Is cytokeratin immunoreactivity useful in the diagnosis of short-segment Barrett's oesophagus in Korea?

BACKGROUND: Cytokeratin 7/20 staining has been reported to be helpful in diagnosing Barrett's oesophagus and gastric intestinal metaplasia. However, this is still a matter of some controversy. OBJECTIVE: To determine the diagnostic usefulness of cytokeratin 7/20 immunostaining for short-segment Barrett's oesophagus in Korea. METHODS: In patients with Barrett's oesophagus, diagnosed endoscopically, at least two biopsy specimens were taken from just below the squamocolumnar junction. If goblet cells were found histologically with alcian blue staining, cytokeratin 7/20 immunohistochemical stains were performed. Intestinal metaplasia at the cardia was diagnosed whenever biopsy specimens taken from within 2 cm below the oesophagogastric junction revealed intestinal metaplasia. Barrett's cytokeratin 7/20 pattern was defined as cytokeratin 20 positivity in only the superficial gland, combined with cytokeratin 7 positivity in both the superficial and deep glands. RESULTS: Barrett's cytokeratin 7/20 pattern was observed in 28 out of 36 cases (77.8%) with short-segment Barrett's oesophagus, 11 out of 28 cases (39.3%) with intestinal metaplasia at the cardia, and nine out of 61 cases (14.8%) with gastric intestinal metaplasia. The sensitivity and specificity of Barrett's cytokeratin 7/20 pattern were 77.8 and 77.5%, respectively. CONCLUSION: Barrett's cytokeratin 7/20 pattern can be a useful marker for the diagnosis of short-segment Barrett's oesophagus, although the false positive or false negative rate is approximately 25%.

Prevalence of Barrett's esophagus in an urban Korean population: a multicenter study.

BACKGROUND: It had been believed that over 75% of cases of esophageal carcinoma were squamous cell carcinoma (SCC). However, recently, in Western countries, the incidence of SCC has decreased, while the rate of adenocarcinoma has increased dramatically, accounting for almost 50% of esophageal carcinomas. With this change, concern over Barrett's esophagus (BE) has increased. Traditionally, it was believed that BE affected Asians less frequently. However, accelerated westernization has changed the lifestyle of Asians dramatically, and this raises the question that the prevalence might be changed in Asians living in Asia. Lacking reports on the prevalence of BE in the Korean population, we examined the data from endoscopic examinations performed at five referral hospitals in Seoul, Korea, to estimate the period prevalence of BE. METHODS: One thousand five hundred and fifty-three patients who presented themselves to five referral hospitals due to various gastrointestinal symptoms prospectively underwent upper gastrointestinal endoscopic examinations and were enrolled in the study. Two biopsy specimens were taken from any parts of pink mucosa 3 cm or more above the squamocolumnar junction. RESULTS: BE was detected in 5 of the 1553 patients who underwent upper gastrointestinal endoscopic examinations, and the approximate period prevalence of BE in Korean patients in the five referral hospitals was 3.2 per 1000. Of the 5 patients, two were men and three women with a mean age of 65 +/- 11.8 (mean +/- SD) years. All these patients had a body mass index (BMI) of less than 25 and were not obese. Regurgitation was described by 2 (40%) patients with BE, and heartburn was complained of by 4 (80%) patients. Of the 5 patients with BE, 3 (60%) patients had esophagitis, 2 (40%) patients had hiatal hernia, and none of the patients had Helicobacter pylori infection. The gross type of BE consisted of type I (spike) in 2 (40%) patients, type II (circumferential type II) in 1 (20%) patient, type III (circumferential type III) in 1 (20%) patient, and mixed type in 1 (20%) patient. Specialized intestinal metaplasia was found in all 5 patients. CONCLUSIONS: The period prevalence of BE among the patients of five referral hospitals was 3.2 per 1000, and it seems that the prevalence of BE in Korean urban area is lower than that in Western countries.

Clinicopathological characteristics of colon cancer diagnosed at primary health care institutions.

