Insights into the Paradox of the Weak Association Between Sleeve Gastrectomy and Barrett's Esophagus.

Sleeve gastrectomy (SG) is deemed a refluxogenic operation but with a low incidence of postoperative Barrett´s esophagus (BE). We aimed to shed some light on the potential paradox of the weak association between SG, BE and esophageal adenocarcinoma (EAC). The high incidence of GERD after SG is not followed by an increased rate of BE and EAC, as these rates are similar to the general population. We hypothesized that this paradox may occur due to a difference in the gastro-esophageal reflux composition secondary to a lower content of bile, to a decrease in inflammation due to weight loss and hormonal changes, and to acquisition of healthier habits such as exercise, smoking cessation, and better eating behavior.

Esôfago de Barrett: o estado da arte / Barrett's Esophagus: the state of the art

Objetivo: Demonstrar fatores envolvidos nos distúrbios do sono em profissionais que fazem plantões. Métodos: Trata-se de estudo transversal, cuja amostra foi composta de 244 voluntários, plantonistas da área da saúde, sendo 191 do sexo feminino, que responderam a um questionário socioeconômico, associado à aplicação da Escala de Sonolência de Epworth e ao Índice de Qualidade do Sono de Pittsburgh. Os dados foram analisados pelos coeficientes de Spearman e de Kendall Tau, com distribuição de probabilidade gama. Resultados: Houve significância (p<0,05) com o Índice de Qualidade do Sono de Pittsburgh e a atividade física (+0,216), ergonomia (+0,148), filhos (-0,146), valor da remuneração (+0,112) e disfunção durante o dia (+0,352). Também houve significância com a Escala de Sonolência de Epworth e atividade física (+0,138), renda familiar (-0,118), trabalho semanal (-0,151), latência do sono (-0,106), duração do sono (-0,107), eficiência do sono (-0,139) e disfunção durante o dia (+0,170). Por fim, a eficiência do sono teve significiância com profissão (-0,209), tabagismo (+0,402), Escala de Sonolência de Epworth (-0,139) e dissonias com a obesidade (índice de massa corporal >30; razão de chance de 1,40; intervalo de confiança de 95% de 1,02-1,94). Conclusão: As medidas autorrelatadas são prontamente obtidas com questionários validados, como a Escala de Sonolência de Epworth e o Índice de Qualidade do Sono de Pittsburgh, encontrando-se correlações com renda familiar, ter ou não filhos, índice de massa corporal, atividade física, ergonomia, condições de trabalho, tabagismo e componentes biopsicossociais. Em virtude do caráter transversal deste estudo é indispensável mais estudos com maior follow-up

Objective: To demonstrate factors involved in sleep disorders in professionals who take shifts. Methods: This is a cross-sectional study whose sample consists of 244 volunteers, on-duty health workers, 191 females, who answered a socioeconomic questionnaire, associated with application of the Epworth Sleepiness Scale and the Pittsburgh Sleep Quality Index. Data were analyzed with Spearman's and Kendall Tau coefficients, and gamma probability distribution. Results: There was significance (p<0,05) with the Pittsburgh Sleep Quality Index and physical activity (+0,216), ergonomics (+0,148), children (-0,146), the wage (+0,112), dysfunction during the day (+0,352). Also there was significance with the Epworth Sleepiness Scale and physical activity (+0,138), family income (-0,118), weekly workload (-0,151), sleep latency (-0,106), sleep duration (-0,107), sleep efficiency (-0,139), and dysfunction during the day (+0,170). Finally, sleep efficiency was significant with occupation (-0,209), smoking habits (+0,402), Epworth Sleepiness Scale (-0,139), dyssomnia with obesity (body index mass >30; OR of 1,40; CI 95% 1,02-1,94). Conclusion: Self-reported measures are readily obtained with validated questionnaires such as Epworth Sleepiness Scale and Pittsburgh Sleep Quality Index, with correlations with family income, having children or not, body mass index, physical activity, ergonomics, working conditions, smoking habits, and biopsychosocial components. Due to the cross-sectional nature of this study, further research with longer follow-up is indispensable

Clinical, Endoscopic, and Histologic Findings at the Distal Esophagus and Stomach Before and Late (10.5 Years) After Laparoscopic Sleeve Gastrectomy: Results of a Prospective Study with 93% Follow-Up.

