ABSTRACT
BACKGROUND: Attention has focused on whether normalization, regression, and development of dysplasia and cancer in specialized intestinal metaplasia (SIM) differ among long-segment Barrett's esophagus (LSBE), short-segment BE (SSBE), and esophagogastric junction SIM (EGJSIM). We prospectively followed a cohort of SIM patients receiving long-term antisecretory medications to determine: (a) histologic normalization (no evidence of SIM on biopsy), (b) change in SIM length, (c) incidence of dysplasia and cancer, and (d) factors associated with normalization. METHODS: One hundred forty-eight patients with SIM were identified in our original cohort. Of these, 60.5% (23/38) LSBE, 69.8% (44/63) SSBE, and 72.3% (34/47) EGJSIM patients underwent repeat surveillance over a mean 44.4 +/- 9.7 months. Demographic, clinical, and endoscopic data were obtained. RESULTS: (a) With long-term, antisecretory therapy, normalization occurred in 0/23 LSBE, 30% (13/44) of SSBE, and 68% (23/34) of EGJSIM (P < 0.001). (b) Normalization was more likely with EGJSIM (odds ratio [OR] 6.7, CI 2.3-19.3, P= 0.005), female gender (OR 7.3, CI 2.3-23.1, P= 0.001), or absence of hiatal hernia (OR 2.9, CI 1.02-8.06, P= 0.002). (c) A significant decrease in mean SIM length was noted for the entire population (2.5 +/- 0.3 to 2.13 +/- 0.3 cm, P= 0.004). (d) Follow-up incidence of dysplasia and cancer was 26.1% (3 indefinite, 2 low-grade dysplasia [LGD], 1 cancer) for LSBE, 6.8% (2 indefinite, 1 LGD) for SSBE, and none for EGJSIM (P < 0.004). CONCLUSIONS: (a) Normalization of SIM occurs most frequently in EGJSIM>SSBE>LSBE. (b) Factors associated with normalization favor less severe GER and shorter segments of SIM. (c) Surveillance of LSBE results in the greatest yield for identifying dysplasia and cancer.
Subject(s)
Esophageal Neoplasms/epidemiology , Esophagogastric Junction/pathology , Stomach Neoplasms/epidemiology , Aged , Biopsy , Disease Progression , Endoscopy, Gastrointestinal , Esophageal Neoplasms/pathology , Female , Follow-Up Studies , Humans , Incidence , Male , Metaplasia/epidemiology , Metaplasia/pathology , Middle Aged , Prevalence , Prognosis , Prospective Studies , Risk Factors , Stomach Neoplasms/pathology , United States/epidemiologyABSTRACT
Ectopic gastric mucosa has been described at various locations of the body, including all levels of the gastrointestinal tract. However, this finding is rare in the rectum and anus, with 38 reported cases. In only six cases, including the present one, has the heterotopic tissue been located within 2 cm of the dentate line. We report a case of gastric heterotopia discovered in a 21-year-old male who presented with anal pain and pruritus. Flexible sigmoidoscopy demonstrated an anal polyp, and biopsy confirmed fundic-type gastric tissue. A (99m)technetium-pertechnetate scan confirmed increased uptake in the anus. After minimal clinical improvement with proton-pump inhibitors, the patient underwent local surgical excision and remains symptom-free at a follow-up of 9 months. We review the potential etiologies, clinical manifestations, treatment options, and patient outcomes.
Subject(s)
Anus Diseases/surgery , Choristoma/surgery , Gastric Mucosa , Adult , Anus Diseases/diagnosis , Choristoma/diagnosis , Humans , MaleSubject(s)
Anti-Arrhythmia Agents/adverse effects , Atrial Fibrillation/drug therapy , Gastroscopy , Quinidine/analogs & derivatives , Quinidine/adverse effects , Stomach Ulcer/chemically induced , Aged , Anti-Arrhythmia Agents/therapeutic use , Diagnosis, Differential , Gastritis, Atrophic/diagnosis , Humans , Male , Quinidine/therapeutic use , Stomach Ulcer/diagnosisSubject(s)
Adenomatous Polyposis Coli/diagnosis , Colonoscopes/adverse effects , Colonoscopy/adverse effects , Intestinal Perforation/etiology , Sigmoid Diseases/etiology , Colonoscopy/methods , Equipment Design , Equipment Safety , Follow-Up Studies , Humans , Intestinal Perforation/surgery , Laparotomy , Male , Middle Aged , Risk Assessment , Sigmoid Diseases/surgeryABSTRACT
BACKGROUND & AIMS: Diminutive adenomas (1-9 mm in diameter) are frequently found during colon cancer screening with flexible sigmoidoscopy (FS). This trial assessed the predictive value of these diminutive adenomas for advanced adenomas in the proximal colon. METHODS: In a multicenter, prospective cohort trial, we matched 200 patients with normal FS and 200 patients with diminutive adenomas on FS for age and gender. All patients underwent colonoscopy. The presence of advanced adenomas (adenoma >or= 10 mm in diameter, villous adenoma, adenoma with high grade dysplasia, and colon cancer) and adenomas (any size) was recorded. Before colonoscopy, patients completed questionnaires about risk factors for adenomas. RESULTS: The prevalence of advanced adenomas in the proximal colon was similar in patients with diminutive adenomas and patients with normal FS (6% vs. 5.5%, respectively) (relative risk, 1.1; 95% confidence interval [CI], 0.5-2.6). Diminutive adenomas on FS did not accurately predict advanced adenomas in the proximal colon: sensitivity, 52% (95% CI, 32%-72%); specificity, 50% (95% CI, 49%-51%); positive predictive value, 6% (95% CI, 4%-8%); and negative predictive value, 95% (95% CI, 92%-97%). Male gender (odds ratio, 1.63; 95% CI, 1.01-2.61) was associated with an increased risk of proximal colon adenomas. CONCLUSIONS: Diminutive adenomas on sigmoidoscopy may not accurately predict advanced adenomas in the proximal colon.
