Heterotopic Gastric Mucosa in Middle Esophagus Complicated with Esophageal Ulcers

Heterotopic gastric mucosa (HGM) of esophagus, primarily occurring in cervical esophagus, is usually asymptomatic. A healthy woman (mid-40s) with postprandial heartburn was diagnosed with middle esophageal HGM and esophageal ulcers by esophagogastroduodenoscopy. Using 8-channel pH monitoring, a sensor near the HGM area detected postprandial acid phase (pH 3-4), while areas adjacent to the proximal and distal sensors were neutral, suggesting acid secretion from the HGM. A biopsy showed fundic gland tissue expressing H⁺/K⁺-ATPase and pepsinogen-I. Oral vonoprazan improved the clinical symptoms and endoscopic findings. This is the first report using 8-channel pH monitoring to diagnose extremely rare middle esophageal HGM.     

食管上段胃黏膜异位症的临床研究概述

食管上段胃黏膜异位症(HGMUE)是一种少见的食管疾病,普遍认为HGMUE是胚胎时期食管黏膜上皮未发育完全的结果,缺乏特异性临床表现,诊断主要依据内镜检查以及组织学活检。随着内镜技术的发展,HGMUE检出率有所提高,使该病得到越来越多的关注。本文就HGMUE的临床研究作一综述。     

Heterotopic Gastric Mucosa in the Distal Part of Esophagus in a Teenager: Case Report

Heterotopic gastric mucosa (HGM) of the esophagus is a congenital anomaly consisting of ectopic gastric mucosa. It may be connected with disorders of the upper gastrointestinal tract, exacerbated by Helicobacter pylori. The diagnosis of HGM is confirmed via endoscopy with biopsy. Histopathology provides the definitive diagnosis by demonstrating gastric mucosa adjacent to normal esophageal mucosa. HGM located in the distal esophagus needs differentiation from Barrett''s esophagus. Barrett''s esophagus is a well-known premalignant injury for adenocarcinoma of the esophagus. Malignant progression of HGM occurs in a stepwise pattern, following the metaplasia–dysplasia–adenocarcinoma sequence.We present a rare case of a teenage girl with HGM located in the distal esophagus, associated with chronic gastritis and biliary duodenogastric reflux. Endoscopy combined with biopsies is a mandatory method in clinical evaluation of metaplastic and nonmetaplastic changes within HGM of the esophagus.     

Heterotopic Gastric Mucosa Accompanied by Aberrant Pancreas in the Duodenum

An operated case of a heterotopic gastric mucosa, accompanied by an aberrant pancreas tissue, in the bulb of the duodenum was reported. A 40-yr-old man complained of epigastralgia and was diagnosed to have a protruding lesion in the duodenum by roentgenological and endoscopic examinations. Partial excision of the duodenal wall including the mass was performed. Cut surface of the specimen showed a yellowish-whitish mass in the submucosal through the subserosal layers, which was covered by a papillary elevated mucous membrane. Histologically the mass was an aberrant pancreas of the Heinrich I-type and the mucous membrane covering the mass was a heterotopic gastric mucosa, consisting of completely developed fundic glands.     

奥美拉唑对大鼠胃粘膜保护作用的研究

目的：探讨奥美拉唑对大鼠胃粘膜的保护作用。方法：在乙醇诱导大鼠胃粘膜损伤前，预先给予奥美拉唑、L－硝基－精氨酸甲酯（L－NAME）静脉注射。测定胃粘膜血流量（GMBF）、胃液pH和胃粘膜NO2^-/NO3^-含量，并观察胃粘膜损伤指数（Ulcer index ,UI)、溃疡坏死组织和中性粒细胞浸润严重程度的变化。结果：与模型损伤组比，奥美拉唑组大鼠UI明显降低（P＜0．01），溃疡坏死组织和中性粒细胞浸润程度明显减轻（P＜0．01）。预先用L－NAME处理后，奥美拉唑保护胃粘膜损伤的作用明显减弱。静脉注射奥美拉唑，可增加GMBF和胃粘NO2^-/NO3^－含量，L－NAME可逆转这种作用，但对奥美拉唑抑制酸分泌作用无明显影响。结论：奥美拉唑对大鼠胃粘膜具有重要的保护作用，一氧化氮介导了这种作用。     

