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1.
Background
Two types of ectopic Cushing syndrome (ECS) are described: ECS associated with aggressive neoplasms, and ECS with indolent and occult tumors, however, there is a lack of studies that thoroughly review their characteristics.Methods
A systematic review was carried out on PUBMED of all the papers about the ECS, in order to better define the types of this subcategory of Cushing’s syndrome, highlighting the differential aspects between these subgroups.Results
It was found that in 50% of cases the prototypic “aggressive” ECS is caused by small cell lung carcinomas (SCLC). In these cases, the clinical presentation may be atypical, predominating the signs and symptoms derived from the protein catabolism. Cortisol and ACTH levels are extremely high, the clinical presentation is abrupt (<?3–6 months) and the tumor is usually advanced, being impossible a curative treatment. On the other hand, “indolent” ECS is mainly represented by carcinoid tumors (CT). In these cases the clinical presentation overlaps enormously with that of Cushing’s disease (CD). Cortisol and ACTH levels are slightly elevated, the clinical presentation is progressive (>?6 months) and the prognosis is usually good, and a curative treatment is possible in about 75% of the cases.Conclusion
Although there is no absolute differentiation between the two extremes of ECS, a classification could be established in two groups, guided by its clinical and biochemical characteristics, and mainly by the type and stage of the ACTH-secreting tumor. However, a small percentage of tumors do not fit in this simple grouping, and may present both phenotypes or an intermediate one.2.
Purpose of Review
In this review, we discuss current diagnostic testing modalities for both gastroesophageal reflux disease (GERD) and eosinophilic esophagitis (EoE) and then introduce mucosal impedance (MI), a novel technology that measures epithelial integrity in real time during endoscopy. We describe the advantages and disadvantages of MI as compared with traditional diagnostic testing.Recent Findings
We review studies that demonstrate that GERD and EoE have distinct MI patterns, and that physicians can accurately diagnose and distinguish the two during endoscopy with minimal time added to the procedure. We also review studies showing that MI has the capability to assess treatment response in both GERD and EoE and that it can be used to diagnose GERD in patients with extraesophageal reflux symptoms.Summary
Mucosal impedance testing is a major advancement in the diagnosis of GERD and EoE. Future studies are planned to assess whether MI can be used as a treatment endpoint in EoE and whether it can be used to predict response to anti-reflux surgery.3.
Shi-wang Wen Yue-feng Zhang Yong Li Yan-zhao Xu Zhen-hua Li Huilai Lü Yong-gang Zhu Zhen-xu Liu Zi-qiang Tian 《Digestive diseases and sciences》2018,63(9):2285-2293
Background
This study was designed to explore the anticancer potential of isoalantolactone, a sesquiterpene lactone, on esophageal squamous cell carcinoma (ESCC) cells and associated molecular mechanisms.Methods
ESCC cell lines were treated with isoalantolactone or vehicle and tested for viability, proliferation, cell cycle distribution, and apoptosis. Xenograft tumor studies in nude mice were done to examine the in vivo anticancer effect of isoalantolactone.Results
Isoalantolactone treatment reduced ESCC cell viability and proliferation in vitro, which was coupled with induction of G0/G1 cell cycle arrest and apoptosis. In vivo studies confirmed the growth-suppressive effect of isoalantolactone on ESCC cells. Mechanistically, isoalantolactone reversed microRNA-21-mediated repression of programmed cell death 4 (PDCD4). Overexpression of microRNA-21 and knockdown of PDCD4 blocked the growth suppression and apoptosis induction by isoalantolactone in ESCC cells.Conclusions
Isoalantolactone shows growth-suppressive activity against ESCC cells, which is ascribed to upregulation of PDCD4 via downregulation of microRNA-21.4.
