Magnification Endoscopy and Chromoendoscopy in Evaluation of Specialized Intestinal Metaplasia in Barrett’s Esophagus

Background  

Specialized intestinal metaplasia (SIM) in Barrett’s esophagus is a risk factor of esophageal adenocarcinoma. It often occurs focally and cannot be distinguished from surrounding columnar epithelium with conventional endoscopy.     

Intercellular Space Volume Is Mainly Increased in the Basal Layer of Esophageal Squamous Epithelium in Patients with GERD

Background/Aims  

At present, the dilation of esophageal intercellular spaces (ICS) is considered an early morphologic marker of acid damage in patients with GERD. Nevertheless, previous electron microscopic (EM) studies had focused only on the suprabasal layer of squamous epithelium or did not nearly specify which layer of squamous epithelium was studied. Therefore, we aimed to assess the volumetric amount of the ICS in all layers of SE in patients with GERD.     

Muscular thickness of lower esophageal sphincter and therapeutic outcomes in achalasia: A prospective study using high‐frequency endoscopic ultrasound

Background and Aim

Patients with achalasia typically have thicker lower esophageal sphincter muscles, which can affect the distensibility of the esophagogastric junction. We aimed to assess whether these muscular features, measured using high‐frequency endoscopic ultrasound, affect treatment outcomes.

Methods

Consecutive adult patients with suspected achalasia were enrolled prospectively. They underwent a comprehensive diagnostic workup, including endoscopic ultrasound. The thickness of the lower esophageal sphincter, including the internal circular and outer longitudinal muscles, was measured using a 12‐MHz ultrasonic miniprobe. Follow‐up was performed at 1 month and then at 6‐month intervals, after treatment. Treatment response was defined as a reduction in Eckardt score to ≤3 or an improvement in the height of the timed barium esophagogram of ≥50%.

Results

Of the 29 patients who received pneumatic dilatation, all but one (96.6%) exhibited a good short‐term treatment response. At an average follow‐up time of 18.5 (12–55.5) months, patients who had a mid‐term recurrence after pneumatic dilatation had a significantly thicker outer longitudinal muscle (1.8 [1.5–1.8] vs 0.9 [0.8–1.7] mm, P = 0.036), but not internal circular muscle (2.0 [1.9–2.5] vs 2.1 [1.2–2.7] mm, P = 0.874) or total lower esophageal sphincter (3.7 [3.5–4.4] vs 3.6 [2.0–4.1] mm, P = 0.362). Patients with an outer longitudinal muscle ≥1.3 mm thick had a significantly lower mid‐term remission rate than others (36.3% vs 100%, P = 0.01).

Conclusion

Thickening of the outer longitudinal muscle at the lower esophageal sphincter is associated with poor mid‐term treatment outcomes for achalasia patients treated with pneumatic dilatation.     

Relationship between manometric findings and reported symptoms in nutcracker esophagus: insights gained from a review of 313 patients

Background  

Nutcracker esophagus (NE) is a well-described esophageal motility disorder often implicated as the cause of chest pain (CP). The aim of this study was to analyze the role of peristaltic amplitude, lower esophageal sphincter (LES) pressure, and 24 h pH scores in patient symptomatology.     

Multilayered epithelium in a rat model and human Barrett's esophagus: Similar expression patterns of transcription factors and differentiation markers

Background  

In rats, esophagogastroduodenal anastomosis (EGDA) without concomitant chemical carcinogen treatment leads to gastroesophageal reflux disease, multilayered epithelium (MLE, a presumed precursor in intestinal metaplasia), columnar-lined esophagus, dysplasia, and esophageal adenocarcinoma. Previously we have shown that columnar-lined esophagus in EGDA rats resembled human Barrett's esophagus (BE) in its morphology, mucin features and expression of differentiation markers (Lab. Invest. 2004;84:753–765). The purpose of this study was to compare the phenotype of rat MLE with human MLE, in order to gain insight into the nature of MLE and its potential role in the development of BE.     

Preoperative chemotherapy with weekly docetaxel plus low-dose cisplatin and 5-fluorouracil for stage II/III squamous cell carcinoma of the esophagus

Background  

Docetaxel is a powerful anticancer agent for esophageal cancer. Preoperative combined chemotherapy with weekly docetaxel plus low-dose cisplatin and 5-fluorouracil (DFP) followed by surgery is expected to improve the survival of patients with resectable esophageal squamous cell carcinoma.     

Inter- and Intraobserver Reliability and Validation of a New Method for Determination of Eosinophil Counts in Patients with Esophageal Eosinophilia

Background  

Diagnosis of eosinophilic esophagitis (EoE) requires quantification of esophageal eosinophilia.     

The Impact of Time Elapsed Between Endoscopic Ultrasound and Esophagectomy on Concordance of Ultrasonographic and Pathologic Staging of Esophageal Malignancy

Background  

Endoscopic ultrasound (EUS) is frequently used for staging of esophageal malignancies prior to esophagectomy.     

GP73 contributes to the sensitivity of cisplatin in esophageal cancer

Background  

The prognosis of esophageal cancer patients is poor. Cisplatin (CDDP) is most often used for advanced esophageal cancer; however, the emergence of drug resistance has prevented successful treatment in many cases.     

Low Grade Esophageal Eosinophilia in Adults: An Unrecognized Part of the Spectrum of Eosinophilic Esophagitis?

Background  

Eosinophilic esophagitis (EoE) is defined by a minimum of 15 eosinophils (eos) per high-powered field (HPF) on esophageal biopsy, along with esophageal symptoms and the exclusion of gastroesophageal reflux (GERD). The clinical significance of fewer eosinophils is unknown.     

