Barrett's esophagus in scleroderma: Increased prevalence and radiographic findings

Ten of 27 patients (37%) with scleroderma who underwent endoscopy at our hospital between 1980 and 1984 for symptoms of reflux esophagitis had biopsy-proven Barrett's esophagus. Two of those 10 patients had esophageal adenocarcinomas. In a blinded review of esophagrams (all but 2 using double-contrast technique) from 16 of the 27 patients, only 1 patient was thought to be at high risk for Barrett's esophagus due to a high esophageal stricture with an adjacent reticular pattern of the mucosa. The latter patient had biopsy-proven Barrett's mucosa. Eight patients were thought to be at moderate risk for Barrett's esophagus due to reflux esophagitis and/or distal strictures in 6 and polypoid intraluminal masses in 2. Three of the 6 patients with esophagitis and/or strictures had Barrett's esophagus, and both patients with masses had adenocarcinomas arising in Barrett's mucosa. Finally, 7 patients who had no esophagitis or strictures were thought to be at low risk for Barrett's esophagus. None of those 7 had histologic evidence of Barrett's mucosa. Thus, the major value of double-contrast esophagography is its ability to classify patients into high-, moderate-, and low-risk for Barrett's esophagus to determine the relative need for endoscopy and biopsy in these patients.     

Radiologic diagnosis of Barrett's esophagus: Critical analysis of 65 cases

A recent increase in the number of Barrett's esophagis being diagnosed is probably directly related to a proportional increase in endoscopic biopsies of the esophagus and awareness of premalignant potential of Barrett's mucosa. While the endoscopist can detect Barrett's mucosa with fair degree of accuracy, the radiologic diagnosis of Barrett's esophagus still remains a diagnostic challenge despite several well established radiologic features. We reviewed 65 patients with pathologically proven Barrett's esophagus and found a wide spectrum of radiologic features. These include hiatus hernia in 49, gastroesophageal reflux in 38, strictures in 32, esophagitis in 20, and characteristic Barrett's ulcer in 12. In addition ascending or migrating strictures were found in 10, mucosal pattern simulating areae gastricae in 5, cricopharyngeal dysfunction in 4, and fixed spiral folds in 3 patients. This constellation of radiologic features, some of which have not been previously emphasized, should further assist radiologists in suggesting the diagnosis of Barrett's esophagus.     

Barrett's esophagus occurring as a complication of scleroderma

Two patients had both scleroderma and a columnar epithelium-lined lower esophagus (Barrett esophagus). Features of Barrett's esophagus included high esophageal strictures in both patients and ulcer craters in the columnar area of one. Biopsy confirmed columnar epithelium in the lower esophagus of each patient. In these patients, the Barrett esophagus probably was a complication of scleroderma and resulted from long-standing gastroesophageal reflux.     

Barrett食管的氩离子凝固术或激光治疗

复习国外氩离子凝固术 (Argonplasmacoagulation ,APC)或激光治疗Barrett食管的有关文献资料结果表明 :APC联合高剂量奥美拉唑或腹腔镜抗反流术治疗BE安全、有效 ;单用激光或联合奥美拉唑治疗Barrett食管 (Barrett’sesopha gus ,BE)患者的肠化上皮消失。因此APC或激光可用于BE的治疗     

Infiltrating carcinoma simulating achalasia

Three cases of carcinoma infiltrating the esophagus and simulating achalasia are presented and the differential diagnostic problems discussed. The radiologic distinction between achalasia and carcinoma can be extremely difficult. Any rigidity, irregularity, nodularity, or ulceration of the distal-most esophagus or gastric fundus or symptoms of short duration in older patients should alert the radiologist to the possibility of carcinoma. It is suggested that all patients with suspected achalasia undergo esophageal and gastric endoscopy with biopsy and esophageal manometry to confirm the diagnosis, expecially if pneumatic dilatation is contemplated.     

Radiologic demonstration of multiple foci of malignancy in the esophagus

Three patients, each with two synchronous esophageal carcinomas demonstrated radiologically, are presented. The importance of complete esophageal evaluation in patients with one obvious tumor of the esophagus is emphasized. Assessment of the full extent of disease in such cases directly affects treatment planning.     

