Subtypes of Barrett's oesophagus and oesophageal adenocarcinoma based on genome-wide methylation analysis.

OBJECTIVE: To identify and characterise DNA methylation subtypes in oesophageal adenocarcinoma (EAC) and its precursor Barrett's oesophagus (BE). DESIGN: We performed genome-wide DNA methylation profiling on samples of non-dysplastic BE from cancer-free patients (n=59), EAC (n=23), normal squamous oesophagus (n=33) and normal fundus (n=9), and identified methylation subtypes using a recursively partitioned mixture model. We assessed genomic alterations for 9 BE and 22 EAC samples with massively parallel sequencing of 243 EAC-associated genes, and we conducted integrative analyses with transcriptome data to identify epigenetically repressed genes. We also carried out in vitro experiments treating EAC cell lines with 5-Aza-2'-Deoxycytidine (5-Aza-dC), short hairpin RNA knockdown and anticancer therapies. RESULTS: We identified and validated four methylation subtypes of EAC and BE. The high methylator subtype (HM) of EAC had the greatest number of activating events in ERBB2 (p<0.05, Student's t-test) and the highest global mutation load (p<0.05, Fisher's exact test). PTPN13 was silenced by aberrant methylation in the HM subtype preferentially and in 57% of EACs overall. In EAC cell lines, 5-Aza-dC treatment restored PTPN13 expression and significantly decreased its promoter methylation in HM cell lines (p<0.05, Welch's t-test). Inhibition of PTPN13 expression in the SK-GT-4 EAC cell line promoted proliferation, colony formation and migration, and increased phosphorylation in ERBB2/EGFR/Src kinase pathways. Finally, EAC cell lines showed subtype-specific responses to topotecan, SN-38 and palbociclib treatment. CONCLUSIONS: We identified and characterised methylator subtypes in BE and EAC. We further demonstrated the biological and clinical relevance of EAC methylator subtypes, which may ultimately help guide clinical management of patients with EAC.

Efficacy and safety of sublingual immunotherapy with Dermatophagoides farinae drops in pre-school and school-age children with allergic rhinitis.

BACKGROUND: The safety and efficacy of sublingual immunotherapy (SLIT) have been confirmed by many studies. However, in China, the research on efficacy and safety in young and older children with allergic rhinitis (AR) is still rare. OBJECTIVE: The aim of this retrospective study is to evaluate the efficacy and safety of SLIT with Dermatophagoides farinae drops in pre-school and school-age children with AR. METHODS: A total of 282 subjects aged 2-13 years with AR received a two-year course of sublingual immunotherapy along with pharmacotherapy. According to the age, patients were defined as the pre-school group (2-6 years old, n=116) and school-age group (7-13 years old, n=166). Total nasal rhinitis symptom scores (TNSS), visual analogue score (VAS) and total medication scores (TMS) were evaluated at four time points: baseline, after SLIT for half a year, one year and two years. The adverse events (AEs) were evaluated at each visit. RESULTS: After two-year SLIT, the four rhinitis symptom scores, TNSS, VAS and TMS scores were significantly lower than baseline (all P<0.05). The comparison of efficacy between one and two-year duration showed no significant difference in global clinical outcomes (all P>0.05). In addition, there were no significant differences between the pre-school and school-age group in TNSS (all P>0.05), VAS (all P>0.05) and TMS scores (P>0.05) after SLIT for half a year, one year and two years. No severe systemic AEs were reported. CONCLUSION: SLIT with D. farinae drops is clinically effective and safe in pre-school and school-age patients with house dust mites (HDMs)-induced AR.

[The prevalence of snoring and its association with academic performance among school-aged children in Beijing].