Magnifying Observation of Ectopic Gastric Mucosa of the Cervical Esophagus

We attempted to investigate the fine mucosal patterns of inlet patches using a transparent-tip-hood-fitted magnifying electronic endoscope (Olympus, GIF-200Z). The prevalence of inlet patch was 10.1%, 26 out of 257 patients undergoing screening endoscopic examination using a GIF-200Z. This rate was higher than that of previous reports in Japan, higher in the young group than in the aged group, and higher in males than in females. The mean inlet patch size, measured by the new method using a transparent hood, was 5.2 mm. Large inlet patches, above 8.1 mm, were found more frequently in males than in females. The number of inlet patches in one patient was one in 19 patients and two in seven. The inlet patches were oval and had a smooth margin in 23 (69.7%) cases, and irregular in 10 (30.3%). The oval patches with smooth margins were significantly larger than those with an irregular form. The fine mucosal pattern of inlet patches was mixed with B, BC and C type. Inlet patches with acid production were suggested to be fewer in number than expected, and patients with an inlet patch appear to have minimal, if any, complaints. A transparent-tip-hood-fitted magnifying electronic endoscope was thought to facilitate accurate diagnosis of the inlet patch.     

胃粘膜肠上皮化生的内镜诊断

目的探讨内镜下胃粘膜肠上皮化生诊断的可行性及准确度.方法应用放大或普通型内镜对受检者的胃底、胃体及胃窦进行仔细观察,详细描述肠上皮化生的表现特点并至少于胃窦小弯、大弯及胃体各取活检一块,收集同期病理诊断肠化生的病例并将内镜表现与病理进行对照分析.结果同期病理组织学诊断肠上皮化生患者329例.根据内镜下的特异性肠上皮化生的表现淡黄色结节状、瓷白色小结状、鱼鳞状和弥漫不规则颗粒不平状,内镜诊断肠上皮化生134例,经活检病理证实128例,内镜诊断符合率95.5%.胃粘膜活检诊断而内镜未予诊断者201例,内镜检查诊断肠上皮化生的总符合率38.9%.轻、中、重度肠上皮化生内镜诊断率不同,分别为23.8%、48.5%和51.7%.而放大内镜对轻、中、重度肠上皮化生诊断准确率分别为47.5%、78.5%和75.4%,明显高于普通型内镜组的1.9%、28.6%和34.9%,(P＜0.05),差异有显著意义.结论胃粘膜肠上皮化生内镜表现除淡黄色结节型和粘膜不规则颗粒不平的弥漫型外,尚有鱼鳞状和瓷白色半透明的小结节型,这四种典型的肠上皮化生形态学特征,是内镜诊断肠化生的特异型标志.这四种肉眼形态学特征与病理肠上皮化生程度无关,但肠化生程度与内镜诊断呈平行关系.放大内镜对肠上皮化生诊断率明显高于普通型内镜.     

Biliary Obstruction by Heterotopic Gastric Mucosa at the Ampulla of Vater

Tumorous growths of heterotopic gastric mucosa have been infrequently found in the small intestine. Some have presented as intussusception and obstruction; others have been associated with mucosal ulceration, bleeding, and even more rarely with perforation. This ease report describes an elderly man who developed biliary obstruction secondary to a tumor mass of heterotopic gastric mucosa at the ampulla of Vater.     

Endoscopic Characteristics of Gastric Polyps and Their Background Mucosa on the Gastric Body

Abstract: We investigated the endoscopic and histopathological characteristics of 112 gastric polyps on the gastric body. According to the histopathological findings of the glands in the biopsy specimens, we classified the polyps into 6 categories; dense fundic gland type (group A), sparse fundic gland type (B), mixed fundic and pyloric gland type (C), pyloric gland type (D), complete atrophic gland type (E) and others (F). The grade of atrophic gastritis was defined by the fundic-pyloric border type of the stomach, and was found to change from mild to severe respectively in groups A to E. The gastric area type of background fundic gland mucosa also changed from F₀ to F₃ in parallel with the order of the groups A to E. Thirty-five of the 36 polyps in group A, all 19 in group B, 2 out of 3 in group C, 1 of 4 in group D, and the 1 in group E were located on the dye-endoscopically defined fundic gland mucosal area. The gland type of biopsy specimens which were obtained from the mucosa adjacent to the polyps changed from fundic to fundic-pyloric and to pyloric type in groups A to E respectively. In conclusion, the histopathological findings of polyps on the gastric body reflect the background mucosa, and in particular the extent of the atrophic change of the stomach. The majority of polyps, either fundic gland polyps (groups A and B) or hyperplastic polyps (groups C, D and E), on the gastric body were found to be the same gland type as their respective background mucosa. They thus seem to fall into the same category as hyperplastic polyps of background mucosal origin but are not the same as a hamartomatous polyp.     