Cervical esophageal web associated with a patch of heterotopic gastric mucosa

Cervical esophageal webs are a relatively common finding on esophograms. We report a web resulting from the squamocolumnar junction produced by heterotopic gastric mucosa. The clinical significance of this lesion is discussed and the importance of differentiating it from Barrett's esophagus is stressed.     

Circumferential web of the upper esophagus

Two patients with circumferential webs of the upper esophagus are presented. Both patients had a long history of intermittent dysphagia, particularly with solid food. The clinical, endoscopic, and radiologic features of these webs are discussed.     

Barrett食管患者幽门螺杆菌感染率的Meta分析

目的分析Barrett食管患者幽门螺杆菌感染率及caga阳性的幽门螺杆菌感染率，并与内镜检查正常者和胃食管反流病患者比较，探讨幽门螺杆菌（Helicobacter pylori，Hp）感染与Barrett食管的关系。方法计算机检索MEDLINE和EMbase数据库至2008年2月，纳入比较Barrett食管患者和内镜检查正常者及胃食管反流病（gastroesophageal reflux disease，GERD）患者Hp感染率的病例对照研究或队列研究。统计分析采用RevMan4．2．8，计算比值比OR（95％CI）。结果共纳入19篇文献，包括16篇病例对照研究和3篇队列研究。病例对照研究分析结果显示，Barrett食管患者比内镜检查正常者Hp感染率低[OR0．56，95％CI（0．40，0．79）]，与GERD患者相比差异无统计学意义[OR0．86，95％CI（0．74，1．00）]。队列研究的分析结果显示，Barrett食管患者与内镜检查正常者及GERD患者相比Hp感染率差异无统计学意义[OR1．12，95％CI（0．77，1．61）；OR1．10，95％CI（0．32，3．83）]。cagA阳性Hp感染率较内镜正常者及GERD患者低[OR0．30，95％CI（0．12，0．74）；OR0．55，95％CI（0．33，0．94）]。病例对照研究长节段较短节段Barrett食管Hp感染率低[OR0．32，95％CI（0．16，0．66）]。而队列研究结果显示，长节段较短节段Barrett食管患者Hp感染率差异无统计学意义[OR0．66，95％CI（0．29，1．48）]。结论Barrett食管患者和GERD患者Hp感染率无差别，Barrett食管患者Hp感染率，特别是cagA阳性Hp菌株感染率较内镜检查正常者明显减少。     

Radiologic manifestations of iatrogenic changes of the esophagus

The review of the roentgen manifestations of iatrogenic changes in the esophagus permits their grouping into two major categories of intentional and nonintentional alterations. In the first group, iatrogenic changes are encountered following reconstructive or other types of surgery, radiotherapy, and their respective complications. Nonintentional changes of the esophagus include injuries induced during diagnostic procedures, life-saving measures, and drug therapy. The knowledge of the spectra of possible iatrogenic alterations is important for accurate radiologic evaluation of the patients and the recognition of complications.     

Epidemiology of Barrett's esophagus--comparison of Japan and the West

We compared the epidemiology of Barrett's esophagus in Japan and the West. Japan GERD Society Study Committee conducted the epidemiological survey in 2,595 patients who underwent endoscopy the first time, confirming that Barrett's mucosa was observed in 536 patients (20.8%) out of 2,577. But Barrett's esophagus (>3 cm of columnar lined epithelium) was detected only 5 (0.2%). The prevalence of typical Barrett's esophagus was markedly low in Japanese compared with Westerners. In Western, the incidence of Barrett's esophagus has increased markedly since the 1970s. It is estimated that Barrett's esophagus is found in approximately 6-12% of patients undergoing endoscopy for symptoms of GERD and in 1% or less of unselected patient populations undergoing endoscopy.     