OBJECTIVE: Perform a prospective study based on sequential clinical, endoscopic, and histologic evaluations of the foregut late after laparoscopic sleeve gastrectomy (LSG) in obese patients. After LSG, several studies have suggested an increase in the incidence of clinical gastroesophageal reflux (GERD) while others have reported an improvement but based mainly on clinical questionnaires. METHODS: Prospective study of 104 consecutive patients submitted to LSG. Several postoperative endoscopic and histologic evaluations of the esophagogastric junction (EGJ) and the gastric tube (GT) were performed and correlated with symptomatic findings. RESULTS: According to clinical preoperative findings, patients were divided into non-refluxers (Group I) and refluxers (Group II). Seven patients were unreachable, leaving 97 (93%) for late evaluation. Among Group I, 58.5% developed de novo GERD, while in Group II just 13.6% showed the disappearance of them. Endoscopic evaluations showed progressive deterioration of the EGJ in Group I, with the development of erosive esophagitis (EE), hiatal hernia (HH), and dilated cardia in a large proportion of them. In the GT, the presence of bile was seen in 40%, and an open immobile pylorus was detected in 82%. Short-segment Barrett's esophagus (BE) appeared in 4%. CONCLUSIONS: Patients submitted to LSG showed a significant and progressive increase in the presence of "de novo" GERD. Also, an increased duodenogastric reflux was seen through an open and immobile pylorus. Therefore, based on these results, it seems like LSG is a "pro-reflux" surgical procedure, which should be continuously evaluated late after surgery.

Barrett's esophagus: Ten years of experience at a tertiary care hospital center in Mexico. / Esófago de Barrett: experiencia de 10 años en un centro de tercer nivel en México.

INTRODUCTION: The prevalence of Barrett's esophagus has been calculated at between 1.3 and 1.6%. There is little information with respect to this in Mexico. AIM: To determine the frequency and characteristics of Barrett's esophagus in patients that underwent endoscopy at a national referral center, within a 10-year time frame. MATERIAL AND METHODS: The databases of the pathology and gastrointestinal endoscopy departments of the Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán" were analyzed, covering the period of January 2002 to December 2012. Patients with a histologic diagnosis of Barrett's esophagus were included. The variables of age, sex, the presence of dysplasia/esophageal adenocarcinoma, Barrett's esophagus length, and follow-up were analyzed. RESULTS: Of 43,639 upper gastrointestinal endoscopies performed, 420 revealed Barrett's esophagus, corresponding to a frequency of 9.6 patients for every 1,000 endoscopies. Of those patients, 66.9% (n=281) were men, mean patient age±SD was 57.2±15.3 years, 223 patients (53%) presented with long-segment Barrett's esophagus, and 197 (47%) with short-segment Barrett's esophagus. Dysplasia was not present in 339 patients (80.7%). Eighty-one (19.3%) patients had some grade of dysplasia or cancer: 48/420 (11.42%) presented with low-grade dysplasia, 20/420 (4.76%) with high-grade dysplasia, and 13/420 (3.1%) were diagnosed with esophageal cancer arising from Barrett's esophagus. Mean follow-up time was 5.6 years. CONCLUSIONS: The frequency of Barrett's esophagus was 9.6 cases for every 1,000 upper gastrointestinal endoscopies performed. Dysplasia was not documented in the majority of the patients with Barrett's esophagus and they had no histopathologic changes during follow-up. A total of 19.3% of the patients presented with dysplasia or cancer.

Baixa prevalência de esôfago de Barrett em área de risco para câncer esofágico no Sul do Brasil / Low prevalence of barrett's esophagus in a risk area for esophageal cancer in south of brazil

ABSTRACT BACKGROUND: Barrett's esophagus a complication of gastroesophageal reflux disease (GERD) is a precursor of esophageal adenocarcinoma. The incidence of esophageal adenocarcinoma has been increasing in most Western countries. Rio Grande do Sul (RS), the Southernmost state of Brazil has the highest rates of esophageal cancer with low prevalence of esophageal adenocarcinoma. OBJECTIVE: To investigate the prevalence of Barrett's esophagus among patients underwent to upper gastrointestinal endoscopy in the last 5 years. METHODS: The records of patients underwent upper gastrointestinal endoscopy between 2011 and 2015 were analyzed. Demographic data, GERD symptoms, endoscopic findings, extension and histological diagnosis of columnar epithelia of the esophagus were recorded. Significance among the variables was accessed by chi-square test and Fisher's exact test with 95% CI. RESULTS: A total of 5996 patients underwent to upper gastrointestinal endoscopy in the period were included. A total of 1769 (30%) patients with GERD symptoms or esophagitis and 107 (1.8%) with columnar lined esophagus were identified. Except for eight patients, the others with columnar lined esophagus had GERD symptoms or esophagitis. Barrett's esophagus defined by the presence of intestinal metaplasia occurred in 47 patients; 20 (43%) with segments over 3 cm and 27 (57%) with segments shorter than 3 cm. The global prevalence of Barrett's esophagus was 0.7% and in GERD patients 2.7%. The odds ratio for the occurrence of columnar lined esophagus in patients with GERD was 30 (95%CI=15.37-63.34). The odds ratio for the presence of intestinal metaplasia in long segments was 8 (95%CI=2.83-23.21). CONCLUSION: GERD patients had a risk 30-folds greater to present columnar lined esophagus than patients without GERD symptoms. Long segments of columnar lined esophagus, had a risk eight-folds higher to have Barrett's esophagus than short segments. Barrett's esophagus overall prevalence was 0.7%. In GERD patients, the prevalence was 2.7%. Long Barrett's esophagus represented globally 0.3% and 1.1% in GERD patients.

