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AMERICAN JOURNAL OF GASTROENTEROLOGY 2000年第8期95卷 1881-1887页

作者： Eloubeidi, MA Provenzale, D Duke Univ Med Ctr Vet Affairs Med Ctr Inst Clin Epidemiol Res Durham NC USA Duke Univ Med Ctr Div Gastroenterol Dept Med Durham NC USA

OBJECTIVES: The aims of this study were: 1) to compare the health-related quality of life (HRQL) of patients with barrett's esophagus (BE) to that of patients with GERD who did not have BE;2) to compare HRQL of gastroesophageal reflux disease (GERD) patients to that of normative data for the US general population;and 3) to examine the impact of GERD symptom frequency and severity on HRQL. METHODS: The SF-36 and a validated GERD questionnaire were administered to 107 patients with biopsy-proven BE and to 104 patients with GERD but no BE by endoscopy. Frequent symptoms were defined as symptoms that occurred at least once weekly. Severity of symptoms was rated on a scale from 1 to 4 (mild to very severe). RESULTS: In all, 85% of the GERD patients and 82% of BE patients completed the questionnaires. There was no difference in the scores of the eight subscales of the SF-36 between BE patients and those with GERD but without BE (p > 0.05). However, both groups scored below average on all subscales of the SF-36 compared to published US norms for an age- and gender-matched group. Using multivariable linear regression, the social functioning subscale of the SF-36 correlated with the presence of heartburn or acid regurgitation, severity of acid regurgitation, frequency of heartburn, frequency of acid regurgitation, and number of comorbidities. Similarly, the physical functioning subscale correlated with age, frequency of heartburn, and number of comorbidities. The bodily pain subscale correlated with the frequency of heartburn and number of comorbidities. The bodily pain subscale correlated with the frequency of heartburn and the severity of dysphagia, whereas the role emotional subscale correlated with the frequency of heartburn and the presence of dysphagia. CONCLUSIONS: Although there were no differences in HRQL between BE and GERD patients, both groups scored below average on the subscales of the SF-36 compared to normal controls. GERD symptom frequency and severity were

关键词： barrett食管/并发症 barrett食管/病理生理学 barrett食管/心理学胃食管反流/并发症胃食管反流/病理生理学胃食管反流/心理学健康状况胃灼热/病因学胃灼热/病理生理学人际关系多元分析生活质量问卷调查参考值老年人女(雌)性人类男(雄)性中年人

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Late results of a randomized clinical trial comparing total fundoplication versus calibration of the cardia with posterior gastropexy

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BRITISH JOURNAL OF SURGERY 2000年第3期87卷 289-297页

作者： Csendes, A Burdiles, P Korn, O Braghetto, I Huertas, C Rojas, J Univ Chile Hosp Dept Surg Santiago Chile

Background: The aim was to perform a prospective randomized study in patients with chronic gastrooesophageal reflux treated either by total fundoplication or calibration of the cardia with posterior gastropexy. Late follow-up considered subjective and objective parameters, and related outcome to the presence of barrett's oesophagus. Methods: A total of 164 patients were randomized to fundoplication (n = 76) or calibration of the cardia (n = 88). They were evaluated by clinical questionnaire, upper gastrointestinal endoscopy with biopsies, oesophageal manometry and gastro-oesophageal reflux studies, including scintigraphy and 24-h oesophageal pH monitoring. Results: There were no operative deaths. There was 95 per cent follow-up at a mean of 85 months. The mean recurrence rate for both operations was near 40 per cent at 10 years, but patients without barrett's oesophagus had a recurrence rate after both operations of around 23 per cent compared with 83 per cent after 10 years for those with barrett's oesophagus (P < 0.0001). Low-grade dysplasia developed in 13 per cent of the patients with barrett's oesophagus. There were significant differences in all objective parameters in a comparison of patients with Visick I or II and those with Visick III or IV disease at the late assessment. Conclusion: Both total fundoplication and calibration of the cardia with posterior gastropexy had similar subjective and objective late results. However, results were significantly worse in patients with barrett's oesophagus.

关键词： barrett食管/并发症内窥镜检查胃肠道随访研究胃底折叠术/方法胃食管反流/并发症胃食管反流/外科学氢离子浓度测压法前瞻性研究复发胃/外科学成年人老年人女(雌)性人类男(雄)性中年人

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Chromosomal imbalances in barrett's adenocarcinoma and the metaplasia-dysplasia-carcinoma sequence

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AMERICAN JOURNAL OF PATHOLOGY 2000年第2期156卷 555-566页

作者： Walch, AK Zitzelsberger, HF Bruch, J Keller, G Angermeier, D Aubele, MM Mueller, J Stein, H Braselmann, H Siewert, JR Höfler, H Werner, M GSF Natl Res Ctr Environm & Hlth Inst Pathol Neuherberg Germany GSF Natl Res Ctr Environm & Hlth Inst Radiobiol Neuherberg Germany Univ Munich Inst Radiat Biol Munich Germany Tech Univ Munich Dept Surg D-8000 Munich Germany Tech Univ Munich Inst Pathol D-8000 Munich Germany