Objective: To investigate the snoring status of school-aged children in Beijing and explore the association of snoring and academic performance. Methods: A total of 7 925 children aged from 6 to 14 were selected from 15 primary and middle schools at 7 districts (Xicheng, Chaoyang, Changping, Shunyi, Fangshan, Huairou and Mentougou) in Beijing in 2015, using multi-stage stratified cluster random sampling method. The recruited children were asked to complete the Pediatric Sleep Questionnaire (PSQ) and a questionnaire related to sleep behavior. The multiplelogistic regression was used to analyze the association of snoring and academic performance. Results: A total of 794 (12.44%) children showed a decline in academic performance among 6 383 eligible respondentsfor data analysis. 580 (9.08%) children with snoring was identified, of which 333 and 247 were in frequency of 1-2 times per week and frequency of ≥3 times per week, respectively; 357, 170 and 53 were in snoring grade Ⅰ, grade Ⅱ and grade Ⅲ, respectively. Compared with the children without snoring, the OR (95%CI) for children with 1-2 times per week and ≥3 times per week was 1.363 (1.000-1.857) and 1.605 (1.135-2.269), respectively; and the OR (95%CI) for children with grade Ⅰ, grade Ⅱ and grade Ⅲ of snoring was 1.226 (0.893-1.683), 1.595 (1.062-2.397) and 2.31 (1.17-4.565), respectively. Conclusion: There is a statistical relationship between snoring and the decline of academic performance. The decline of academic performance positively associated with increased frequency and grade of snoring.

MicroRNA-520f suppresses growth of gastric carcinoma cells by target ATPase family AAA domain-containing protein 2 (ATAD2).

MicroRNAs (miRNAs) are small, non-coding RNAs that can serve as tumor suppressor genes or oncogenes in tumorigenesis. More and more evidence demonstrate that abnormal expression of miRNAs lead to the gastric carcinoma occurrence. In the present study, we revealed that the expression levels of miR-520f were significantly down-regulated in gastric carcinoma cells and clinical gastric carcinoma samples. Next, we demonstrated that introduction of miR-520f inhibited the growth of gastric carcinoma cells in vitro. However, down-regulate the expression levels of miR-520f by anti-miR-520f lead to an enhanced cell proliferation, implying that miR-520f maybe serve as a novel tumor suppressor. Moreover, we found that ATPase family AAA domain-containing protein 2 (ATAD2) was one target genes of miR-520f downstream regulator, which caused the decreased expression of ATAD2. Meanwhile, the overexpression of ATAD2 reversed the inhibited proliferation ability caused by miR-520f. Therefore, our find that miR-520f involves in gastric carcinoma proliferation, pointing a therapeutic probability of miR-520f in the therapy of gastric carcinoma.

Reversal of cisplatin resistance in non-small cell lung cancer stem cells by Taxus chinensis var.

Drug resistance in cells is a major impedance to successful treatment of lung cancer. Taxus chinensis var. inhibits the growth of tumor cells and promotes the synthesis of interleukins 1 and 2 and tumor necrosis factor, enhancing immune function. In this study, T. chinensis var.-induced cell death was analyzed in lung cancer cells (H460) enriched for stem cell growth in a defined serum-free medium. Taxus-treated stem cells were also analyzed for Rhodamine 123 (Rh-123) expression by flow cytometry, and used as a standard functional indicator of MDR. The molecular basis of T. chinensis var.-mediated drug resistance was established by real-time PCR analysis of ABCC1, ABCB1, and lung resistance-related protein (LRP) mRNA, and western blot analysis of MRP1, MDR1, and LRP. Our results revealed that stem cells treated with higher doses of T. chinensis var. showed significantly lower growth inhibition rates than did H460 cells (P < 0.05). The growth of stem and H460 cells treated with a combination of T. chinensis var. and cisplatin was also significantly inhibited (P < 0.05). Rh-123 was significantly accumulated in the intracellular region and showed delayed efflux in stem cells treated with T. chinensis var. (P < 0.05), compared to those treated with verapamil. T. chinensis var.-treated stem cells showed significant downregulation of the ABCC1, ABCB1, and LRP mRNA and MRP1, MDR1, and LRP (P < 0.05) compared to H460 cells. Thus, T. chinensis var.-mediated downregulation of MRP1, MDR1, and LRP might contribute to the reversal of drug resistance in non-small cell lung cancer stem cells.

Containment of Clostridium difficile infection without reduction in antimicrobial use in Hong Kong.