RESUMO CONTEXTO: Esôfago de Barrett, complicação da doença do refluxo gastroesofágico (DRGE), é lesão precursora do adenocarcinoma esofágico. O adenocarcinoma esofágico apresenta incidência crescente principalmente no ocidente. O estado do Rio Grande do Sul apresenta as taxas mais altas de câncer esofágico no Brasil, porém com baixa prevalência de adenocarcinoma. OBJETIVO: Investigar a prevalência de esôfago de Barrett em pacientes submetidos a endoscopia digestiva alta nos últimos 5 anos. MÉTODOS: Revisão de prontuários dos pacientes submetidos a endoscopia digestiva alta entre 2011 e 2015. Registrados dados demográficos, sintomas de DRGE, achados endoscópicos, extensão e diagnóstico histológico de epitelização colunar do esôfago. A significância entre as variáveis foi acessada pelos testes do qui-quadrado e exato de Fisher com IC95%. RESULTADOS: Foram incluídos 5996 pacientes. Identificamos 1769 (30%) com sintomas de DRGE ou esofagite e 107 (1,8%) com epitelização colunar. À exceção de oito pacientes com epitelização colunar, os demais apresentavam sintomas de DRGE ou esofagite. Esôfago de Barrett definido pela presença de metaplasia intestinal ocorreu em 47 pacientes; 20 (43%) com segmentos acima de 3 cm e em 27 (57%) com segmentos menores. A prevalência global de esôfago de Barrett foi 0,7% e em pacientes com DRGE foi 2,7%. A razão de chances para a ocorrência de epitelização colunar em pacientes com DRGE foi 30 (IC95%=15,37-63,34) e para a ocorrência de metaplasia intestinal em segmentos longos foi 8 (IC95%=2,83-23,21). CONCLUSÃO: Pacientes com DRGE apresentaram risco 30 vezes maior que pacientes sem DRGE para a ocorrência de epitelização colunar. O risco de ocorrência de esôfago de Barrett em segmentos longos foi oito vezes maior. A prevalência global de esôfago de Barrett foi 0,7%. Em pacientes com DRGE a prevalência foi 2,7%. Segmentos longos de esôfago de Barrett representaram globalmente 0,3% e em pacientes com DRGE 1,1%.

LOW PREVALENCE OF BARRETT'S ESOPHAGUS IN A RISK AREA FOR ESOPHAGEAL CANCER IN SOUTH OF BRAZIL.

BACKGROUND: Barrett's esophagus a complication of gastroesophageal reflux disease (GERD) is a precursor of esophageal adenocarcinoma. The incidence of esophageal adenocarcinoma has been increasing in most Western countries. Rio Grande do Sul (RS), the Southernmost state of Brazil has the highest rates of esophageal cancer with low prevalence of esophageal adenocarcinoma. OBJECTIVE: To investigate the prevalence of Barrett's esophagus among patients underwent to upper gastrointestinal endoscopy in the last 5 years. METHODS: The records of patients underwent upper gastrointestinal endoscopy between 2011 and 2015 were analyzed. Demographic data, GERD symptoms, endoscopic findings, extension and histological diagnosis of columnar epithelia of the esophagus were recorded. Significance among the variables was accessed by chi-square test and Fisher's exact test with 95% CI. RESULTS: A total of 5996 patients underwent to upper gastrointestinal endoscopy in the period were included. A total of 1769 (30%) patients with GERD symptoms or esophagitis and 107 (1.8%) with columnar lined esophagus were identified. Except for eight patients, the others with columnar lined esophagus had GERD symptoms or esophagitis. Barrett's esophagus defined by the presence of intestinal metaplasia occurred in 47 patients; 20 (43%) with segments over 3 cm and 27 (57%) with segments shorter than 3 cm. The global prevalence of Barrett's esophagus was 0.7% and in GERD patients 2.7%. The odds ratio for the occurrence of columnar lined esophagus in patients with GERD was 30 (95%CI=15.37-63.34). The odds ratio for the presence of intestinal metaplasia in long segments was 8 (95%CI=2.83-23.21). CONCLUSION: GERD patients had a risk 30-folds greater to present columnar lined esophagus than patients without GERD symptoms. Long segments of columnar lined esophagus, had a risk eight-folds higher to have Barrett's esophagus than short segments. Barrett's esophagus overall prevalence was 0.7%. In GERD patients, the prevalence was 2.7%. Long Barrett's esophagus represented globally 0.3% and 1.1% in GERD patients.