Eboni G. Price-Haywood Katherine G. Roth Kit Shelby Lisa A. Cooper 《Journal of general internal medicine》2010,25(2):126-129
BACKGROUND
Low health literacy (HL) is an important risk factor for cancer health disparities.OBJECTIVE
Describe a continuing medical education (CME) program to teach primary care physicians (PCP) cancer risk communication and shared decision-making (SDM) with low HL patients and baseline skills assessment.DESIGN
Cluster randomized controlled trial in five primary care clinics in New Orleans, LA.PARTICIPANTS
Eighteen PCPs and 73 low HL patients overdue for cancer screening.INTERVENTION
Primary care physicians completed unannounced standardized patient (SP) encounters at baseline. Intervention physicians received SP verbal feedback; academic detailing to review cancer screening guidelines, red flags for identifying low HL, and strategies for effective counseling; and web-based tutorial of SP comments and checklist items hyperlinked to reference articles/websites.MAIN MEASURES
Baseline PCP self-rated proficiency, SP ratings of physician general cancer risk communication and SDM skills, patient perceived involvement in care.RESULTS
Baseline assessments show physicians rated their proficiency in discussing cancer risks and eliciting patient preference for treatment/decision-making as “very good”. SPs rated physician exploration of perceived cancer susceptibility, screening barriers/motivators, checking understanding, explaining screening options and associated risks/benefits, and eliciting preferences for screening as “satisfactory”. Clinic patients rated their doctor’s facilitation of involvement in care and information exchange as “good”. However, they rated their participation in decision-making as “poor”.DISCUSSION
The baseline skills assessment suggests a need for physician training in cancer risk communication and shared decision making for patients with low HL. We are determining the effectiveness of teaching methods, required resources and long-term feasibility for a CME program.5.
Bhaskarjyoti Baruah Tarun Kumar Prasenjit Das Bhaskar Thakur Vishnubatla Sreenivas Vineet Ahuja Siddhartha Datta Gupta Govind K. Makharia 《Indian journal of gastroenterology》2017,36(5):353-360
Background
Eosinophilic esophagitis (EoE) is being recognized increasingly all over the globe; Indian data is however sparse. We screened patients with symptoms of gastroesophageal reflux disease (GERD) for presence of EoE in them.Methods
Consecutive patients with symptoms suggestive of GERD underwent gastroduodenoscopy and esophageal biopsies, obtained from both the upper esophagus (5 cm below the upper esophageal sphincter) and lower esophagus (5 cm above gastroesophageal junction), as well as from any other endoscopically visible abnormal mucosa. Demographic and clinical characteristics, endoscopic findings, peripheral blood eosinophilic count, and history of use of proton-pump inhibitors (PPIs) were analyzed. Stool examination was done to rule out parasitoids. EoE was diagnosed if number of mucosal eosinophil infiltrate was >20 per high-power field. In the latter, Warthin-Starry stain was performed to rule out presence of H elicobacter pylori.Results
Of 190 consecutive patients with symptoms of GERD screened, esophageal biopsies were available in 185 cases. Of them, 6 had EoE, suggesting a prevalence of 3.2% among patients with GERD. On univariate analysis, history of allergy, non-response to PPI, and absolute eosinophil counts and on multivariable analysis, history of allergy and no response to PPIs were significant predictors of EoE. Presence of EOE did not correlate with severity of reflux symptoms.Conclusion
In this hospital-based study from northern part of India, prevalence of EoE in patients with GERD was 3.2%. EoE should be considered as a diagnostic possibility, especially in those with history of allergy, no-response to PPI, and absolute eosinophil count of ≥250/cumm.6.
