The definition of Barrett's esophagus

Recently, according to increasing gastroesophageal reflux disease (GERD), the patients with Barrett's esophagus (BE) are increasing. Since Barrett have reported cases of esophageal ulcers surrounding by columnar epithelium, the various criteria of the BE have been proposed. In 1998, practice guidelines for BE were developed under the auspices of the American College of Gastroenterology. They proposed that BE was a chance in the esophageal epithelium of any length that can be recognized at endoscopy, and confirmed to have intestinal metaplasia by biopsy of the tubular esophagus and excludes intestinal metaplasia of the cardia. Endoscopically, BE is determined, when 'gastric-appearing mucosa' or apparent 'columnar lined esophagus' is evident proximal to the esophagogastric junction. Histologically, BE has double muscularis mucosae, and contains a mixture cell types; gastric-fundic type epithelium, junctional type epithelium, and specialized columnar epithelium (SCE). Especially SCE is distinctive features of BE, available for diagnosis. On the other hand, BE is premalignant condition for the adenocarcinoma of the esophagus, therefore the features of the BE are researched to prevent and find out earlier development of adenocarcinoma. In this review, we referred to the definition of BE with some topics.     

智能电子分光技术在Barrett食管诊断中的初步研究

目的 观察智能电子分光技术(FICE)在Barrett食管(BE)及早期食管腺癌(EA)诊断中的价值.方法 2006年6月～2008年12月该院胃镜检查的患者16 000例次,对其食道下端随机采用传统白光或FICE技术观察.FICE内镜检查组拟诊BE 133例(实验组);普通内镜检查组拟诊BE 128例(对照组),对检查部位进行活检,并与组织学诊断进行对比.结果 实验组确定BE 127例(95.5％),其中轻度不典型增生(LGD)13例(9.77％)、高度不典型增生(HGD) 10例(7.51％)、EA 9例(6.02％);对照组确定BE 105例(82.O％),其LGD 10例(7.81％)、HGD 3例(2.45％)、EA 2例(1.56％),实验组除LGD外,其余检出率均明显高于对照组(P＜0.05).结论 FICE对BE病灶发现及指导活检优于普通白光内镜.     

Barrett食管的病理本质及其与返流性食管炎,食管腺癌关系的研究

从１０００例食管粘膜咬检及１５８０例食管贲门癌切除标本中交界处癌１６５例的形态学、粘液组化及ＦＣＭ分析，探讨ＢＥ病理本质及其与返流性食管炎、食管腺癌的关系。结果：１０００例咬检中２２７例有不同程度的返流性食管炎，其中３例符合ＢＥ。１５８０例食管贲门癌中，交界处癌２３例（１．５％）为食管腺癌，１３例（５６．５％）根据部位、形态、粘液组化分析证明为ＢＥ来源的腺癌。本文认为慢性胃液返流使食管粘膜鳞状上皮长期受损，修复中，部分病例食管鳞状上皮由邻接耐酸性较强、增殖更活跃的胃贲门上皮向上异位生长而代替。长期非特异性刺激附加致癌因素刺激下，修复性增生转变为渐进性异型增生，最终导致癌变，形成ＢＥ来源的腺癌。     

Barrett食管与胃食管反流病及食管腺癌的关系

胃食管反流(gastroesophageal reflux,GER)在人群中普遍存在,Barrett食管(Barrett’s esophagus,BE)及食管腺癌(esophageal adenocarcinoma,EA)的发病率也在逐年升高。为了解BE与胃食管反流病(gastroesophageal reflux dis-ease,GERD)、EA的关系,本文复习近年相关文献,从病理生理基础及诊断、治疗方法入手进行探讨,结果发现三者的病情进展过程为正常食管黏膜-GERD-BE化生-BE低度和高度异型增生-EA。故BE的治疗应以减轻GER症状为主,并定期筛检和评价预后,以早期发现EA。     

Barrett食管与食管腺癌——3例报告及文献复习

目的Barrett食管在我国少见,故复习文献并报告Barrett食管合并食管腺癌3例。方法复习北京协和医院近10年来手术切除的食管癌病例,其中Barrett食管合并食管腺癌仅有3例。结果3例均为男性,平均年龄56岁。2例为贲门型／交界型Barrett食管,1例为特异型Barrett食管;其中1例合并印戒细胞癌,2例合并低分化腺癌。结论诊断Barrett食管时应注意病变的解剖学部位,以避兔过度诊断。     