Clostridium difficile ribotype 002 with hypersporulating capacity has been increasingly identified in Hong Kong. Proactive infection control measures are important to prevent the establishment of endemicity of C. difficile ribotype 002. A total of 329 patients with healthcare-associated C. difficile infection (CDI) were recruited in our healthcare network between 1 January 2008 and 30 June 2012 in this study. The incidence rates of healthcare-associated CDI per 10,000 admissions and 10,000 patient-days increased significantly by 15.3 and 17.0%, respectively, per quarter (p < 0.001) from 2008 1Q to 2010 1Q by segmented Poisson regression. With the full implementation of enhanced infection control interventions, there was an immediate significant reduction in both healthcare-associated CDI rates per 10,000 admissions and per 10,000 patient-days by 47% (p < 0.001) in 2010 2Q, followed by a further decline of CDI per 10,000 admissions and CDI per 10,000 patient-days by -19.4 and -19.8% from 2010 2Q to 2012 2Q, respectively (p < 0.001), despite a replacement of hand washing with soap and water by alcohol-based hand rub in the healthcare network. The proportion of C. difficile ribotype 002 was not statistically different (34/177, 19.2% vs. 25/152, 16.4%, p = 0.515), and the consumption of broad-spectrum antibiotics presented as divided daily dose per 1,000 acute bed-day occupancy per quarter remained unchanged (140.9 vs. 152.3) before and after infection control interventions. Our results suggested that the reduction of healthcare-associated CDI was attributable to infection control interventions instead of replacement of ribotypes or reduction in antimicrobial selective pressure.

Establishing an accountability benchmark for equity, diversity, and inclusion: A 10-year scoping review of Families, Systems, & Health.

INTRODUCTION: In 2022, Families, Systems, & Health (FSH) issued a statement of purpose to equity, diversity, and inclusion (EDI) and developed a strategic plan for promoting EDI in scientific communication and publishing. The purpose of this review was to evaluate a decade of research published in FSH prior to the journal's initiatives to improve EDI. METHOD: We utilized a scoping review to broadly review literature published in FSH that focused on topics of race, ethnicity, racism, and/or BIPOC (Black, Indigenous, and people of color) groups. All research studies published in FSH between 2012 and 2021 were independently assessed by two reviewers for inclusion. Charting of data from each study was based on a diversity accountability index. RESULTS: Of the 360 research studies identified, 41 were included in the review. Characteristics and frequencies of keywords, research designs, and samples among the included studies were examined, alongside the reporting of results that focused on the differences between racial/ethnic groups and within BIPOC groups. DISCUSSION: Research focused on race, ethnicity, racism, and diversity science is not well represented among published studies in FSH prior to the implementation of the above-described EDI efforts. Among articles that did focus on these topics, comparisons largely were of a racial/ethnic minority sample to a White sample. Action steps for FSH and other journals wishing to promote EDI include a thorough examination of current journal review procedures paired with the establishment of procedures for combatting bias and racism. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

A descriptive examination of international family/shared meals: Prevalence, meal types, media at meals, and emotional well-being.

INTRODUCTION: Studies in the United States have shown associations between family/shared meal frequency and child health and well-being. Less is known about family/shared meal characteristics (e.g., frequency, meal type, meal activities) in adults and international samples and whether there are protective associations between family/shared meal frequency and emotional well-being. Also unknown, is whether family meals provide protective associations for other family members in the household. METHOD: In a 2022 cross-sectional study, an online survey was administered in the United States, Italy, and Germany. One adult respondent (49.5% female; Mage = 45.6) from each household (n = 1,983) reported on family/shared meals and well-being. A second family member (e.g., partner, child) responded in a subset of households (n = 1,915). Descriptive statistics by country, Spearman correlations between meal frequency and well-being, and Kruskal-Wallis comparisons of mood indicators across countries were run. RESULTS: The majority of adults across countries engaged in six or more family/shared meals per week, with more meals on weekends. Breakfast, lunch, and dinner family/shared meals were more common on weekends, and European countries reported engaging in a higher prevalence of all meal types. Higher frequency of family/shared meals was significantly correlated with fewer depressive symptoms, more connectedness, and higher levels of happiness in adults across countries and in a second household member. DISCUSSION: Family/shared meals were beneficial across an international sample and may provide protective spillover effects for multiple household members. Clinicians and researchers who work with families may want to consider assessing for and intervening on family meal frequency. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Screening of m6A gene-related lncRNAs in colon adenocarcinoma and construction of a prognostic prediction model.