To characterize cytogenetic alterations found in barrett's adenocarcinoma (BA) and, more importantly, its premalignant stages, we studied chromosomal imbalances in various lesions in the histologically proposed metaplasia-dysplasia-carcinoma sequence using comparative genomic hybridization (CGH). Using 30 esophageal adenocarcinoma resection specimens, we were able to study 30 areas of barrett's adenocarcinoma and 8 lymph node metastases (LN). In addition, we investigated 25 premalignant lesions adjacent to BA derived from a subset of 14 resection specimens including 11 areas of high grade dysplasia (HGD), 8 areas of low grade dysplasia (LGD), and 6 areas of intestinal metaplasia (IM), which were laser-microdissected and studied with CGH. To validate the CGH findings, fluorescence ill situ hybridization analysis on 13 BA with probes specific for HER-2/neu and 20q13.2 were performed. The chromosomal alterations most often identified in BA were: gains on 8q (80%), 20q (60%), 2p, 7p and 10q (47% each), Gp (37%), 15q (33%) and 17q (30%). Losses were observed predominantly on the Y-chromosome (76%), 4q (50%), 5q and 9p (43% each), 18q(40%), 7q (33%) and 14q (30%). High-level amplifications were observed on 8q23-qter, 8p12-pter, 7p11-p14, 7q21-31, 17q11-q23. Recurrent chromosomal changes were also identified in metaplastic (gains on 8q, Gp, 10q, losses on 13q, Y, 9p) and dysplastic epithelium (gains on 8q, 20q, 2p, 10q, 15q, losses on Y, 5q, 9P, 13q, 18q). Novel amplified chromosomal regions on chromosomes 2p and 10q were detected in both barrett's adenocarcinoma and premalignant lesions. An increase of the average number of detected chromosomal imbalances from IM (7.0 +/- 1.7), to LGD (10.8 +/- 2.2), HGD (13.4 +/- 1.1), BA (13.3 +/- 1.4), and LN(22 +/- 1.2) was seen. Although the detection of common chromosomal alterations in premalignant lesions and adjacent carcinomas suggest a process of clonal expansion, the occurrence of several chromosomal changes in an apparently r

关键词：腺癌/病因学腺癌/遗传学 barrett食管/并发症癌/病理学染色体畸变染色体障碍食管肿瘤/病因学食管肿瘤/遗传学食管/病理学原位杂交荧光淋巴转移/遗传学化生癌前状态/病理学成年人老年人女(雌)性人类男(雄)性中年人

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Waist-to-hip ratio, weight gain, and dietary and serum selenium are associated with DNA content flow cytometry in barrett's esophagus

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NUTRITION AND CANCER-AN INTERNATIONAL JOURNAL 2000年第1期36卷 7-13页

作者： Moe, GL Kristal, AR Levine, DS Vaughan, TL Reid, BJ Seattle Pacific Univ Dept Family & Consumer Sci Seattle WA 98119 USA Fred Hutchinson Canc Res Ctr Canc Prevent Res Program Seattle WA 98109 USA Univ Washington Nutr Sci Program Seattle WA 98195 USA Univ Washington Dept Epidemiol Seattle WA 98195 USA DeAstra Merck Wayne PA USA Fred Hutchinson Canc Res Ctr Program Epidemiol Seattle WA 98109 USA Fred Hutchinson Canc Res Ctr Canc Prevent Res Program Seattle WA 98109 USA Univ Washington Dept Med Div Gastroenterol Seattle WA 98195 USA

This cross-sectional study reports associations between anthropometric measures, serum antioxidant concentrations, and present diet with measures of elevated cell proliferation in 51 patients with barrett's esophagus. Cell proliferation was assessed as fractions of cells in the S and G(2) phases, measured in biopsies of barrett's tissue and analyzed by DNA content flow cytometry. Elevated proportions in the S and G(2) phases predict progression to adenocarcinoma. The percentage of cells in the S phase was positively associated with waist-to-hip ratio (r = 0.33, p < 0.05) and negatively associated with serum and dietary selenium (r = -0.34 and -0.32, respectively, p < 0.05). The percentage of cells in the G(2) phase was positively associated with weight change from age 25 (r = 0.39, p < 0.01) and negatively associated with dietary selenium (r = -0.31, p < 0.05). Selenium from breads and grains was negatively associated with the percentage of cells in the S phase (r = -0.41, p < 0.01) and the percentage of cells in the G(2) phase (r = -0.41, p < 0.01). These results suggest that increasing weight gain in adulthood, increasing waist-to-hip ratio, and decreasing dietary selenium intake and serum levels increase the risk of progression of barrett's esophagus to adenocarcinoma.