Barrett's esophagus

Esophageal cancer staging is a widely accepted indication for endoscopic ultrasonography (EUS). The evaluation of Barrett's esophagus (BE) with EUS is indicated only when there is high-grade dysplasia or a concern for malignancy in an endoscopic lesion. Because the options for the management of BE and early adenocarcinoma are diverse, proper selection of patients by accurate staging with EUS is critical, particularly when nonoperative management is considered. For example, patients with BE with high-grade dysplasia may be offered esophagectomy in some medical centers, but nonoperative therapies such as endoscopic ablative therapy or mucosal resection may be the preferred treatment options in other gastroenterology practices. This article discusses the scientific evidence for the use of EUS in BE or early esophageal adenocarcinoma.     

Population screening for barrett esophagus: a prospective randomized pilot study

OBJECTIVETo assess the feasibility of unsedated transnasal endoscopy (uTNE) and video capsule endoscopy (VCE) as alternatives to sedated endoscopy (sEGD) as screening tools for Barrett esophagus (BE) and to obtain preliminary estimates of participation rates for sEGD, uTNE, and VCE when used for community BE screening in a population cohort.PATIENTS AND METHODSFrom February 1, 2009, to May 31, 2010, patients from Olmsted County, Minnesota, who were older than 50 years and had no history of known BE were randomized (stratified by age, sex, reflux symptoms noted in a validated questionnaire) into 3 groups for esophageal evaluation with sEGD, uTNE, or VCE. Participation rates and safety profiles were estimated.RESULTSWe contacted 127 patients to recruit 20 for each procedure arm (60 total). The probability of participation was 38% (95% confidence interval [CI], 26%-51%) for sEGD, 50% (95% CI, 35%-65%) for uTNE, and 59% (95% CI, 42%-74%) for VCE. Both uTNE and VCE were well tolerated without adverse effects. BE was identified in 3 patients and esophagitis in 8.CONCLUSIONUnsedated techniques may be acceptable, feasible, and safe alternatives to sEGD to screen for BE in the community.Trial Registration: clinicaltrials.gov Identifier: NCT00943280     

乌鲁木齐市Barrett食管的发病情况和内镜下特点临床意义的研究

目的：研究乌鲁木齐市 Barrett 食管（BE）的发病情况和内镜、临床特点及其与反流性食管炎（RE）的关系。方法根据2011年6月4日在重庆召开的全国第二届Barrett食管专题学术研讨会上制定的BE诊治共识作为诊断标准诊断BE,研究BE患者的内镜检出率、内镜下的表现、分型及病理检查结果,分析研究患者的性别、年龄、体重、身高、症状、幽门螺杆菌（Hp）感染情况及其与BE和RE的关系。结果检出BE患者人数为总胃镜检查人数的7.9%,男女之比为1.98∶1,平均年龄（44.6±13.4）岁。其中仅19.14%患者有典型的反流症状。BE内镜分型中短节段占83.85%,多为舌状、岛状这2种形状。食管活检组织病理诊断为肠化型占BE的25.31%,10.04%伴异型增生,Hp阳性率为40.37%。RE检出率为2.07%。0.66%的BE伴RE。BE和RE合并消化性溃疡发生率差异无统计学意义（P＞0.05）。结论乌鲁木齐市地区居民BE的患病率较高,多为短节段舌状或岛状,约1/3为肠化型,以中年男性多见,常无症状,部分伴异型增生。体重超重增加了BE的发病风险。Hp感染可能与BE和RE的关系均不密切。     

The pathogenesis of Barrett's esophagus

Significant progress has been made in clinicians' understanding of the molecular pathogenesis of BE, and the laboratory findings are beginning to lead to hypothesis-driven clinical studies; however, the following questions remain unanswered: (1) how can clinicians identify the persons most at risk for the development of esophageal adenocarcinoma, (2) what are the environmental gene interactions in esophageal carcinogenesis, and (3) can clinicians prevent the development of esophageal adenocarcinoma in the population at risk? As esophageal adenocarcinoma starts to reach epidemic proportions, further research in these areas is urgently required. With the advent of the genomic era and an explosion in studies in BE, significant progress can be made.     