Increased DNA adducts in Barrett's esophagus and reflux-related esophageal malignancies

BACKGROUND: DNA adduct formation can initiate carcinogenic processes. AIM: To examine the pre-malignant condition of Barrett's esophagus by measuring the DNA adducts. METHODS: DNA adducts were measured in the proximal and distal esophagus of patients with Barrett's esophagus (n = 9), patients with adenocarcinoma in the distal esophagus/esophagogastric junction (n = 28), and in control group of patients (n = 8) using the 32-P-postlabeling method. The average levels of DNA adducts are expressed as mean adducts/10(9) nucleotides + standard error of the mean. RESULTS. The average DNA adduct levels in the distal esophagus were significantly higher in both the Barrett's esophagus (24.5 +/- 7.9) and the adenocarcinoma (12.0 + 3.0) than in the control patients (0.1 +/- 0.08), P < 0.001. In the proximal esophagus, the DNA adduct levels were approximately equal in the Barrett's esophagus (7.0 +/- 1.0) and in the adenocarcinoma group (6.4 +/- 0.65). However, the levels in the proximal esophagus in both groups were significantly higher than in the control group (2.1 +/- 0.67), P < 0.05. CONCLUSIONS: Patients with Barrett's esophagus and patients with esophageal/esophagogastric junction adenocarcinoma had significantly more DNA adducts than the control group. These results support the current concept of the carcinogenic potential of chronic gastroesophageal reflux, and the pre-malignant condition of Barrett's esophagus.     

Clinical outline of Barrett's esophagus

Barrett's esophagus is one of the important gastrointestinal disease in Europe and the United States. It was recognized as not only complication of reflux esophagitis, but also pre-malignant lesion of adenocarcinoma. Recently, realization of Barrett's esophagus is attentioned in Japan, because increasing of reflux esophagitis for westernization of eating habit, living habit and aging of the population. In this section, we present general consideration and clinical research of Barrett's esophagus. We expect Barrett's esophagus will gradually increase near the future and need to research abundantly about controversial point of Barrett's esophagus. We also think it is important to accumulate intensively the clinical data of Barrett's esophagus patients.     

Methylene blue chromoendoscopy for the detection of Barrett's esophagus in a Greek cohort

BACKGROUND AND STUDY AIMS: Specialized columnar epithelium of Barrett's esophagus is a precursor of dysplasia and adenocarcinoma, and methylene blue selectively stains this type of epithelium. The present prospective study examined the detection of short-segment and long-segment Barrett's esophagus using methylene blue chromoendoscopy-directed biopsies, in comparison with biopsies directed using conventional endoscopic criteria. PATIENTS AND METHODS: Biopsies were obtained from macroscopically conspicous areas in the distal esophagus observed during conventional endoscopy in a total of 975 patients. Immediately after conventional biopsies, the distal esophagus was sprayed with methylene blue and directed biopsies were then obtained from the stained regions. All patients with a histologically established Barrett's esophagus underwent a second upper gastrointestinal endoscopy within 1 year in order to assess the reproducibility of the method. RESULTS: In a total of 3,900 conventional biopsy specimens (without staining), 54 specimens (1.4%) were found to show Barrett's esophagus and were confined to 16 of the 975 patients (1.6%). Of the total 130 directed biopsy specimens obtained during chromoendoscopy, 114 (87.7%) revealed Barrett's esophagus (P<0.00001) and were confined to 35 of the 975 patients (3.5%; P < or = 0.001). The findings were confirmed within 1 year in all dye-positive patients. CONCLUSIONS: Chromoendoscopy with methylene blue appears to be an accurate, simple, safe, inexpensive, and reproducible method of detecting specialized columnar epithelium in Barrett's esophagus.     

Barrett's esophagus and esophageal adenocarcinoma: the scope of the problem

Conclusion Barrett's esophagus is probably a more common condition than previously recognized. Although the classic radiologic findings of Barrett's esophagus are present in only a small percentage of patients, this condition should be suspected whenever reflux esophagitis or peptic strictures are demonstrated on double-contrast esophagography. Recent literature also suggests that Barrett's carcinomas comprise up to 50% of all esophageal cancers. Because of the increased risk of developing adenocarcinoma in Barrett's esophagus, endoscopic surveillance has been advocated to detect dysplastic or carcinomatous changes at the earliest possible stage. When barium studies are performed on patients with known Barrett's esophagus, the radiographs should be carefully evaluated for signs of early adenocarcinoma, so these patients can be referred for appropriate management prior to the development of advanced, unresectable tumors.     