Heritage J Robinson JD Elliott MN Beckett M Wilkes M 《Journal of general internal medicine》2007,22(10):1429-1433
Context
In primary, acute-care visits, patients frequently present with more than 1 concern. Various visit factors prevent additional concerns from being articulated and addressed.Objective
To test an intervention to reduce patients’ unmet concerns.Design
Cross-sectional comparison of 2 experimental questions, with videotaping of office visits and pre and postvisit surveys.Setting
Twenty outpatient offices of community-based physicians equally divided between Los Angeles County and a midsized town in Pennsylvania.Participants
A volunteer sample of 20 family physicians (participation rate?=?80%) and 224 patients approached consecutively within physicians (participation rate?=?73%; approximately 11 participating for each enrolled physician) seeking care for an acute condition.Intervention
After seeing 4 nonintervention patients, physicians were randomly assigned to solicit additional concerns by asking 1 of the following 2 questions after patients presented their chief concern: “Is there anything else you want to address in the visit today?” (ANY condition) and “Is there something else you want to address in the visit today?” (SOME condition).Main Outcome Measures
Patients’ unmet concerns: concerns listed on previsit surveys but not addressed during visits, visit time, unanticipated concerns: concerns that were addressed during the visit but not listed on previsit surveys.Results
Relative to nonintervention cases, the implemented SOME intervention eliminated 78% of unmet concerns (odds ratio (OR)?=?.154, p?=?.001). The ANY intervention could not be significantly distinguished from the control condition (p?=?.122). Neither intervention affected visit length, or patients’; expression of unanticipated concerns not listed in previsit surveys.Conclusions
Patients’ unmet concerns can be dramatically reduced by a simple inquiry framed in the SOME form. Both the learning and implementation of the intervention require very little time.7.
Purpose of Review
Investigation of the esophageal microbiome is a relatively new field. This review will outline data characterizing the esophageal microbiome in both health and disease states, including gastroesophageal reflux disease (GERD), Barrett’s esophagus, esophageal cancer, eosinophilic esophagitis, and motility disorders.Recent Findings
While the esophagus was previously considered devoid of a significant bacterial population, development of culture-independent techniques, specifically 16S rRNA gene sequencing, as well as novel, minimally invasive microbial sampling modalities, has facilitated characterization of the esophageal microbiome in both health and several disease states. Although limited, there is evidence that the esophagus contains a diverse microbial population, with Gram-positive bacteria, specifically Streptococcus, dominating in health, while Gram-negative bacteria prevail in reflux disorders including GERD and Barrett’s esophagus. The microbiome is altered with other esophageal disorders as well, including eosinophilic esophagitis and esophageal motility disorders, though these changes have been less well characterized.Summary
Characterization of the gut microbiome has advanced significantly; however, further investigation is essential. Understanding changes in the esophageal microbiome could affect our understanding of the natural history of diseases of the esophagus and present potential therapeutic approaches.8.
Nobuo Omura Fumiaki Yano Kazuto Tsuboi Masato Hoshino SeRyung Yamamoto Shunsuke Akimoto Takahiro Masuda Hideyuki Kashiwagi Katsuhiko Yanaga 《Esophagus》2018,15(4):217-223
Background
Surgical results of GERD have mainly been reported from the Western countries, with a few reports found in Japan. We examined the surgical results of laparoscopic Toupet fundoplication and clarify the characteristics of recurrent cases.Methods
The subjects included 375 patients who underwent laparoscopic Toupet fundoplication from June 1997 to December 2016 as the initial surgery. Patient characteristics, pathophysiology, and surgical results were examined. In addition, we compared the patient characteristics and pathophysiology of recurrent cases in comparison with non-recurrent cases.Results
Age 59 (43–70) and male 211 (56.3%). The operation time was 141 min (113–180) and intraoperative complications were found to have onset in 13 subjects (3.5%). Dysphagia after surgery was found in 18 cases (4.8%). The A factor (the degree of hiatal hernia), P factor (the degree of esophagitis), and pH?<?4 holding time significantly improved after surgery compared with prior to surgery (p?<?0.001 for all), while the LES lengths and abdominal LES lengths were extended (p?<?0.001 for each). Recurrence was found in 48 patients (15.1%) among the 318 patients for whom we could confirm the presence or absence of recurrence. The A factor, P factor, and pH?<?4 holding time prior to surgery were, respectively, higher in the recurrence group (p?=?0.031, p?<?0.001, p?<?0.001).Conclusions
Laparoscopic Toupet fundoplication for GERD could be performed safely, with a response rate as good as 85%. Compared with non-recurrent cases, preoperative clinical conditions such as esophageal hiatal hernia, reflux esophagitis, and acid reflux time were all advanced in recurrent cases.9.