Chromoendoscopy and magnification endoscopy in Barrett's esophagus

Chromoendoscopy and magnification endoscopy appear to be a valuable adjuncts for the detection and classification of BE. These techniques may also prove to be useful aids in surveillance protocols for identifying dysplastic epithelium or early cancer within a segment of BE. Ideally, the use of these techniques would enable the endoscopist to rule in or out the presence of IM and of dysplastic or cancerous epithelium by obtaining only a minimal number of targeted biopsy specimens, or potentially performing no biopsies at all. This could transform upper endoscopy into a much more effective screening and surveillance tool for BE. Several problems currently exist for the use of chromoendoscopy for BE. Results of studies reporting the accuracy of chromoendoscopy remain mixed,and are likely explained by the wide range of techniques and materials used in the investigations. Staining adds several steps, and likely several minutes, to an upper endoscopy. Staining within the esophagus is often patchy and uneven. In addition, poor spraying technique exaggerates the irregular uptake by the mucosa. There is a high false-positive rate when staining gastric-type epithelium and denuded epithelium. Areas of dysplasia or cancer may take up stain in an irregular manner, or may not stain at all. Chromoendoscopy is a relatively new technique in the management of BE and depends on the skill and experience of the endoscopist. Magnification, however, only allows the endoscopist to observe small areas of mucosa at a time, increasing the overall complexity and length of the procedure. The learning curve for this procedure is relatively short, however, and endoscopists can usually become proficient in the technique quickly. Currently, the greatest body of literature exists concerning the use of methylene blue for diagnosing BE. At the present time, chromoendoscopy and magnification endoscopy appear to be most beneficial in detecting IM in short segments of esophageal columnar-appearing mucosa. If used consistently by practicing physicians, the accuracy of biopsies for IM could be improved. If endoscopic ablative therapy for HGD and early adenocarcinoma becomes accepted, sensitive methods of detecting residual BE after ablation will be needed to help guide additional endoscopic therapy. Chromoendoscopy and magnification endoscopy could prove helpful in this setting. Further research in this field remains to be performed. As a first step, a uniform classification system for staining and magnification patterns should be devised. If investigators can reach a consensus, and validate classification, terminology, and pattern-types, future studies could be performed using "common and similar language." More controlled investigations with larger numbers of patients must be performed before tissue staining and magnification endoscopy become a part of the practicing endoscopist's armamentarium. The ultimate aims of chromoendoscopy and magnification endoscopy in the setting of BE are to show improved outcomes--namely, early detection of cancer and improved survival rates. These goals have not yet been realized and meeting them will require well-designed studies in the future.     

Barrett's esophagus: contemporary diagnostic and therapeutic approaches

The author considers the modern concepts of the epidemiology, pathophysiology, clinical manifestations, and diagnostics of Barrett's esophagus (BE). Special attention is paid to the evaluation of BE as precancer elevating the risk of esophageal adenocarcinoma, as well as the issues of the treatment and regular medical check-up of such patients.     

Staging of early adenocarcinoma in Barrett's esophagus

The main goal in the staging of patients with early neoplasia arising in the context of Barrett's esophagus (BE) is to identify individuals who are eligible for endoscopic therapy and differentiate them from those who require surgical management. To make the proper patient selection a combined staging strategy consisting of endoscopy evaluation, endoscopic ultrasonography, and endoscopic mucosal resection is necessary. In this article, the authors summarize the evidence behind each different staging modality in the setting of early BE adenocarcinoma and propose a staging approach that helps to select patients who are suitable for endoscopic therapy.     

Barrett食道和Barrett食道腺癌的临床病理学研究

本文报告Ｂａｒｒｅｔｔ食道４２例，其中８例具有腺癌结构。内镜观察：食道粘膜上皮粗糙、糜烂、颗粒状增生、斑块状隆起、溃疡、粘膜充血或苍白。组织学观察：Ｂａｒｒｅｔｔ食道上皮有三种不同形态，其中胃底型上皮８例，交界型上皮１４例，特殊型上皮２０例，８例具有腺癌结构，特殊型上皮与腺癌结构间可见过渡形态。粘液组化染色观察：２０例特殊型上皮，ＨＩＤ（＋）１８例，８例具有腺癌结构的病例，ＡＢ、ＨＩＤ均呈不同程度的阳性。ＡｇＮＯＲ染色观察，Ｂａｒｒｅｔｔ食道三种上皮与食道腺癌平均每核含ＡｇＮＯＲ颗粒数相比均有非常显著的统计学差异（Ｐ＜０．０１）；观察结果提示：Ｂａｒｒｅｔｔ食道与食道腺癌关系密切，特殊上皮型Ｂａｒｒｅｔｔ食道可能是食道腺癌的癌前病变。     