Control of Gastric Acid with High Dose H2-Receptor Antagonists after Omeprazole Failure: Report of Two Cases

Successful omeprazole therapy in patients with symptomatic gastroesophageal reflux (GER) refractory to treatment with H2-receptor antagonists has often been reported. In contrast, successful treatment of GER by H2-receptor antagonists in patients resistant to the acid-suppressing effects of omeprazole is rarely reported. We describe two patients who demonstrated therapeutic responses to high dose H2-receptor antagonists after high dose omepra/ole failed to suppress gastric acidity and GER.     

Endoscopic Therapy in Patients with Inoperahle Early Gastric Cancer

The efficacy and safety of endoscopic therapy was investigated prospectively in 42 patients with 44 early gastric cancers who were not candidates for surgery. Thirty-five of the 44 lesions (80%) were treated by endoscopic therapy alone. Adequate tumor resection was possible in lesions less than 2 cm in diameter, in those of the protruding, flat, and erosive types, and in those located in the antrum. None of the 35 patients who were judged completely cured by the initial therapy developed recurrence or lymph node metastases in the follow-up period (range, 3-114 months; mean, 37 months). Therefore, endoscopic therapy appears effective in the treatment of patients with early gastric cancer when the risks of surgery are too high.     

大剂量精制胸腺肽联合阿昔洛韦治疗慢性乙型肝炎初步报告

目的:提高和调节细胞免疫功能及病毒复制抑制功能。方法:以大剂量精制胸腺肽联合阿昔洛韦治疗慢性乙型肝炎36例,其中男27例,女9例,平均年龄26±11岁。结果:经57±27天治疗后,CD_4~ 细胞及CD_4~ /CD_8~ 率明显上升,CD_8~ 细胞明显下降,均优于对照组(P<0.01),HBeAg和HBV-DNA阴转率分别为61％与44％,与对照组相比有显著性差异。结论:将大剂量精制胸腺肤与阿昔洛韦联用,具有协同作用,可以提高和调节细胞免疫功能。     

Endoscopic Therapy with 2-Octyl-cyanoacrylate for the Treatment of Gastric Varices

Background

Gastric variceal bleeding is associated with significant morbidity and mortality and limited endoscopic therapeutic options.

Aim

The aim of this study was to evaluate the short- and long-term efficacy and safety of endoscopic therapy with 2-octyl-cyanoacrylate in patients with gastric variceal bleeding.

Methods

A single-center retrospective review of patients receiving endoscopic therapy for gastric variceal hemorrhage. Patient demographics, laboratory, and procedural data were collected. Patients were followed to death, liver transplantation, or last follow-up. Success rates were defined as immediate control of bleeding; early re-bleeding (1–7 days), short-term re-bleeding (1–12 weeks), overall survival, and serious procedure complications.

Results

A total of 41 patients (39 with cirrhosis) underwent 54 cyanoacrylate injections during study period. Mean age was 57 and 73 % were males. Twenty-four (58.5 %) patients had failed or were deemed ineligible for transjugular intra-hepatic portosystemic shunt, and 5 % were done for primary prophylaxis. Immediate hemostasis was achieved in five active bleeders. During a median survival time of 117 days, early re-bleeding was seen in 1 (2.4 %), short-term re-bleeding in five patients (12 %), and varices were eradicated in 15 (46.8 %) patients on follow-up. Mean MELD score at the time of the first injection was 17.1 ± 7.8. Mean volume injected was 3.4 cc and median number of varices injected per session was one. Eight patients died during the long-term follow-up: metastatic cancer (2), infections (3), liver failure (1), and re-bleeding (2). There were no serious procedure-related complications.

Conclusions

Endoscopic cyanoacrylate therapy appears effective and safe for treatment of patients with bleeding from gastric varices or high-risk stigmata.