Lingling Chen Sujie Ni Mei Li Chaoyan Shen Zhipeng Lin Yu Ouyang Fei Xia Li Liang Wenyan Jiang Runzhou Ni Jianguo Zhang 《Digestive diseases and sciences》2017,62(2):387-395
Background
BCCIP was originally identified as a BRCA2 interacting protein in humans and Ustilago maydis. It had low expression in some human cancer tissues. However, recent research indicated that many caretaker genes are also necessary for cell viability and their expression could contribute to tumor progression.Aim
To characterize whether BCCIP is a caretaker gene in esophageal squamous cell carcinoma (ESCC).Methods
Western blotting and immunohistochemistry were used to measure the expression of BCCIP β. In vitro studies were used to verify the effects of BCCIP β in Eca109 cells.Results
Expression of BCCIP β was notably higher in tumor tissues of ESCC and Eca 109 cells. Meanwhile, the immunohistochemistry stain revealed that BCCIP β was positively correlated with clinical pathologic variables such as tumor size and tumor grade, as well as Ki-67, and prompted poor prognosis. In vitro studies such as starvation and refeeding assay along with BCCIP β-shRNA transfection assay demonstrated that BCCIP β expression promoted proliferation of ESCC cells. In addition, BCCIP β downregulation by silencing RNA significantly decreased the rate of colony formation, alleviated cellular apoptosis and increased the chemosensitivity of cisplatin.Conclusions
This research first put forward that BCCIP β is an oncogene in human ESCC and contributes to the poor outcome of the deadly disease.10.
Rakesh Kalapala Harshal Shah Zaheer Nabi Santosh Darisetty Rupjyoti Talukdar D. Nageshwar Reddy 《Indian journal of gastroenterology》2017,36(5):337-342
Background
Gastroesophageal reflux disease (GERD) is the most common chronic gastrointestinal disorder, affecting one third of the population worldwide. Recently, there has been a renewed interest in Stretta therapy in view of potential long-term side effects of PPIs and the durability of relief with fundoplication.Method
Prospective randomized study comparing the Stretta treatment with controls receiving PPIs. Patient (>?18 years, n = 20) with symptoms of heartburn, regurgitation, abnormal esophageal acid exposure (≥?4%), and endoscopically confirmed esophagitis were included into the study. The primary measure was improvement in quality of life (QOL) and decrease in the frequency and severity of GERD symptoms.Results
The mean age of the patients was 39 (±?15) years and controls were 34 (±?11) years. Three months after Stretta, 80% reported improvement in QOL compared to 40% in the control group. At the end of 3 months, significant (p < 0.05) improvement in GERD symptom score for heartburn, regurgitation, chest pain, and cough compared with the control group was observed. After Stretta treatment, 60% of the patients were free of PPIs whereas there was no change in the control group. Almost 80% of the patients on Stretta treatment were satisfied with the treatment compared to 30% of the patients in the control group.Conclusion
Stretta was effective in the short-term for the management of GERD.11.
Shira Maguen Erin Madden Beth Cohen Daniel Bertenthal Thomas Neylan Lisa Talbot Carl Grunfeld Karen Seal 《Journal of general internal medicine》2013,28(2):563-570
BACKGROUND
Obesity is a growing public health concern and is becoming an epidemic among veterans in the post-deployment period.OBJECTIVE
To explore the relationship between body mass index (BMI) and posttraumatic stress disorder (PTSD) in a large cohort of Iraq and Afghanistan veterans, and to evaluate trajectories of change in BMI over 3 years.DESIGN
Retrospective, longitudinal cohort analysis of veterans’ health recordsPARTICIPANTS
A total of 496,722 veterans (59,790 female and 436,932 male veterans) whose height and weight were recorded at the Department of Veterans Affairs (VA) healthcare system at least once after the end of their last deployment and whose first post-deployment outpatient encounter at the VA was at least 1 year prior to the end of the study period (December 31, 2011).MAIN MEASURES
BMI, mental health diagnoses.KEY RESULTS
Seventy-five percent of Iraq and Afghanistan veterans were either overweight or obese at baseline. Four trajectories were observed: “stable overweight” represented the largest class; followed by “stable obese;” “overweight/obese gaining;” and “obese losing.” During the 3-year ascertainment period, those with PTSD and depression in particular were at the greatest risk of being either obese without weight loss or overweight or obese and continuing to gain weight. Adjustment for demographics and antipsychotic medication attenuated the relationship between BMI and certain mental health diagnoses. Although BMI trajectories were similar in men and women, some gender differences were observed. For example, the risk of being in the persistently obese class in men was highest for those with PTSD, whereas for women, the risk was highest among those with depression.CONCLUSIONS
The growing number of overweight or obese returning veterans is a concerning problem for clinicians who work with these patients. Successful intervention to reduce the prevalence of obesity will require integrated efforts from primary care and mental health to treat underlying mental health causes and assist with engagement in weight loss programs.12.