OBJECTIVE: We aimed to screen the long non-coding RNAs (lncRNAs) related to N6-methyladenosine (m6A) gene and build the prognostic prediction model of colon adenocarcinoma (COAD). MATERIALS AND METHODS: The RNA sequencing data of 435 COAD cases with clinical survival and prognosis information and the GSE39582 dataset were obtained from TCGA and GEO, respectively. The lncRNAs related to the m6A gene with significant independent prognosis were identified. We used Cox regression analyses to acquire the lncRNAs associated with prognosis. Moreover, we built a prognostic prediction model of COAD. The Cox regression analyses were applied to obtain the independent prognostic clinical factors. Furthermore, we built the ceRNA regulation network of COAD, and the gene ontology (GO) and Kyoto Encyclopedia of Genes (KEGG) enrichment analysis for the lncRNAs was applied. RESULTS: Overall, 5 lncRNAs (MAGI1-IT1, CSNK1G2-AS1, ALMS1-IT1, LINC01341, LOXL1-AS1) related to m6A gene with significant independent prognosis were acquired. A prognostic prediction model of COAD was built, and 4 correlation-independent prognostic factors were found. In addition, the ceRNA regulation network of COAD was built, and mRNAs were significantly enriched in the 15 GO biological processes (such as regulation of transcription) and in 14 KEGG pathways (such as taurine). CONCLUSIONS: We identified 5 lncRNAs related to the m6A gene with significant independent prognosis. The ceRNA regulation network of COAD was built, which has great significance for identifying the biomarkers associated with m6A in COAD.

molecular typing of Legionella pneumophila strains isolated from environment in Morocco.

Legionella pneumophila is a common cause of hospital and community-acquired pneumonia, being transmitted by inhalation of aqueous aerosols. Most legionellosis outbreaks are linked to contaminated hot water systems or cooling towers. The aim of this study was to determine the genetic diversity of (n= 55) environmental strains of L. pneumophila recovered from the hot water distribution systems of 16 establishments in seven Moroccan towns during the period 2009-2011. Thirteen chromosomal restriction patterns determined by Pulsed field gel electrophoresis were detected. The strains of L. pneumophila serogroup1 exhibited in 6/13 different PFGE patterns, while the strains of L. pneumophila serogroups 2-14 showed 7/13 PFGE patterns. The PFGE showed the existence of various patterns in Morocco, The pattern -XI- have tree similar profiles with the endemic L. pneumophila Paris's strain. This technique also allowed to conclude that the same pulsotype was found for many strains isolated from different establishments. Moreover, different pulsolypes were found for strains isolated from the same establishment. These results showed that PFGE analysis is a powerful tool to reveal the clonal nature and genetic differences among L. pneumophila strains.

Couple and family interventions for high mortality health conditions: A strategic review (2010-2019).

The earliest publications in the field of marriage and family therapy introduced interventions conducted with families experiencing complex health conditions. This strategic review captures an evaluation of efficacy for 87 couple and family interventions published between 2010 and 2019 with a focus on the leading causes of mortality in the United States. These health conditions include chromosomal anomalies and accidents with infants aged 0-4 years; accidents and cancer among children aged 5-14; accidents among adolescents aged 15-24; and heart disease, cancer, accidents, chronic lower respiratory diseases, stroke, Alzheimer's disease, diabetes, influenza/pneumonia, and nephritis/nephrosis among adults 25 and older. Results support the need for greater inclusion of couples and families in assessments and interventions. The greatest chasm in efficacy research was with minoritized couples and families. Implications include ways to initiate couple and family interventions in the context of health conditions with attention given to accessibility, recruitment, retention, and evaluation.

Clostridium difficile isolates with increased sporulation: emergence of PCR ribotype 002 in Hong Kong.

We identified a predominant clone of Clostridium difficile PCR ribotype 002, which was associated with an increased sporulation frequency. In 2009, 3,528 stool samples from 2,440 patients were tested for toxigenic C. difficile in a healthcare region in Hong Kong. A total of 345 toxigenic strains from 307 (13.3%) patients were found. Ribotype 002 was the predominant ribotype, which constituted 35 samples from 29 (9.4%) patients. The mean sporulation frequency of ribotype 002 was 20.2%, which was significantly higher than that of the 56 randomly selected ribotypes other than 002 as concurrent controls (3.7%, p < 0.001). Patients carrying toxigenic ribotype 002 were more frequently admitted from an elderly home (p = 0.01) and received more ß-lactam antibiotics in the preceding 3 months compared with the controls (p = 0.04) . The identification of toxigenic ribotype 002 in 2009 was temporally related to a significant increase in both the incidence of toxigenic C. difficile from 0.53 to 0.95 per 1,000 admissions (p < 0.001) and the rate of positive detection from 4.17% to 6.28% (p < 0.001) between period 1 (2004-2008) and period 2 (2009). This finding should alert both the physician and the infection control team to the establishment of and possible outbreaks by ribotype 002 in our hospitals, as in the case of ribotype 027.