The use of imaging and biomarkers in diagnosing Barrett’s esophagus and predicting the risk of neoplastic progression

Long-standing gastroesophageal reflux disease can result in transformation of the normal squamous lining of the esophagus into columnar epithelium (with goblet cells). This condition, Barrett’s esophagus (BE), is considered a risk factor for esophageal cancer (EAC) and may be the cause of the increased incidence of EAC over the last few decades. Currently, endoscopy with biopsies revealing dysplasia is the best predictor for neoplastic progression in patients with BE. However, the use of more sophisticated imaging techniques and biomarkers with or without histological assessment may be helpful in more accurate prediction of malignant transformation in these patients. New approaches to the evaluation of BE such as epigenetics, miRNA analysis, detection of DNA content abnormalities and loss of heterozygosity have great potential to shed light on the complex gastroesophageal reflux disease –BE–EAC sequence.     

Risk prediction in Barrett’s esophagus – aspects of a combination of molecular and epidemiologic biomarkers reflecting alterations of the microenvironment

Abstract

Barrett’s esophagus (BE) is a chronic, metaplastic lesion of the esophagus and the only known precursor of esophageal adenocarcinoma. The identification of risk factors to assess the risk for BE and their correspondence with hallmarks of malignant progression for early stratification purposes is critically needed. Data legitimate the assumption that aside of reflux symptoms and related conditions, also demographic and environmental factors are thought to be associated with the risk for BE and its progression to esophageal adenocarcinoma. Molecular biomarkers and inflammatory mechanisms are subjects of intensive research and dispone of promising features regarding risk assessment especially for progressive BE. The amount of investigated epidemiologic factors, as well as discovered biomarkers gets confusingly large. Despite the recognized potential relevance of environmental and molecular factors, the efforts to date have resulted in moderately applicable risk estimates. More prospective data is needed to allow an imputation of the mostly retrospectively assessed factors to reappraise their meaningfulness in risk prediction approaches.     

光动力学疗法治疗Barrett食管和早期食管癌

光动力学疗法(PDT)是治疗Barrett食管(BE)相关的高度不典型增生或早期食管腺癌的有吸引力的一种新技术。通过对国外有关PDT时常用的光敏剂及其在治疗BE及早期食管癌中疗效文献复习发现,PDT治疗BE和早期食管癌安全、有效。     

Newly developed Barrett's esophagus after subtotal esophagectomy

BACKGROUND AND STUDY AIMS: More detailed information regarding the early mucosal events that lead to intestinal metaplasia would be very beneficial for understanding the pathogenesis of Barrett's esophagus (BE). Gastroesophageal reflux and duodenogastroesophageal reflux play a major role in the pathogenesis of Barrett's esophagus. The aim of this study was to investigate the prevalence of newly developed BE in patients who had previously undergone a subtotal esophagectomy - a clinical condition characterized by the absence of a lower esophageal sphincter and massive gastroesophageal reflux. PATIENTS AND METHODS: A retrospective examination was carried out on all patients who underwent subtotal esophagectomy (n = 87) listed in our institution's computer files from 1995 to 2000. Twenty-one patients were excluded due to missing data or no upper gastrointestinal endoscopy after surgery. RESULTS: Based on the Savary-Miller classification, 47 patients developed either type I (n = 2), II (n = 8), III (n = 11) or IV (n = 26) esophagitis after surgery. Newly developed BE was observed in nine patients (13.5 %) after subtotal esophagectomy (median time to diagnosis: 489 days, range 43 - 1172). None of the patients had persistent BE immediately after surgery, and two of the patients with newly developed BE had had no history of BE before surgery or at the time of surgery. Proton-pump inhibitor therapy after surgery and neoadjuvant chemotherapy did not appear to influence the development of BE after subtotal esophagectomy. CONCLUSIONS: Newly developed BE after subtotal esophagectomy may provide further insights into the early mucosal events that lead to intestinal metaplasia and into the roles of gastroesophageal and duodenoesophageal reflux in the pathogenesis of BE.     