Prevalence of Barrett's esophagus: An observational study from a gastroenterology clinic. / Prevalencia de esófago de Barrett: estudio observacional en una clínica de gastroenterología.

INTRODUCTION AND AIMS: Barrett's esophagus is a condition that predisposes to esophageal adenocarcinoma. Our aim was to establish the prevalence of Barrett's esophagus at our center, as well as determine its associated factors. MATERIALS AND METHODS: We retrospectively assessed the endoscopic reports of 500 outpatients seen at our Gastroenterology Service from November 2014 to April 2016. We determined the prevalence of Barrett's esophagus and analyzed the demographic, clinical, and endoscopic findings associated with that pathology. RESULTS: The prevalence of Barrett's esophagus was 1.8%. The mean age of the patients with Barrett's esophagus was 58.7 years (range: 45-70) and there was a predominance of men (66%). In the subgroup of patients with symptoms of gastroesophageal reflux (n=125), Barrett's esophagus prevalence was 7.2%. In the multivariate analysis, the factors that were independently associated with Barrett's esophagus were gastroesophageal reflux (P=.005) and hiatal hernia (P=.006). CONCLUSIONS: The overall prevalence of Barrett's esophagus was 1.8% in our population, with a prevalence of 7.2% in patients that had symptoms of gastroesophageal reflux.

Management of Barrett's esophagus: From screening to newer treatments. / Manejo del esófago de Barrett: del tamizaje a los nuevos tratamientos.

Barrett's esophagus is a premalignant condition of the esophagus in which the squamous epithelium of the lower end of the esophagus is replaced with columnar epithelium. Since the incidence of esophageal adenocarcinoma is on the rise, the major gastroenterology societies have come up with their recommendations for screening and surveillance. Specific factors like obesity, white race, age over 50 years, early age of onset of GERD, smoking and hiatal hernia have been identified as increasing the risk of Barrett's esophagus and adenocarcinoma. The diagnosis requires both endoscopic identification of columnar-lined mucosa and histological confirmation with biopsy. Most medical societies recommend screening people with GERD and other risk factors with endoscopy, but other alternatives employing less invasive methods are currently being studied. Surveillance strategies vary depending on the endoscopic findings and the Seattle biopsy protocol with random 4-quadrant sampling is recommended. Biomarkers have shown promising results, but more studies are needed in the future. White light endoscopy is the standard practice, but other advanced imaging modalities have shown variable results and hence more studies are awaited for further validation. Endoscopic eradication techniques, including both resection and ablation, have shown good but variable results for treating dysplastic lesions confined to the mucosa. Resection procedures to remove visible lesions followed by ablation of the dysplastic mucosa have shown the best results with higher eradication rates and lower recurrence rates. Surgical management is reserved for lesions with sub-mucosal invasion and lymph node spread with increased risk of metastasis.

Prevalence of Barrett's Esophagus in Bariatric Patients Undergoing Sleeve Gastrectomy.

BACKGROUND: The appearance and incidence of gastroesophageal reflux after sleeve gastrectomy is not yet resolved, and there is an important controversy in the literature. No publications regarding the appearance of Barrett's esophagus after sleeve gastrectomy are present in the current literature. PURPOSE: The purpose of this paper was to report the incidence of Barrett's esophagus in patients submitted to sleeve. MATERIAL AND METHODS: Two hundred thirty-one patients are included in this study who were submitted to sleeve gastrectomy for morbid obesity. None had Barrett's esophagus. Postoperative upper endoscopy control was routinely performed 1 month after surgery and 1 year after the operation, all completed the follow-up in the first year, 188 in the second year, 123 in the third year, 108 in the fifth year, and 66 patients over 5 years after surgery. RESULTS: Among 231 patients operated on and followed clinically, reflux symptoms were detected in 57 (23.2%). Erosive esophagitis was found in 38 patients (15.5%), and histological examination confirmed Barrett's esophagus in 3/231 cases (1.2%) with presence of intestinal metaplasia. CONCLUSION: Bariatric surgeons should be aware of the association of gastroesophageal reflux (GER) disease and obesity. Appropriate bariatric surgery should be indicated in order to prevent the occurrence of esophagitis and Barrett's esophagus.