S. Sujatha Umesh Jalihal Yashoda Devi N. Rakesh Pallavi Chauhan Shivani Sharma 《Indian journal of gastroenterology》2016,35(3):186-189
Aims and Objectives
The aim of this study is to compare surface pH in various parts of the oral cavity between patients with gastroesophageal reflux disease (GERD) and healthy controls.Methods
Using a flat pH meter sensor, fixed electrode pen type digital pH meter, oral pH levels were assessed at different mucosal sites among 34 GERD patients and 32 healthy controls. Salivary flow rates and buffering capacity were also assessed in them. A thorough oral examination was performed to screen for any oral and dental changes.Result
A significantly lower pH of 6.65?±?0.13 (mean?±?SD) was found in the GERD group compared to control group 7.23?±?0.12 (p?<?0.05). Least pH was found in the floor of the mouth 6.594?±?0.17 and highest in the lower labial mucosa among the GERD patients. Salivary flow rate and buffering capacity were low in these patients. Significant changes were noticed in the hard and soft tissues of the oral cavity among the GERD group.Conclusion
Oral mucosal pH is altered in GERD patients and may contribute to effects on the oral cavity.13.
Polly Hitchcock Noël Michael L. Parchman John W. WilliamsJr. John E. Cornell Lee Shuko John E. Zeber Lewis E. Kazis Austin F. S. Lee Jacqueline A. Pugh 《Journal of general internal medicine》2007,22(3):419-424
Background
Although multiple co-occurring chronic illnesses within the same individual are increasingly common, few studies have examined the challenges of multimorbidity from the patient perspective.Objective
The aim of this study is to examine the self-management learning needs and willingness to see non-physician providers of patients with multimorbidity compared to patients with single chronic illnesses.Design
This research is designed as a cross-sectional survey.Participants
Based upon ICD-9 codes, patients from a single VHA healthcare system were stratified into multimorbidity clusters or groups with a single chronic illness from the corresponding cluster. Nonproportional sampling was used to randomly select 720 patients.Measurements
Demographic characteristics, functional status, number of contacts with healthcare providers, components of primary care, self-management learning needs, and willingness to see nonphysician providers.Results
Four hundred twenty-two patients returned surveys. A higher percentage of multimorbidity patients compared to single morbidity patients were “definitely” willing to learn all 22 self-management skills, of these only 2 were not significant. Compared to patients with single morbidity, a significantly higher percentage of patients with multimorbidity also reported that they were “definitely” willing to see 6 of 11 non-physician healthcare providers.Conclusions
Self-management learning needs of multimorbidity patients are extensive, and their preferences are consistent with team-based primary care. Alternative methods of providing support and chronic illness care may be needed to meet the needs of these complex patients.14.