The accuracy of PillCam ESO capsule endoscopy versus conventional upper endoscopy for the diagnosis of esophageal varices: a prospective three-center pilot study

BACKGROUND AND STUDY AIMS: Variceal bleeding is a major complication of cirrhosis, and is associated with a 20 % mortality at 6 weeks. Current international guidelines recommend that patients with cirrhosis are screened by conventional upper endoscopy (esophagogastroduodenoscopy, EGD) in order to detect esophageal varices. The recently developed PillCam ESO esophageal capsule endoscope has been shown to be an accurate diagnostic tool in the investigation of patients with gastroesophageal reflux and Barrett's esophagus. We compared the PillCam ESO capsule endoscope with EGD for the detection of esophagogastric varices and portal hypertensive gastropathy in patients with cirrhosis. PATIENTS AND METHODS: A pilot trial was conducted at three sites. Patients with cirrhosis who were undergoing clinically indicated EGD for screening or surveillance for esophageal varices underwent a PillCam ESO study followed by an EGD within 48 hours. Capsule videos were assessed by an investigator who was blinded to the patient's medical history and EGD findings. RESULTS: A total of 23 of the 32 enrolled patients were found to have esophageal varices at both EGD and PillCam ESO endoscopy. In one patient PillCam ESO detected small varices that were not seen at EGD. The overall concordance between PillCam ESO and EGD was 96.9 % for the diagnosis of esophageal varices and 90.6 % for the diagnosis of portal hypertensive gastropathy. There were no adverse events related to PillCam ESO endoscopy. CONCLUSIONS: In a high-prevalence population, PillCam ESO may represent an accurate noninvasive alternative to EGD for the detection of esophageal varices and portal hypertensive gastropathy. A large-scale trial is underway to validate and expand these findings.     

Barrett食管的治疗研究及p53在治疗前后的表达

目的：研究不同方法治疗Barrett食管（BE）患者的疗效，并通过检测治疗前后食管中p53的表达改变．探索各种治疗方法产生效果的可能机制。方法：经胃镜及活检确诊的BE患者75例，随机分为5组进行治疗。（1）对照组（A组），不进行特殊治疗；（2）抑酸药组（B组），口服奥美拉唑20mg，每日2次。（3）胆汁吸附剂组（C组）．口服铝碳酸镁1000mg，每日3次。（4）抑酸药＋胆汁吸附剂组（D组），口服奥美拉唑及铝碳酸镁，用法用量同B、C组。（5）氩气凝固术（APC）＋抑酸药及胆汁吸附剂组（E组），在D组治疗基础上对BE患者行内镜下APC治疗。各组均治疗3个月。治疗前、治疗后1个月及3个月后观察并记录临床症状及内镜下表现，取得食管黏膜组织标本行病理学检查．并采用SABC免疫组化染色检测食管上皮中p53的表达情况。结果：3个月后各治疗组的症状均较治疗前明显减轻，与A组相比均有统计学差异（P〈0．05）；各治疗组间相比，症状缓解率无明显差异（P〉0．05）。内镜检查发现。A、B、C、D组的BE黏膜均未见明显变化，而E组能使91％的患者BE黏膜消除。D、E组治疗后食管p53表达均较治疗前显著降低，与A组相比有统计学差异（P〈0．05），E组改变比D组更显著。各治疗组均未发现严重不良反应。结论：抑酸药和（或）胆汁吸附剂不能使BE逆转，但可消除临床症状并可改变BE中p53的表达。APC＋抑酸药及胆汁吸附剂方案可以消除症状。也可消除BE黏膜。安全性好，可降低p53的表达，是治疗BE的一种合理可行、有效实用的方法。p53的表达可作为判定治疗效果的可能指标。     

新型Barrett食管、食管腺癌动物模型及COX-2对其发生的影响

目的：建立新型安全的Barrett食管（BE）及食管腺癌（EA）动物模型，并探讨环氧合酶-2（COX-2）表达在BE、EA发生发展中的作用，、方法：150只SD大鼠分为对照组、铁剂组、反流组、反流铁剂组，后两组行手术造成十二指肠胃食管反流，铁剂组、反流铁剂组大鼠腹腔注射右旋糖酐铁（5mg／kg，每周2次，共22同）。术后8周每组各处死5只，24周后全部处死，取得食管标本进行组织形态学研究观察大鼠食管BE及EA的发生情况，应用SP免疫组化染色检测COX-2的表达。结果：对照组与铁剂组未发生BE和EA，反流铁剂组BE、异型增生及EA的发生率高于反流组（P〈0．05）．反流铁剂组COX-2表达阳性率及阳性程度高于其他组（P〈0．05）。COX-2在肿瘤中表达最高，异型增生中次之，正常黏膜表达最低。结论：应用手术致食管反流并注射铁剂的方法制作大鼠BE及EA模型成功率高．安全性好．COX-2表达的增加可能与BE及EA的发生发展有关