Concordancia de hallazgos endoscópicos e histológicos en pacientes con esófago de Barrett / Concordance of endoscopic and histological findings in patients with Barrett's esophagus

Introducción: se denomina esófago de Barrett(EB) a la sustitución del epitelio esofágico escamoso normal de la zona distal, por un epitelio columnar, confirmado mediante la evaluación histológica con la presencia de células caliciformes que indican la presencia de una metaplasia intestinal especializada, constituyendo un desencadenante del desarrollo de adenocarcinoma esofágico. Existe discrepancia entre la interpretación de los hallazgos endoscópicos e histológicos, debido a que se presentan resultados dispares en operadores dependientes. Si bien el riesgo de progresión a malignidad es bajo,se debe establecer criterios adecuados de vigilancia para un manejo eficiente costo-efectivo.Objetivo: determinar la concordancia existente entre los hallazgos endoscópicos e histológicos en pacientes con EB que acudieron al Servicio de Endoscopía Digestiva del Hospital Central del Instituto de Previsión Social (Asunción, Paraguay)del 2012 al 2014. Materiales y Métodos: estudio observacional descriptivo, retrospectivo, de corte transversal. Se revisaron expedientes clínicos de pacientes. Resultados: se tenía sospecha de EB en 1,54% (265/17.207) de los pacientes, en quienes fueron tomadas muestras de biopsias durante la realización de endoscopía digestiva alta. Hubo confirmación histológica en 32,08% (85/265) de los casos, siendo hallada displasia en 16,47% (14/85), correspondiendo la totalidad a displasia de bajo grado. Por tanto, del total de pacientes la frecuencia de EB fue 0,49% (85/17.207). Conclusión: existe una escasa concordancia entre los hallazgos endoscópicos e histológicos de EB. Es una entidad de baja frecuencia en nuestro medio. No fue encontrado ningún caso que conlleve riesgo significativo de malignidad.

Introduction: Barrett's esophagus(BE) is called to the replacement of normal epithelial squamous esophagic epithelium by columnar epithelium in the distalend, confirmed by histological evaluation with the presence of goblet cells indicating the presence of specialized intestinal metaplasia, constituting a trigger for the development of esophageal adenocarcinoma. There is a discrepancy between the endoscopic interpretation and histological findings, due to the similar results between dependent operators. Although the risk of progression to malignancy is low, it should be establishedadecuate criteria for efficient monitoring and low cost. Objetive: To determine the relation between the endoscopic and histological findings in patients with Barrett's esophagus who were attended the Esophagogastroduodenos copy in the service ofthe Central Hospital of the Social Security, from 2012 to 2014. Materials and Methods: A descriptive, retrospective, observational cross-sectional study;patients clinical records were reviewed. Results: It was suspected to have BE 1.54% (265 / 17,207) of patients in whom biopsies were taken during upper gastrointestinal endoscopy. There were histologically confirmed in 32.08% (85/265) of cases, dysplasia were found in 16.47% (14/85), bring all of them low-grade dysplasia. Therefore, the total frequency of EB patients was 0.49% (85/17,207). Conclusion: There is a low correlation between the endoscopic and histological findings of BE. It is an entity of low frequency in our media. It was not found any case that involves significant risk of malignancy.

The prevalence of Barrett's-esophagus-associated dysplasia in Puerto Rico.

OBJECTIVE: Barrett's esophagus (BE) is the strongest risk factor of esophageal adenocarcinoma (EAC). A previous study found a lower incidence of EAC in Puerto Rico (PR) as compared to other racial/ethnic groups in the United States (US). Notwithstanding, BE epidemiology in PR is unknown. Study aims: i) to determine BE prevalence among individuals with gastroenterological pathology reports from three major anatomic pathology laboratories in PR and ii) to describe the association between dysplastic BE with age and gender. METHODS: Clinic-based study examined data collected from three anatomic pathology laboratories encompassing the majority of gastroenterology practices in PR. Individuals with histology confirmed BE (January 2007-December 2011) were analyzed (n = 1,232). We estimated BE prevalence and adjusted odds ratios (AOR) to assess magnitude of association between dysplastic BE with age and gender using logistic regression models. RESULTS: Overall BE prevalence was 4.4% (95% CI = 4.1-4.6). Most BE patients were males (male-to-female ratio = 2.3:1) with mean age of 64 ± 13 years. Ninety one percent of BE biopsies showed no dysplasia whereas 6.2% had EAC. BE patients age > 74 years had an increased risk of EAC (AOR: 2.38, 95% CI = 1.14-4.94) compared to those < 55 years old. Males had increased EAC risk (AOR: 2.23, 95% CI = 1.23-4.06) compared to females. CONCLUSION: BE prevalence in PR is similar to that of non-Hispanic whites and Hispanics in US. The lower occurrence of dysplastic BE in PR could explain EAC incidence disparities between PR and other groups in the US.

Laparoscopic surgical treatment for patients with short- and long-segment Barrett's esophagus: which technique in which patient?