There, but gone.

The author, a licensed marriage and family therapist, briefly describes his therapy with a male patient who had suicidal ideation over a broken relationship with a lover. The patient had agreed to at least a half-dozen "no-harm contracts" to not kill himself. However, the patient no-showed at his next visit, and was found by police to have taken his life. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The type-specific polysaccharides of Streptococcus suis.

Streptococcus suis types 1 and 2 were subjected to digestion with lysozyme. Serologically type-specific capsular polysaccharides were isolated from the lysates by ethanol precipitation followed by Sepharose 6B chromatography. The purified type 1 polysaccharide has a Kd value of 0.074 on a Sepharose 4B column and contains galactose, glucose, N-acetyl glucosamine, N-acetyl galactosamine, and sialic acid in a molar ratio of 2.42:1.00:1.00:1.13:1.39. The type 2 polysaccharide has a Kd value of 0.185 and is composed of rhamnose, galactose, glucose, N-acetyl glucosamine, and sialic acid in a molar ratio of 1.07:3.17:1.00:0.94:1.00. A comparison is drawn between the type polysaccharides of S. suis and those of group B streptococci.

Isolation of type-specific polysaccharide antigen from group B type Ib streptococci.

Group B streptococcus type Ib (strain H36B) was subjected to digestion with extracellular muralytic enzymes prepared from Streptomyces albus. Type Ib-specific polysaccharide antigen was isolated from the lysate by alcohol precipitation and Sepharose 6B chromatography. The purified type Ib antigen has a Kd value of 0.31 on a Sepharose 4B column and contains four sugars, galactose, glucose, N-acetyl glucosamine, and sialic acid in a molar ratio of 2.05:0.86:1.00:0.90. Acid treatment (pH 2.0) of this polysaccharide results in partial degradation of the antigen (Kd = 0.41 on Sepharose 4B) with the loss of 93% of the sialic acid. The molar ratio of the remaining sugars in the polysaccharide remains identical to that in the native one. This suggests that the sialic acid is at the terminal position in the molecule. Both intact and acid-treated antigen cross-react with some type Ia and type Ic antisera as a result of the common Iabc determinant, but not with type II and type III antisera. Absorption studies indicate that Ib-specific determinant and Iabc determinant are on the same molecule and that sialic acid is not the cross-reactive determinant.

Gonococcal pili. Primary structure and receptor binding domain.

The complete amino acid sequence of pilin from gonococcal strain MS11 and the sequence of constant and variable regions from strain R10 pilin have been determined in order to elucidate the structural basis for adherence function, antigenic diversity, and polymeric structure. The MS11 pilin sequence consists of 159 amino acids in a single polypeptide chain with two cysteines in disulfide linkage and serine-bonded phosphate residues. TC-2 (31-111), a soluble monomeric pilus peptide prepared by arginine-specific digestion, bound human endocervical, but not buccal or HeLa cells and therefore is postulated to encompass the receptor binding domain. Variable regions of CNBr-3 appear to confer antigenic diversity and comprise segments in which changes in the position of charged residues occur in hydrophilic, beta-turns. Residues 2-21 and 202-221 of gonococcal pilins and lower eucaryotic actins, respectively, exhibit 50% homology. When these residues are arranged at intervals of 100 degrees of arc on "helical wheels," the identical amino acids comprise a hydrophobic face on one side of the helix. This observation, the hydrophobic character of this region and the tendency for TC-1 (residues 1-30) to aggregate in water, suggest that this stretch interacts with other subunits to stabilize polymeric structure.

Polarity-variable birefringence on hyperlens structure.

A variable birefringence effect has been observed with 1D PMMA surface gratings on a gold film substrate. By changing the operation wavelength on the Au film, the birefringence value Δn(eff) changes from positive to negative. The result verified that this uniaxial crystal-like plasmonic surface gratings showed good superlensing effect at 515 nm when PMMA width:Air width=1:1 where the absolute value of Δn(eff) is relatively large.