Kristina Maria Würth Stella Reiter-Theil Wolf Langewitz Sylvie Schuster 《Journal of general internal medicine》2018,33(11):1885-1891
Background
While the need to address language barriers to provide quality care for all is generally accepted, little is known about the complexities of decision-making around patients’ limited language proficiency in everyday clinical encounters.Objective
To understand how linguistic complexities shape cross-cultural encounters by incorporating the perspective of both, patients and physicians.Design
A qualitative hospital study with semi-structured interviews and participant-observation in a Swiss University Hospital. Thirty-two encounters were observed and 94 interviews conducted.Participants
Sixteen patients of Turkish and 16 of Albanian origin and all actors (administration, nurses, physicians, if required, interpreters) involved in the patients’ entire process.Main Approach
Interviews were audio-recorded and transcribed verbatim. A thematic content analysis was conducted using MAXQDA. For reporting, the COREQ guidelines were used.Key Results
Three themes were relevant to patients and physicians alike: Assessment of the language situation, the use of interpreters, and dealing with conversational limits. Physicians tend to assess patients’ language proficiency by their body language, individual demeanor, or adequacy of responses to questions. Physicians use professional interpreters for “high-stakes” conversations, and “get by” through “low-stakes” topics by resorting to bilingual family members, for example. Patients are driven by factors like fearing costs or the wish to manage on their own. High acceptance of conversational limits by patients and physicians alike stands in stark contrast to the availability of interpreters.Conclusions
The decision for or against interpreter use in the “real world” of clinical care is complex and shaped by small, frequently inconspicuous decisions with potential for suboptimal health care. Physicians occupy a key position in the decision-making to initiate the process of medical interpreting. The development and testing of a conceptual framework close to practice is crucial for guiding physicians’ assessment of patients’ language proficiency and their decision-making on the use of interpreting services.15.
Satoru Shikata Takeo Nakayama Hisakazu Yamagishi 《Journal of hepato-biliary-pancreatic sciences》2008,15(3):297-303
Background/Purpose
In this study, we conducted a limited survey of reports of surgical randomized controlled trials, using the consolidated standards of reporting trials (CONSORT) statement and additional check items to clarify problems in the evaluation of surgical reports.Methods
A total of 13 randomized trials were selected from two latest review articles on biliary surgery. Each randomized trial was evaluated according to 28 quality measures that comprised items from the CONSORT statement plus additional items. Analysis focused on relationships between the quality of each study and the estimated effect gap (“pooled estimate in meta-analysis” — “estimated effect of each study”).Results
No definite relationships were found between individual study quality and the estimated effect gap. The following items could have been described but were not provided in almost all the surgical RCT reports: “clearly defined outcomes”; “details of randomization”; “participant flow charts”; “intention-to-treat analysis”; “ancillary analyses”; and “financial conflicts of interest”. The item, “participation of a trial methodologist in the study” was not found in any of the reports.Conclusions
Although the quality of reporting trials is not always related to a biased estimation of treatment effect, the items used for quality measures must be described to enable readers to evaluate the quality and applicability of the reporting. Further development of an assessment tool is needed for items specific to surgical randomized controlled trials.16.
Jennifer N. Miller Paula Schulz Bunny Pozehl Douglas Fiedler Alissa Fial Ann M. Berger 《Sleep & breathing》2018,22(3):569-577
Purpose
Home sleep apnea testing (HSAT) has increased due to improvements in technology, accessibility, and changes in third party reimbursement requirements. Research studies using HSAT have not consistently reported procedures and methodological challenges. This paper had two objectives: (1) summarize the literature on use of HSAT in research of adults and (2) identify methodological strategies to use in research and practice to standardize HSAT procedures and information.Methods
Search strategy included studies of participants undergoing sleep testing for OSA using HSAT. MEDLINE via PubMed, CINAHL, and Embase with the following search terms: “polysomnography,” “home,” “level III,” “obstructive sleep apnea,” and “out of center testing.”Results
Research articles that met inclusion criteria (n?=?34) inconsistently reported methods and methodological challenges in terms of: (a) participant sampling; (b) instrumentation issues; (c) clinical variables; (d) data processing; and (e) patient acceptability. Ten methodological strategies were identified for adoption when using HSAT in research and practice.Conclusions
Future studies need to address the methodological challenges summarized in this paper as well as identify and report consistent HSAT procedures and information.17.
