacter pylori-associated gastritis. Histopathological examination of the colonic polyps revealed cystic dilatation and elongation of scattered glands with epithelial hyperplasia and stromal edema and inflammatory cell infiltrates. Thus, a diagnosis of Cronkhite-Canada syndrome was made. The patient was given clarithromycin, amoxicillin and lansoprazole, resulting in negative (13)C-urea breath tests. Three months later, his clinical symptoms and edema of the legs resolved with normalization of serum total protein and albumin levels and return to his previous body. The ectodermal abnormalities were resolved 8 months later. On repeat colonoscopic examinations, there was progressive remission of the duodenal and colorectal polyposis, leaving scattered pedunculated polyps in the transverse and ascending colon and on the almost normal-appearing ileocecal valve. At the follow-up magnifying endoscopic examination 8 months later, small round or round-oval pits were densely and regularly distributed.

Interleukin 8 and 1beta and RANTES levels in esophageal mucosa predict recurrence of endoscopy-negative gastroesophageal reflux disease.

BACKGROUND/AIMS: Endoscopy-negative gastroesophageal reflux disease (ENRD), an incipient GERD phenotype without mucosal breaks, is a chronic relapsing condition with an impact on quality of life. Proinflammatory cytokines and chemokines play a role in the pathogenesis of various conditions including GERD. METHODOLOGY: This study investigated the relationship between interleukin 8 (IL-8), monocyte chemoattractant protein 1 (MCP-1), regulated on activation normal T-cell expressed and presumably secreted (RANTES) and IL-1beta levels in esophageal mucosa and recurrence of the reflux symptom in 22 patients with ENRD. RESULTS: Based on analysis using Cox's proportional hazard regression model, significantly positive association was observed between the mucosal levels of cytokines (IL-8 and -1beta and RANTES) and ENRD recurrence. Otherwise, parameters including age, gender, body mass index, smoking habits, alcohol intake, hiatal hernia and Helicobacter pylori status were not significantly related to relapse of the symptom. CONCLUSIONS: Enhanced production of such cytokines as IL-8 and -1beta and RANTES in esophageal mucosa can be potential predictors for ENRD recurrence.

Clinical implications of antimitochondrial antibodies in type 1 autoimmune hepatitis: a longitudinal study.

BACKGROUND/AIMS: Autoimmune hepatitis (AIH) is a chronic liver disease characterized by the presence of antinuclear antibodies. However, antimitochondrial antibodies (AMA) and bile duct changes, which are the characteristics of primary biliary cirrhosis (PBC), can be detected in AIH patients. METHODOLOGY: Twenty patients with definite AIH were prospectively followed-up, and the serial changes in AMA profiles were determined. We also examined the correlations between these antibodies and histopathological findings in the liver. RESULTS: Of the 20 patients, 7 (35%) had bile duct injury, and 2 of these 7 patients also showed chronic nonsuppurative destructive cholangitis or ductopenia of interlobular bile ducts histopathologically. Serologically, 7 patients (35%) were positive for AMA at least once by immunoblotting during the follow-up periods. There were no significant differences in biochemical hepatobiliary indices, the presence of bile duct lesions, or the changes in biochemical profiles between AMA-positive and AMA-negative AIH patients during the follow-up periods. CONCLUSIONS: We confirmed that AMA and certain histopathological findings that are characteristics of PBC can be seen in some AIH patients. However, there was no significant correlation between AMA positivity and the histopathological findings in the liver, or biochemical hepatobiliary indices. Thus, the clinical implications of AMA in AIH patients remain unclear.