Item analysis for the written test of Taiwanese board certification examination in anaesthesiology using the Rasch model.

BACKGROUND: On the written test of board certification examination for anaesthesiology, the probability of a question being answered correctly is subject to two main factors, item difficulty and examinee ability. Thus, item analysis can provide insight into the appropriateness of a particular test, given the ability of examinees. METHODS: Study subjects were 36 Taiwanese examinees tested with 100 questions related to anaesthesiology. We used the Rasch model to perform item analysis of questions answered by each examinee to assess the effects of question difficulty and examinee ability using a common logit scale. Additionally, we evaluated test reliability and virtual failure rates under different criteria. RESULTS: The mean examinee ability was higher than the mean item difficulty in this written test by 1.28 (sd=0.57) logit units, which means that the examinees, on average, were able to correctly answer 78% of items. The difficulty of items decreased from 4.25 to -2.43 on the logit scale, corresponding to the probability of having a correct answer from 5% to 98%. There were 60 items with difficulty lower than the least able examinee and seven difficult items beyond the most able one. The agreement of item difficulty between test developers and our Rasch model was poor (weighted kappa=0.23). CONCLUSIONS: We demonstrated how to assess the construct validity and reliability of the written examination in order to provide useful information for future board certification examinations. The study was approved by the institutional review board with the following trial registered number: VGHIRB No. 97-08-14A.

The Family Education Diabetes Series (FEDS): community-based participatory research with a midwestern American Indian community.

Indigenous people around the globe tend to struggle with poorer health and well-being than their non-indigenous counterparts. One area that this is especially evident is in the epidemic of diabetes in North America's American Indians (AIs) - who evidence higher prevalence rates and concomitant disease-related complications than any other racial/ethnic group. As researchers and AI communities work together to transcend conventional top-down, service-delivery approaches to care, community-based participatory research is beginning to show promise as a way to partner contemporary biomedical knowledge with the lived-experience, wisdom, and customs of Indigenous people. This study describes the Family Education Diabetes Series (FEDS) as an example of such effort, and highlights pilot findings assessing its value and impact across key diabetes-relevant variables. Following 36 intervention participants across baseline, 3-month, and 6-month time periods, data show significant improvements in weight, blood pressure, and metabolic control (A1c). Strengths and limitations of this investigation are presented, along with suggestions about how to further advance and empirically test the work across other Indigenous communities.

The effect of metabolic risk factors on the natural course of gastro-oesophageal reflux disease.

BACKGROUND AND AIMS: The effect of metabolic risk factors on the natural course of gastro-oesophageal reflux disease (GORD), which remains elusive, was quantified. METHODS: The population included 3669 subjects undergoing repeated upper endoscopy. Data were analysed using a three-state Markov model to estimate transition rates (according to the Los Angeles classification) regarding the natural course of the disease. Individual risk score together with the kinetic curve was derived by identifying significant factors responsible for the net force between progression and regression. RESULTS: During three consecutive study periods, 12.2, 14.9 and 17.9% of subjects, respectively, progressed from non-erosive to erosive disease, whereas 42.5, 37.3 and 34.6%, respectively, regressed to the non-erosive stage. The annual transition rate from non-erosive to class A-B disease was 0.151 per person year (95% CI 0.136 to 0.165) and from class A-B to C-D was 0.079 per person year (95% CI 0.063 to 0.094). The regression rate from class A-B to non-erosive disease was 0.481 per person year (95% CI 0.425 to 0.536). Class C-D, however, appeared to be an absorbing state when not properly treated. Being male (relative risk (RR) 4.31; 95% CI 3.22 to 5.75), smoking (RR 1.20; 95% CI 1.03 to 1.39) or having metabolic syndrome (RR 1.75; 95% CI 1.29 to 2.38) independently increased the likelihood of progressing from a non-erosive to an erosive stage of disease and/or lowered the likelihood of disease regression. The short-term use of acid suppressants (RR 0.54; 95% CI 0.39 to 0.75) raised the likelihood of regression from erosive to non-erosive disease. CONCLUSIONS: Intraoesophageal damage is a dynamic and migratory process in which the metabolic syndrome is associated with accelerated progression to or attenuated regression from erosive states. These findings have important implications for the design of effective prevention and screening strategies.