Isao Nozaki Shinji Hato Shinichirou Hori Norifumi Nishide Akira Kurita 《Esophagus》2016,13(2):195-199
Background
In spite of appropriate preparation, food residue that interferes with endoscopic examination is occasionally observed in an operated stomach. The present study aimed to elucidate the incidence of such food residue and determine its risk factors in gastric pull-up after esophagectomy.Methods
A total of 116 esophagectomized patients underwent the first postoperative endoscopy to survey their gastric pull-up with a median interval of 14 months (range 6–24) after the surgery. Fasting time was 13–16 h before the examination. The amount of food residue was retrospectively classified from Grade 0 (no food residue) to Grade 4 (a large amount of food residue) by two expert endoscopists.Results
Among the 116 patients, 73 patients were classified as Grade 0, 23 patients as Grade 1, 10 patients as Grade 2, 9 patients as Grade 3, and 1 patient as Grade 4. Food residue (≥Grade 2) that interfered with the examination was observed in 20 patients (17.2 %). There was no significant association between the food residue and patient baseline characteristics.Conclusion
The food residue interfering with postoperative endoscopic examination was observed in 17.2 % of all surveyed gastric pull-ups.18.
Kenichi Goda Junko Fujisaki Ryu Ishihara Manabu Takeuchi Akiko Takahashi Yasuhiro Takaki Dai Hirasawa Kumiko Momma Yuji Amano Kazuyoshi Yagi Hiroto Furuhashi Tomoki Shimizu Takashi Kanesaka Satoru Hashimoto Yoichiro Ono Taku Yamagata Junko Fujiwara Takane Azumi Masako Nishikawa Gen Watanabe Yasuo Ohkura Tsuneo Oyama 《Esophagus》2018,15(3):153-159
Aim and methods
The Japan Esophageal Society created a working committee group consisting of 11 expert endoscopists and 2 pathologists with expertise in Barrett’s esophagus (BE) and esophageal adenocarcinoma. The group developed a consensus-based classification for the diagnosis of superficial BE-related neoplasms using magnifying endoscopy.Results
The classification has three characteristics: simplified, an easily understood classification by incorporating the diagnostic criteria for the early gastric cancer, including the white zone and demarcation line, and the presence of a modified flat pattern corresponding to non-dysplastic histology by adding novel diagnostic criteria. Magnifying endoscopic findings are composed of mucosal and vascular patterns, and are initially classified as “visible” or “invisible.” Morphologic features were evaluated for “visible” patterns, and were subsequently rated as “regular” or “irregular,” and the histology, non-dysplastic or dysplastic, was predicted.Conclusion
We introduce the process and outline of the magnifying endoscopic classification.19.
Behnam Rabiee Nima Motamed Vahid Hosseini Gholam Reza Hemasi Mansooreh Maadi Farhad Zamani 《Esophagus》2016,13(4):330-336
Background
Gastroesophageal reflux disease (GERD) is one of the most frequent disorders in daily clinical practice with numerous associated consequences. A large number of studies were conducted to determine the prevalence of GERD and its associated risk factors which led to inconsistent results. The present study was performed to evaluate the prevalence of GERD and its related risk factors in north of Iran.Methods
Nine hundred and thirty-three educated participants aged 18–77 years who had at least a High School Diploma were enrolled in the present study. Validated Persian version of Gastroesopahageal reflux questionnaire was used to collect the data. To determine the GERD associated risk factors, logistic regression was performed.Results
The prevalence of GERD was 53.5 % (frequent GERD: 12.1 %). Among seven potential risk factors, the positive history of reflux in first relatives (OR = 2.37, CI = 1.76–3.20, p value < 0.001) and asthma (OR = 2.605, CI = 1.553–4.368, p < 0.001) were significantly associated with GERD. Spouse history of GERD in interaction with first relatives history of GERD and smoking was significantly associated with GERD too.Conclusion
The prevalence of GERD is increasing in our country compared to previus studies, which may lead to serious increment of malignant conditions such as esophagus adenocarcinoma.20.