Laparoscopic antireflux surgery is very successful in patients with short-segment Barrett's esophagus (BE), but in patients with long-segment BE, the results remain in discussion. In these patients, during the open era of surgery, we performed acid suppression + duodenal diversion procedures added to the antireflux procedure (fundoplication + vagotomy + antrectomy + Roux-en-Y gastrojejunostomy) to obtain better results at long-term follow-up. The aim of this prospective study is to present the results of 3 to 5 years' follow-up in patients with short-segment and long-segment or complicated BE (ulcer or stricture) who underwent fundoplication or the acid suppression-duodenal diversion technique, both performed by a laparoscopic approach. One hundred eight patients with histologically confirmed BE were included: 58 patients with short-segment BE, and 50 with long-segment BE, 28 of whom had complications associated with severe erosive esophagitis, ulcer, or stricture. After surgery, among patients treated with fundoplication with cardia calibration, endoscopic erosive esophagitis was observed in 6.9% of patients with short-segment BE, while 50% of patients with long-segment BE presented with positive acid reflux, persistence of endoscopic esophagitis with intestinal metaplasia, and progression to dysplasia (in 5% of cases; P = 0.000). On the contrary, after acid suppression-duodenal diversion surgery in patients with long-segment BE, more than 95.6% presented with successful results regarding recurrent symptoms and endoscopic regression of esophagitis. Regression of intestinal metaplasia to the cardiac mucosa was observed in 56.9% of patients with short-segment BE who underwent fundoplication and in 61% of those with long-segment BE treated with the acid suppression-duodenal diversion procedure. Patients with long-segment BE who experienced fundoplication alone presented no regression of intestinal metaplasia; on the contrary, progression to dysplasia was observed in 1 case (P = 0.049). Patients with short-segment BE can be successfully treated with fundoplication, but for patients with long-segment BE, we suggest performance of fundoplication plus an acid suppression-duodenal diversion procedure.

[Prevalence of intestinal metaplasia of the gastric cardia and its relation with Helicobacter pylori strains cagA and vacA]. / Prevalencia de metaplasia intestinal en el cardias gástrico y su relación con cepas virulentas de Helicobacter pylori cagA y vacA.

BACKGROUND: Esophageal metaplasia progression is a consequence of chronic gastroesophageal reflux (CGR). Patients with this condition are frequently infected by Helicobacter pylori and show several symptoms including gastritis as well as ulcer formation. In addition, they present an increased risk for the development of gastric adenocarcinoma. Several pathogenic markers for Helicobacter pylori such as ureC, vacA and cagA genes have been described. Evidence indicates that direct injury to the epithelial mucosa is caused by cytotoxins and enzymes codified by these genes. We undertook this study to establish a relationship between the presence of pathogenic Helicobacter pylori strains and the presence of metaplasia progression in patients with CGR. METHODS: We detected the presence of Helicobacter pylori cagA and vacA positive strains in patients with CGR. Using polymerase chain reaction, we analyzed 120 samples obtained from 60 patients with CGR and 60 control group patients, including samples from both anatomic areas: cardia and gastric antrum. RESULTS: We detected 56% of Helicobacter pylori positive patients; 57.5% of these patients were positive for either cagA(+) and/or vacA(+) Helicobacter pylori strains. Cardiac intestinal metaplasia was observed in 35% of the patients. A marked tendency was observed to develop cardiac intestinal metaplasia in those patients diagnosed with high-pathogenicity strains infected in both anatomic areas. CONCLUSIONS: These results suggest that infection with Helicobacter pylori can be considered a risk factor for developing gastric cardiac intestinal metaplasia.

[Barrett's esophagus: prevalence and risk factors in the National Hospital Arzobispo Loayza in Lima-Peru]. / Esófago de Barrett: prevalencia y factores de riesgo en el Hospital Nacional "Arzobispo Loayza" Lima-Perú

INTRODUCTION: Barrett's esophagus (BE)is a condition where squamous epithelium is substituted for glandular type intestinal as consequence gastroesophageal reflux chronic. The BE is a lesion pre malignant (adenocarcinoma ). Factors like age, generous, biliary reflux, antecedent of esophagitis, hiatus hernia, obesity, fatty diet could be risk factors in BE, while Helicobacter pylori could be protect factor. OBJECTIVE: To identify prevalence and risk factors in the development of the BE in the Arzobispo Loayza Hospital during 2004. METHODS: This was a descriptive, transversal, analytic, case-control study, where group of cases were 30 patients with diagnosis of BE according endoscopic and histologic criteria. 95 subjects formed the control group. The Correspondence Multiple Analysis, Logistic Regression analysis was used and the Odds ratio (OR,95% CI) was calculated. RESULTS: BE prevalence was 0.30% and the Incidence 0.28%. The risk factors found were: age (OR:2.57; IC95%, 1.41-4.69, p0.00), antecedent of esophagitis (OR: 14.61; IC95%, 3.96-55.41, p0.00) spend pork meat cooked fried (OR: 8.67, IC95%, 2.28-32.99; p0.00). Female was a protect factor (OR: 0.23;IC95%; 0.05-1.05; p0.06) considered at 10%. CONCLUSIONS: This study found prevalence 0.30% of BE prevalence and the risk factors were: males up 60 years old, antecedent of esophagitis of gastro esophageal reflux, spend pork meat, preference to cook fried food. Female gender is protector factor. En this study, the biliary reflux, obesity, hiatus hernia, Helicobacter pylori weren't identified as risk factors.

