Esophageal cancer (EC) is a dreadful disease with a poor prognosis and poses heavy health burden worldwide. Developing effective methods to identify high-risk individuals is urgently needed for preliminary screening before endoscopy. The novel non-endoscopic device has the potential advantages of low cost, simple operation, and minimal invasiveness. Approximately 90% of participants can swallow the device successfully with high safety profiles, and sufficient esophageal exfoliated cells can be collected for cytological examination and biomarker detection. Cytological examination based on the device combined with trefoil factor 3 (TFF3) protein or DNA methylation examinations could effectively screen Barrett's esophagus-associated dysplasia and early esophageal adenocarcinoma, but large prospective studies are needed to further validate the diagnostic value of this device to improve the quality of evidence. Although the device-based cytological examination in combination with biomarker detection holds promise in the early screening of esophageal squamous dysplasia and early esophageal squamous cell carcinoma, related research is still in its infancy, and there is still a lack of sufficient evidence for population screening in China. Active research into the application of this novel non-endoscopic device in EC screening and early diagnosis is of great significance for optimizing EC screening strategies and improving the early diagnosis of EC.
Humans ; Esophageal Neoplasms/pathology* ; Early Detection of Cancer ; Esophageal Squamous Cell Carcinoma ; Barrett Esophagus/pathology* ; Biomarkers/analysis* ; Esophagoscopy

Esophageal cancer (EC) is a dreadful disease with a poor prognosis and poses heavy health burden worldwide. Developing effective methods to identify high-risk individuals is urgently needed for preliminary screening before endoscopy. The novel non-endoscopic device has the potential advantages of low cost, simple operation, and minimal invasiveness. Approximately 90% of participants can swallow the device successfully with high safety profiles, and sufficient esophageal exfoliated cells can be collected for cytological examination and biomarker detection. Cytological examination based on the device combined with trefoil factor 3 (TFF3) protein or DNA methylation examinations could effectively screen Barrett's esophagus-associated dysplasia and early esophageal adenocarcinoma, but large prospective studies are needed to further validate the diagnostic value of this device to improve the quality of evidence. Although the device-based cytological examination in combination with biomarker detection holds promise in the early screening of esophageal squamous dysplasia and early esophageal squamous cell carcinoma, related research is still in its infancy, and there is still a lack of sufficient evidence for population screening in China. Active research into the application of this novel non-endoscopic device in EC screening and early diagnosis is of great significance for optimizing EC screening strategies and improving the early diagnosis of EC.
Humans ; Esophageal Neoplasms/pathology* ; Early Detection of Cancer ; Esophageal Squamous Cell Carcinoma ; Barrett Esophagus/pathology* ; Biomarkers/analysis* ; Esophagoscopy

Capsule endoscopy can be a diagnostic option for patients with esophageal diseases who cannot tolerate esophagogastroduodenoscopy.Functional modifications of the capsule allow for thorough examination of the esophagus. Esophageal capsule endoscopy has so farfailed to show sufficient performance to justify the replacement of traditional endoscopy for the diagnosis of esophageal diseasesbecause the esophagus has a short transit time and common pathologies appear near the esophagogastric junction. However,technological improvements are being introduced to overcome the limitations of capsule endoscopy, which is expected to become agood alternative to conventional endoscopy.
Barrett Esophagus ; Capsule Endoscopy* ; Diagnosis ; Endoscopy ; Esophageal and Gastric Varices ; Esophageal Diseases ; Esophagogastric Junction ; Esophagus ; Humans ; Pathology