Esophageal Carcinoma in African Americans: A Five-Decade Experience

Background  

Esophageal cancer accounts for a considerable proportion of carcinomas of the upper gastrointestinal tract in African Americans. Our aim was to describe the epidemiology of esophageal squamous cell cancer (ESCC) and esophageal adenocarcinoma (EA) among African Americans in the last five decades.     

Phase I studies of the safety,tolerability, pharmacokinetics and pharmacodynamics of the dual glucagon receptor/glucagon-like peptide-1 receptor agonist BI 456906

Aim

To report two phase I studies of the novel subcutaneous glucagon-like peptide-1 receptor/glucagon receptor (GLP-1R/GCGR) dual agonist BI 456906 versus placebo in healthy volunteers and people with overweight/obesity.

Materials and Methods

A phase Ia study (NCT03175211) investigated single rising doses (SRDs) of BI 456906 in 24 males with a body mass index (BMI) of 20–<30 kg/m². A phase Ib study (NCT03591718) investigated multiple rising doses (MRDs) of BI 456906 (escalated over 6 [Part A] or 16 [Part B] weeks) in 125 adults with a BMI of 27–40 kg/m².

Results

In the SRD study (N = 24), mean body weight decreased with increasing BI 456906 dose. In the MRD study, the maximum decreases in placebo-corrected mean body weight were at week 6 (–5.79%, dosage schedule [DS] 1; Part A) and week 16 (–13.8%, DS7; Part B). BI 456906 reduced plasma amino acids and glucagon, indicating target engagement at GCGRs and GLP-1Rs. Drug-related adverse events (AEs) increased with BI 456906 dose. The most frequent drug-related AE with SRDs was decreased appetite (n = 9, 50.0%), and two subjects (8.3%) did not complete the trial because of AEs (nausea and vomiting). During MRD Part A (N = 80), 10 subjects (12.5%) discontinued BI 456906, most commonly because of a cardiac or vascular AE (n = 6, 7.5%); during Part B (N = 45), eight subjects (17.8%) discontinued BI 456906, mainly because of AEs (n = 6, 13.3%), most commonly gastrointestinal disorders.

Conclusions

BI 456906 produced a placebo-corrected body weight loss of 13.8% (week 16), highlighting its potential to promote clinically meaningful body weight loss in people with overweight/obesity.     

Time esophageal pH < 4 overestimates the prevalence of pathologic esophageal reflux in subjects with gastroesophageal reflux disease treated with proton pump inhibitors

Background  

A Stanford University study reported that in asymptomatic GERD patients who were being treated with a proton pump inhibitor (PPI), 50% had pathologic esophageal acid exposure.     

Late toxicity after definitive chemoradiotherapy for esophageal squamous cell carcinoma

Background  

This study was designed to conduct a retrospective analysis of late toxicity following chemoradiotherapy (CRT) for esophageal carcinoma.     

Defining the Threshold: New Data on the Ability of Capsule Endoscopy to Discriminate the Size of Esophageal Varices

Background  

Endoscopy (esophagogastroduodenoscopy, EGD) to screen for esophageal varices (EV) is recommended in patients with portal hypertension. Reports indicate that capsule endoscopy (CE) is capable of identifying large/medium varices (L/MV) when the varix comprises more than 25% of the circumference of the field of view.     

Oral Bisphosphonate Prescriptions and the Risk of Esophageal Adenocarcinoma in Patients with Barrett’s Esophagus

Background  

Recent case reports suggested a link between oral bisphosphonate use and esophageal cancer. We therefore examined the association between these medications and the risk of esophageal adenocarcinoma (EAC) in patients with Barrett’s esophagus (BE).     

Transient PPI Responsive Esophageal Eosinophilia May Be a Clinical Sub-phenotype of Pediatric Eosinophilic Esophagitis

Background  

Eosinophilic esophagitis (EoE) and gastroesophageal reflux (GERD) both cause esophageal eosinophilia. Reports show that esophageal eosinophilia meeting criteria for EoE may respond to acid suppression mono-therapy. Consensus guidelines have termed this entity “PPI-responsive esophageal eosinophilia” (PPIRee) and recommend a trial with proton-pump inhibitors (PPIs) prior to a definitive EoE diagnosis. The mechanisms of PPIRee and whether this represents a sub-phenotype of GERD, a sub-phenotype of EoE, or its own distinct entity remain unclear.     

Esophageal Motor Disorders in Adults with Eosinophilic Esophagitis

Background  

An association between eosinophilic esophagitis (EoE) and esophageal motility disorders has been described in small studies.     

A Systematic Review of the Risk of Perforation During Esophageal Dilation for Patients with Eosinophilic Esophagitis

Background  

Eosinophilic esophagitis (EoE) is associated with tissue remodeling that can result in esophageal mucosal fragility, and esophageal dilation for patients with EoE is known to cause painful mucosal lacerations. Clinicians have been admonished that patients with EoE may be exceptionally predisposed to perforation with esophageal dilation, a notion supported primarily by case reports. We have conducted a systematic review of literature on esophageal dilation in EoE in an attempt to better define the risk of perforation.     

Natural history of bleeding after esophageal variceal eradication in patients with extrahepatic portal venous obstruction; a 20-year follow-up

Background  

Long-term follow-up studies of patients with extrahepatic portal venous obstruction (EHPVO) after eradication of esophageal varices using endoscopic sclerotherapy (EST) are limited.