Preoperative gastric acid secretion and the risk to develop Barrett's esophagus after esophagectomy for chagasic achalasia.

INTRODUCTION: The aim of this study was to determine the contribution of preoperative gastric secretory and hormonal response, to the appearance of Barrett's esophagus in the esophageal stump following subtotal esophagectomy. METHODS: Thirty-eight end-stage chagasic achalasia patients submitted to esophagectomy and cervical gastric pull-up were followed prospectively for a mean of 13.6 +/- 9.2 years. Gastric acid secretion, pepsinogen, and gastrin were measured preoperatively in 14 patients who have developed Barrett's esophagus (Group I), and the results were compared to 24 patients who did not develop Barrett's esophagus (Group II). RESULTS: In the group (I), the mean basal and stimulated preoperative gastric acid secretion was significantly higher than in the group II (basal: 1.52 vs. 1.01, p = 0.04; stimulated: 20.83 vs. 12.60, p = 0.01). Basal and stimulated preoperative pepsinogen were also increased at the Group I compared to Group II (Basal = 139.3 vs. 101.7, p = 0.02; stimulated = 186.0 vs. 156.5, p = 0.07. There was no difference in preoperative gastrin between the two groups. Gastritis was present during endoscopy in 57.1% of the Group I, while it was detected in 16.6% of the Group II, p = 0.014. CONCLUSIONS: Barrett's esophagus in the esophageal stump was associated to high preoperative levels of gastric acid secretion, serum pepsinogen, and also gastritis in the transposed stomach.

[Prevalence, clinical-endoscopic characteristics and predictive factors of Barrett's Esophagus in endoscopic screening for gastric cancer]. / Prevalencia, características clínico-endoscópicas y factores predictivos de Esófago de Barrett.

PURPOSE: Determine the prevalence, clinical-epidemiological characteristics and predictive factors for Barrets Esophagus (BE). METHOD: An analytical and transversal study was conducted, followed by a case-control study nested in a population participating in a gastric cancer screening campaign, from January to June 2008 at the Central Hospital of the Peruvian Air Force (FAP). A BE case was defined due to the endoscopic presence of columnar-appearing mucosa confirmed by intestinal metaplasia at biopsy. Demographic, clinical and endoscopic variables were evaluated, and bivariate and multivariate studies were conducted to identify predictive risk factors, using patients with gastroesophagic reflux and control patients of the study population as control groups. RESULTS: Out of 2273 patients studied, 11 (0.48%) patients with an average age of 52.2 +/- 7.7 years (43-69 year range) suffered from BE, out of which 81.8% were male. The 81.8% were symptomatic, with dyspepsia in 54.5% and with reflux in 27.3%, while 18.2% were asymptomatic. The short-segment BE was more common than the long-segment BE (72.7% versus 27.3%). The predictive factors found after the bivariate and multivariate analysis (comparing cases versus population control group) were: hiatal hernia [OR = 12.1, CI 95% 2.25 64.75], consumption of AINES [OR = 6.72, CI 95% 1.6-29.1] and consumption of alcohol [OR = 4.22, CI 95% 1.1-16.91]. CONCLUSIONS: BE prevalence in the study was low. The presence of hiatal hernia, consumption of AINES, and consumption of alcohol were predictive risk factors to develop BE in the study.

Prevalence of Barrett's esophagus in individuals without typical symptoms of gastroesophageal reflux disease.

BACKGROUND: Barretts esophagus, the major risk factor for esophageal adenocarcinoma, is detected in approximately 10%-14% of individuals submitted to upper endoscopy for the assessment of gastroesophageal reflux disease related symptoms. Prevalence studies of Barretts esophagus in individuals without typical symptoms of gastroesophageal reflux disease have reported rates ranging from 0.6% to 25%. AIM: To determine the prevalence of Barretts in a Brazilian population older than 50 years without typical symptoms of gastroesophageal reflux disease. METHODS: A total of 104 patients (51 men), mean age of 65 years, with an indication for upper endoscopy but without symptoms of heartburn and/or acid regurgitation (determined with a validated questionnaire) were recruited. Subjects submitted to upper endoscopic examination in the last 10 years or using antisecretory medication (proton pump inhibitors) during the last 6 months were not included. Methylene blue chromoscopy was performed during the endoscopic exam to facilitate identification of the metaplastic epithelium. RESULTS: Barretts esophagus was diagnosed endoscopically and confirmed by histology in four patients, all of them males. The metaplastic segment was short (less than 3 cm) and free of dysplasia in all patients. The prevalence of Barretts esophagus was 7.75% in the male population and 3.8% in the general population studied. CONCLUSION: Due to the low prevalence of Barretts esophagus found in the present study, associated with the finding of short-segment Barretts esophagus in all cases diagnosed and the absence of dysplasia in the material analyzed, endoscopic screening for Barretts esophagus in patients above the age of 50 without the classical symptoms of gastroesophageal reflux disease is not indicated for the Brazilian population.