PURPOSE: During sedated esophagogastroduodenoscopy (EGD), patients may not be able to perform inspiration, which is necessary to examine the esophagogastric junction. Therefore sedation may affect diagnosis of gastroesophageal reflux-related findings. The aim of our study was to investigate the effect of sedation on diagnosis of gastroesophageal reflux-related findings during EGD. MATERIALS AND METHODS: This retrospective study evaluated 28914 patients older than 20 years who underwent EGD at our institution between January 2011 and December 2011. Ultimately, 1546 patients indicated for EGD for health check-up and symptom evaluation were included. RESULTS: There were 18546 patients who had diagnostic EGD: 10471 patients (56%) by non-sedated EGD and 8075 patients (43%) by sedated EGD. After statistical adjustment for age, sex, and body mass index, minimal change esophagitis, and hiatal hernia were significantly less frequently observed in the sedated EGD group [odds ratio (OR), 0.651; 95% confidence interval (CI), 0.586 to 0.722 and OR, 0.699; 95% CI, 0.564 to 0.866]. Nevertheless, there was no significant difference in other findings at the gastroesophageal junction, such as reflux esophagitis with Los Angeles classification A, B, C, and D or Barrett's esophagus, between the two groups. Similarly, there were no differences in early gastric cancer, advanced gastric cancer, and gastric ulcer occurrence. CONCLUSION: Sedation can impede the detection of minimal change esophagitis and hiatal hernia, but does not influence detection of reflux esophagitis of definite severity and Barrett's esophagus.
Adult ; Aged ; Barrett Esophagus ; Body Mass Index ; Endoscopy, Digestive System/instrumentation/*methods ; Esophagitis, Peptic/*diagnosis ; Esophagogastric Junction/*pathology ; Female ; Gastroesophageal Reflux/*diagnosis ; Hernia, Hiatal/*diagnosis ; Humans ; Male ; Middle Aged ; Retrospective Studies

Pathologic specimens, both biopsies and endoscopic mucosal resections, for Barrett esophagus and Barrett-associated dysplasia and malignancy are common for pathologists in North America, and the incidence in South Asian countries seems to be increasing. Dysplasia and malignancy arising in intestinalized gastric-type mucosa raises issues in the interpretation of dysplasia and the evaluation of the depth of invasion of malignancies that are not seen in squamous dysplasia and squamous cell carcinoma. We review the North American approach to these lesions.
Asian Continental Ancestry Group ; Barrett Esophagus* ; Biopsy ; Carcinoma, Squamous Cell ; Humans ; Incidence ; Mucous Membrane ; North America ; Pathology ; Biomarkers

OBJECTIVETo study the clinicopathologic features and differential diagnosis of proximal gastric mucosa and mucosa of Barrett's esophagus (BE) in biopsy specimens.

METHODThirty-eight cases of Barrett's esophagus (diagnosed using WHO criteria) and 44 cases of proximal gastric mucosa were studied by immunohistochemistry (for CK7, CK20, CK4, CK8, S-100 protein, MUC6, COX2 and bcl-2) and fluorescence in-situ hybridization (FISH) (for hTERC gene). The pathologic features were analyzed.

RESULTSThe differences in expression of CK7, CK20, MUC6, COX2 and bcl-2 between BE and proximal gastric mucosa with intestinal metaplasia were not statistically significant (P > 0.05). There was however a statistically significant difference in expression of S-100 protein (P < 0.05). The expression of CK7/CK4 and CK7/CK8 in BE showed positive correlation (P < 0.05). However, such correlation was not demonstrated in proximal gastric mucosa (P > 0.05). The results of hTERC gene expression by FISH showed a statistically significant difference between the two groups: 57.9% (22/38) in BE and 13.6% (6/44) in proximal gastric mucosa (P < 0.05).

CONCLUSIONSThe significance of CK7 and CK20 expression is uncertain in the differential diagnosis between BE and proximal gastric mucosa. On the other hand, positivity for CK7/CK4/CK8 may support the diagnosis of BE and play a role in distinguishing between the two groups. S-100 protein expression and detection of hTERC gene amplification also contribute to the diagnosis of BE.

Barrett Esophagus ; genetics ; metabolism ; pathology ; Gastric Mucosa ; metabolism ; pathology ; Gene Amplification ; Humans ; Immunohistochemistry ; In Situ Hybridization, Fluorescence ; Keratin-20 ; metabolism ; Keratin-4 ; metabolism ; Keratin-7 ; metabolism ; Keratin-8 ; metabolism ; Metaplasia ; genetics ; metabolism ; pathology ; RNA ; genetics ; Retrospective Studies ; S100 Proteins ; metabolism ; Telomerase ; genetics