BACKGROUND/AIMS: The purpose of this study was to evaluate the clinicopathologic characteristics of colon cancers detected at the SOK Sokpeynhan Internal Medical Network, a nationwide system of primary health care institutions. METHODS: We analyzed 579 colon cancer patients diagnosed using colonoscopy at the SOK network from January 2011 through December 2012. Cancers from the rectum to the splenic flexure were classified as left colon cancer. Patients over 65 were classified as senior. RESULTS: The mean age (±SD) of subjects was 60.9±10.5 years and 61.1% were men. More than one quarter (28.2%) of patients were asymptomatic. The prevalence of left colon cancer was higher (77.9%) than that for right colon cancer. The most frequent macroscopic and histologic types were depressed (58.9%) and moderately differentiated adenocarcinoma (52.2%), respectively. Asymptomatic subjects displayed protruding or well differentiated adenocarcinoma, while symptomatic patients were more likely to display depressed or moderately differentiated adenocarcinoma (P<0.05). The mean age of the right colon cancer group was higher than that for the left colon cancer group (P<0.05). Among symptomatic patients, the most frequent symptoms were bloody stool for patients with left colon cancer and abdominal discomfort for patients with right colon cancer (P<0.05). The prevalence of depressed cancer was higher in older subjects as compared to younger subjects (P<0.05). The prevalence of right colon cancer tended to increase with age, although this difference did not achieve statistical significance (P>0.05). CONCLUSIONS: Study results indicated an increase of colon cancer amongst younger demographics in recent years. The effectiveness of colonoscopy screening was also evident, as asymptomatic patients demonstrated frequent findings of well differentiated adenocarcinomas. Study results also suggested a need for closer examination of older patients, as right colon cancer tended to increase with age.

[Clinicopathologic characteristics of superficial gastric cancer diagnosed at primary health care institutions in 2011].

BACKGROUND/AIMS: Stomach cancer is prevalent in Korea. The purpose of this study was to evaluate the characteristics of superficial gastric cancers detected at SOK Sokpeynhan Internal Medical Network, the nationwide primary health care institutions. METHODS: We prospectively analysed the clinicopathologic and endoscopic characteristics of 218 superficial gastric cancer patients diagnosed using gastric endoscopy at SOK network from January 2011 through December 2011. RESULTS: The mean age was 58.5 years old and male to female ratio was 1.7 : 1. Asymptomatic patients were most common (45.0%). The macroscopic classification revealed that simple types (63.8%) were more common than complex types (36.2%). The most common type was IIc (28.4%) and other types were as follows; IIb (16.1%), IIb+IIc (13.3%), IIa (10.6%), III (9.2%), IIa+IIc (7.3%), IIc+IIa (6.0%), IIc+IIb (5.0%). The most commonly involved sites were the body (53.1%) and greater curvature (32.6%) of the stomach. The size of lesion was less than 1 cm (69.3%) and less than 5 mm (33.5%) in diameter. The most common pathologic type was tubular adenocarcinoma (75.7%). Helicobacter pylori infection rate was 50.2%. Fifty five percent of the cases were diagnosed via endoscopy of National Health Insurance Corporation screenings. CONCLUSIONS: Superficial gastric cancers in 2011 at primary health care SOK network were different from those of previous reports. Type IIc was most common but type IIb was more prevalent and the body and greater curvature of the stomach were the most commonly involved sites. Therefore, careful observation of the proximal gastric mucosa and mucosal color change is needed.

Prevalence of Barrett's esophagus in Korea.

BACKGROUND: In contrast to Western countries, the prevalence of Barrett's esophagus (BE) is still believed to be very low in the Far East. The aim of the present paper was to assess the prevalence of BE in Korea. METHODS: Nine hundred and ninety-two consecutive patients undergoing their first diagnostic upper gastrointestinal endoscopies due to various indications were included from four university hospitals in Korea. Esophagus of each patient was examined during insertion of the endoscope with minimum air inflation. From subjects who were found, during endoscopy, to have columnar-lined esophagus, at least two biopsy samples were taken from the columnar epithelium. Patients exhibiting specialized columnar epithelium on histological examination were diagnosed as having BE. RESULTS: Among 992 patients, 108 cases (10.9%) were endoscopically diagnosed as short-segment BE, and three cases (0.3%) were endoscopically diagnosed as long-segment BE. However, only 36 patients (3.6%) met the histological criteria for BE. Among these patients, only one (0.1%) was histologically diagnosed as having long-segment BE. Reflux esophagitis, mostly in a mild degree, was found in 25.0% of the BE group, and 8.6% of the non-BE group (P = 0.0022). Hiatal hernias were more commonly found in the BE group than in the non-BE group (22.2% vs 8.9%, P = 0.0163). CONCLUSIONS: Although the prevalence of BE in Korea appears to be lower than the reported rates from Western countries, it may not be as low as was previously thought.

Effects of voluntary maneuvers on tongue base function for swallowing.

Concurrent manometry and videofluoroscopy were utilized to examine tongue base function during swallowing in 3 patients with head and neck cancer. Subjects were instructed in four voluntary swallow maneuvers, including the supersupraglottic swallow, effortful swallow, Mendelsohn maneuver, and tongue-hold maneuver. Peak catheter pressures (mm Hg) at the tongue base-pharyngeal wall level were recorded and duration of tongue base to pharyngeal wall contact was measured for each swallow. This pilot study revealed that tongue base-pharyngeal wall pressures and contact duration increased with use of maneuvers. Preliminary data are provided to support the use of swallow maneuvers to improve tongue base posterior motion and pressures generated at the tongue base-pharyngeal wall level during swallowing in patients who exhibit this disorder.