Prevalence of Barrett's esophagus in individuals without typical symptoms of gastroesophageal reflux disease

BACKGROUND: Barrett’s esophagus, the major risk factor for esophageal adenocarcinoma, is detected in approximately 10 percent-14 percent of individuals submitted to upper endoscopy for the assessment of gastroesophageal reflux disease related symptoms. Prevalence studies of Barrett’s esophagus in individuals without typical symptoms of gastroesophageal reflux disease have reported rates ranging from 0.6 percent to 25 percent. AIM: To determine the prevalence of Barrett’s in a Brazilian population older than 50 years without typical symptoms of gastroesophageal reflux disease. METHODS: A total of 104 patients (51 men), mean age of 65 years, with an indication for upper endoscopy but without symptoms of heartburn and/or acid regurgitation (determined with a validated questionnaire) were recruited. Subjects submitted to upper endoscopic examination in the last 10 years or using antisecretory medication (proton pump inhibitors) during the last 6 months were not included. Methylene blue chromoscopy was performed during the endoscopic exam to facilitate identification of the metaplastic epithelium. RESULTS: Barrett’s esophagus was diagnosed endoscopically and confirmed by histology in four patients, all of them males. The metaplastic segment was short (less than 3 cm) and free of dysplasia in all patients. The prevalence of Barrett’s esophagus was 7.75 percent in the male population and 3.8 percent in the general population studied. CONCLUSION: Due to the low prevalence of Barrett’s esophagus found in the present study, associated with the finding of short-segment Barrett’s esophagus in all cases diagnosed and the absence of dysplasia in the material analyzed, endoscopic screening for Barrett’s esophagus in patients above the age of 50 without the classical symptoms of gastroesophageal reflux disease is not indicated for the Brazilian population.

RACIONAL: O esôfago de Barrett, principal fator de risco para o adenocarcinoma do esôfago, é uma complicação da doença por refluxo gastroesofágico de longa duração, sendo detectado em, aproximadamente, 10 por cento-14 por cento dos indivíduos submetidos a endoscopia digestiva alta para avaliação de sintomas relacionados à doença por refluxo gastroesofágico. Estudos de prevalência do esôfago de Barrett em indivíduos sem sintomas típicos de doença por refluxo gastroesofágico mostram taxas oscilando entre 0,6 por cento e 25 por cento. OBJETIVO: Determinar a prevalência do esôfago de Barrett em indivíduos maiores de 50 anos sem os sintomas clássicos da doença por refluxo gastroesofágico. MÉTODOS: Foram recrutados 104 pacientes (51 homens e 53 mulheres), idade média 65 anos, com indicação de se submeterem a endoscopia digestiva alta, porém sem sintomas de pirose e/ou regurgitação ácida (certificados através de questionário validado). Foram excluídos indivíduos com exame endoscópico prévio nos últimos 10 anos ou que fizeram uso de medicação anti-secretora nos últimos 6 meses. Durante o exame endoscópico foi realizada cromoscopia com azul de metileno, para facilitar a identificação do epitélio metaplásico. RESULTADOS: O esôfago de Barrett foi diagnosticado por endoscopia e confirmado pela histologia em quatro pacientes, todos do sexo masculino. Os segmentos metaplásicos eram curtos (inferior a 3 cm) e livre de displasia em todos os pacientes. A prevalência encontrada foi de 7,75 por cento na população masculina e 3,8 por cento na população geral avaliada. CONCLUSÃO: Diante da baixa prevalência do esôfago de Barrett encontrada no presente estudo, associada ao achado de segmento curto de Barrett em todos os casos diagnosticados e ausência de displasia no material analisado, rastreamento endoscópico para o esôfago de Barrett em pacientes acima de 50 anos sem os sintomas clássicos da doença por refluxo gastroesofágico não se justificaria na população...

A Caribbean perspective on Barrett's oesophagus.

The aim of this study is to evaluate the prevalence of Barrett's oesophagus at the University Hospital of the West Indies which serves a population predominantly of African descent. In order to maximize accession of all cases in this preliminary study, the broad definition of columnar metaplasia of the lower oesophagus was utilized. Nevertheless, of 18 cases identified in the 21-year period, 14/17 cases (82%) available for review had specialized columnar epithelium diagnostic of Barrett's oesophagus. There was male predominance 5:1, the mean age was 53.8 years and there were two associated adenocarcinomas. These data confirm the occurrence but low prevalence of Barrett's oesophagus in this population but with a disease pattern that is consistent with that reported in other populations, warranting systematic evaluation of the gastro-oesophageal junction even in a Caribbean population.