BACKGROUND/AIMS: The purpose of this study was to estimate the prevalence of Barrett's esophagus (BE) and its association with reflux esophagitis (RE) and peptic ulcer disease detected by free charge endoscopy which was covered by the National Health Insurance at a secondary care hospital, and to compare the results of the biopsy of BE with that of cardiac intestinal metaplasia (CIM). METHODS: A total of 4,002 patients underwent endoscopy from March 2010 to December 2012. BE was diagnosed if there was histologically proven specialized intestinal metaplasia, and CIM was diagnosed if intestinal metaplasia was accompanied with chronic gastritis. RESULTS: Four hundred twenty four patients underwent endoscopic biopsy, and the prevalence of BE was 1.0% (42/4,002). The mean age and the proportion of males in BE were significantly higher than those of the rest of study population, and BE had slight tendency related to RE than the rest of study population. CIM was observed in 34 patients and BE and CIM showed similar results, regarding age, sex and association with RE. The mean length of endoscopic Barrett's mucosa of BE group was 9.2+/-5.1 mm, and it was similar to that of CIM. CONCLUSIONS: The prevalence of BE in the secondary care hospital was not low, and old age and male sex were significantly associated with BE. Because BE was observed in about 10% of biopsied patients and CIM was observed in a similar percentage with BE, the precise targeted biopsy is warranted and the biopsy method should be reestablished through the large prospective study of multiple secondary care hospitals.
Adult ; Aged ; Aged, 80 and over ; Barrett Esophagus/complications/epidemiology/*pathology ; Duodenal Ulcer/complications/epidemiology/pathology ; Esophagoscopy ; Female ; Gastroesophageal Reflux/complications/epidemiology/pathology ; Hospitals ; Humans ; Male ; Metaplasia/complications/epidemiology/*pathology ; Middle Aged ; Prevalence ; Secondary Care ; Stomach Ulcer/complications/epidemiology/pathology

Obesity is prevalent in Korea. An increase in food intake and a decrease in energy expenditure are responsible for obesity. Gut hormones play a role in controlling food intake. Obesity is suggested to be linked to common gastrointestinal functional disorders. Obesity is associated with an increased risk of gastroesophageal reflux disease, Barrett esophagus and esophageal adenocarcinoma. Epidemiologic studies indicate that obesity is associated with chronic gastrointestinal symptoms. This association suggests the possibility that obesity and functional gastrointestinal disorders may be pathophysiologically linked. However, data on the relationship between obesity and functional gastrointestinal disorders are inconsistent. In this paper, we review the role of gastrointestinal hormones in food intake and the relationship between obesity and functional gastrointestinal disorders.
Barrett Esophagus/*etiology ; Energy Intake ; Energy Metabolism ; Esophageal Neoplasms/*etiology ; Gastroesophageal Reflux/*etiology ; Humans ; Obesity/*complications/pathology ; Peptide Hormones/metabolism/physiology

OBJECTIVETo compare the expression patterns of cytokeratin 7 (CK7) and CK20 in the Barrett's esophagus and gastric cardia intestinal metaplasia.

METHODSEndoscopic biopsy specimens from 19 patients with long segment Barrett's esophagus, 36 with short segment Barrett's esophagus, and 20 with histological evidence of gastric cardia intestinal metaplasia were immunostained for CK7 and CK20. The immunohistochemical data were analyzed in relation with the clinicopathological data of the patients including age, hiatal hernia, and Helicobacter pylori status.

RESULTSThe Barrett's pattern of CK7/20 expressions was found in all the 19 patients with long segment Barrett's esophagus, in 31 of the 36 (82%) patients with short segment Barrett's esophagus, and in 2 of the 20 (10%) patients with gastric cardia intestinal metaplasia. Patients with short segment Barrett's esophagus who had a Barrett's CK7/20 pattern showed similar clinicopathological findings to those with long segment Barrett's esophagus, while in cases of short segment Barrett's esophagus where no Barrett's CK7/20 pattern was found, the clinicopathological features were similar to those of gastric cardia intestinal metaplasia cases.

CONCLUSIONA Barrett's CK7/20 expression pattern is an objective marker of Barrett's mucosa. CK7 and CK20 reactivity patterns in routine endoscopic biopsy samples can reliably identify the location of intestinal metaplasia in the esophagus and stomach.

Adult ; Aged ; Barrett Esophagus ; diagnosis ; metabolism ; pathology ; Biomarkers ; metabolism ; Cardia ; metabolism ; pathology ; Female ; Humans ; Keratin-20 ; metabolism ; Keratin-7 ; metabolism ; Male ; Middle Aged ; Reagent Kits, Diagnostic

Barrett Esophagus ; diagnosis ; pathology ; Biopsy ; Consensus ; Epithelial Cells ; pathology ; Esophagitis ; pathology ; Esophagitis, Peptic ; pathology ; Esophagoscopy ; Gastroesophageal Reflux ; diagnosis ; pathology ; Humans