Aphthoid esophageal ulcers in Crohn's disease of ileum and colon

We report 4 cases of tiny aphthous ulcers of the esophagus occurring in patients with confirmed Crohn's disease of the terminal ileum and the colon. These ulcers presented as small collections of barium surrounded by a radiolucent halo, and were demonstrable on double-contrast radiographs of the esophagus. They were located in the middle and distal thirds of the otherwise normal esophagus. A more advanced stage of Crohn's ileocolitis was present in these patients.     

Tuberculous fistulas of the pharynx and esophagus

Four patients with tuberculous fistulas communicating with the pharynx or the esophagus are reported. In 1 patient, there was strong evidence to suggest primary involvement of the esophageal mucosa. The other 3 cases were related to involvement of the pharynx or the esophagus from adjacent tuberculous process, as confirmed by histopathological proof.The patients had varying degrees of symptoms, which in two dramatically responded to antituberculous therapy; the third patient needed surgery for complete cure and the last patient was lost to follow-up.     

Barrett's esophagus: Clinical issues

Barrett's esophagus has been defined conceptually as the condition in which any extent of metaplastic columnar epithelium that predisposes to cancer development replaces the stratified squamous epithelium that normally lines the distal esophagus. The condition develops as a consequence of gastroesophageal reflux disease. Barrett's metaplasia has clinical importance primarily because of its malignant predisposition, and virtually all of the contentious clinical issues in Barrett's esophagus are related in some way to its cancer risk. This article considers some key clinical issues that impact the management of patients with Barrett's esophagus.     

Localized saccular dilatation of the esophagus: An unusual cause of dysphagia

Two young women who had undergone resection of an esophageal enteric cyst subsequently developed saccular dilatation of the esophagus. The abnormality was localized to the site of previous surgery and caused dysphagia in both patients.     

Methylene blue staining of dysplastic and nondysplastic Barrett's esophagus: an in vivo and ex vivo study

BACKGROUND AND STUDY AIMS: Methylene blue selectively stains specialized columnar epithelium in Barrett's esophagus with high accuracy. We prospectively evaluated the methylene blue staining properties of dysplastic and nondysplastic Barrett's esophagus and the association of these properties with the risk for dysplasia and cancer. PATIENTS AND METHODS: In a ex vivo study, we mapped, photographed, and sampled esophagectomy specimens with high grade dysplasia and/or early adenocarcinoma before and after methylene blue staining. In a concurrent in vivo study, we performed methylene blue staining and characterized methylene blue stain characteristics. Pathologists estimated the proportion of specialized columnar epithelium in each specimen and graded dysplasia. RESULTS: We examined 551 biopsies from 47 patients with biopsy-proven Barrett's esophagus and 48 sections from five surgical specimens with Barrett's esophagus and dysplasia and early adenocarcinoma. The accuracy of ex vivo and in vivo methylene blue staining for specialized columnar epithelium was 87% and 90%, respectively. It was influenced by the length of Barrett's esophagus, biopsy location, and the presence of esophagitis and/or dysplasia. Light to absent staining (p = 0.01) and moderate to marked heterogeneity (p = 0.01) were significantly associated with high grade dysplasia or cancer in the univariate analysis and in a multivariate model that adjusted for the length of Barrett's esophagus and the presence of a lesion. These staining characteristics were present in all patients with severe dysplasia and/or adenocarcinoma. CONCLUSIONS: Highly dysplastic or malignant Barrett's esophagus stains differently with methylene blue. Increased heterogeneity and decreased methylene blue stain intensity are significant independent predictors of high grade dysplasia and/or cancer. These features may help to direct biopsies in patients without a lesion.