关键词：腺癌/病因学腺癌/病理学 barrett食管/并发症 barrett食管/病理学 barrett食管/病理生理学活组织检查体质细胞分裂 DNA/分析膳食食管肿瘤/病因学食管肿瘤/病理学流式细胞术 G2期 S期硒/投药和剂量硒/血液体重增长老年人女(雌)性人类男(雄)性中年人

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Safety of a systematic endoscopic biopsy protocol in patients with barrett's esophagus

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AMERICAN JOURNAL OF GASTROENTEROLOGY 2000年第5期95卷 1152-1157页

作者： Levine, DS Blount, PL Rudolph, RE Reid, BJ Univ Washington Dept Med Div Gastroenterol Seattle WA 98195 USA Univ Washington Dept Genet Seattle WA 98195 USA Fred Hutchinson Canc Res Ctr Div Publ Hlth Sci Program GI Oncol Seattle WA 98104 USA Fred Hutchinson Canc Res Ctr Div Human Biol Seattle WA 98104 USA

OBJECTIVE: Widespread implementation of rigorous, systematic endoscopic biopsy protocols for patients with barrett's esophagus may be hindered by concerns about their safety. This report describes the safety experience of a large series of patients with gastroesophageal reflux disease and barrett's esophagus who underwent such procedures. METHODS: Patients in the Seattle barrett's Esophagus Project undergo biopsy surveillance in a research-based clinical setting, using large channel endoscopes and "jumbo" biopsy forceps. After visual inspection, multiple biopsies are obtained from lesions and at 1- to 2-cm intervals throughout the barrett's esophageal segment. RESULTS: From 1983 to 1997, 1,458 consecutive endoscopies were performed on 705 patients and 50,833 biopsies (average, 35;maximum, 120 per procedure) were taken. Procedures lasted from 15 to 90 min during which one to two biopsies were obtained per minute. Eleven patients experienced 18 significant adverse events, five of which led to overnight hospitalizations: two for bleeding attributed to concomitant esophageal stricture dilation;two for cardiac dysrhythmias: and one for respiratory arrest. Events managed In outpatient settings included chest pain during seven endoscopies (all accounted for by two patients), chest or epigastric pain developing after five endoscopies, and one tonsillar abrasion. All patients recovered completely, and no deaths, perforations, aspiration, or esophageal stricturing resulted from the procedures. CONCLUSIONS: A rigorous, systematic endoscopic biopsy protocol in patients with barrett's esophagus does not produce esophageal perforation or bleeding when performed by an experienced team of physicians, nurses, and technicians. (C) 2000 by Am. Cell. of Gastroenterology.

关键词： barrett食管/并发症 barrett食管/病理学活组织检查/仪器和设备活组织检查/方法内窥镜检查/方法食管肿瘤/诊断食管肿瘤/病因学食管/病理学人类

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Oesophageal resection for high-grade dysplasia in barrett's oesophagus

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BRITISH JOURNAL OF SURGERY 2000年第8期87卷 1102-1105页

作者： Zaninotto, G Parenti, AR Ruol, A Costantini, M Merigliano, S Ancona, E Univ Padua Sch Med Dept Med & Surg Sci Clin Chirurg 4 I-35100 Padua Italy Univ Padua Sch Med Dept Oncol & Surg Sci I-35100 Padua Italy

Background: The aims of this study were to evaluate the prevalence of invasive cancer in patients with high-grade dysplasia in barrett's oesophagus and to verify whether a second endoscopy with multiple biopsies could improve the accuracy of preoperative diagnosis. In addition, the mortality, morbidity and survival rates in patients with high-grade dysplasia having oesophageal resection were recorded. Methods: Fifteen patients were observed from 1982 to 1998;the first seven patients were offered primary oesophageal resection after diagnosis. The other eight patients underwent a second endoscopy with a median of 12 biopsies examined. All later underwent oesophageal resection. Results: Invasive adenocarcinoma was found in five patients, with a minimal difference between the first and second periods (two of seven versus three of eight). There were no perioperative deaths. Early morbidity was observed in eight patients and late morbidity in four. The actuarial survival rate was 79 per cent at 5 years. The Karnofsky status was unchanged from preoperative values in 13 of 15 patients after a median follow-up of 46 months. Conclusion: These patients with high-grade dysplasia had a 33 per cent probability of harbouring invasive oesophageal carcinoma but even a second endoscopy failed to identify patients with invasive tumour. Oesophagectomy was performed with no deaths and remains a rational treatment in patients fit for surgery.

关键词：腺癌/诊断腺癌/外科学 barrett食管/并发症 barrett食管/病理学 barrett食管/外科学食管肿瘤/诊断食管肿瘤/外科学食管切除术/方法治疗结果老年人人类男(雄)性中年人

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Fundoplication provides effective and durable symptom relief in patients with barrett's esophagus

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AMERICAN JOURNAL OF SURGERY 1999年第1期178卷 18-21页

作者： Farrell, TM Smith, CD Metreveli, RE Johnson, AB Galloway, KD Hunter, JG Emory Univ Sch Med Dept Surg Atlanta GA 30322 USA

BACKGROUND: Columnar-lined esophagus with intestinal metaplasia (IM), also called barrett's esophagus, is a manifestation of severe gastroesophageal reflux (GER) and may predict poor symptom relief and high failure rate after fundoplication. We compared symptom scores and reoperation rates in GER patients with and without barrett's esophagus. METHODS: Between July 1992 and July 1997, 646 patients underwent fundoplication (626 laparoscopic). Of 150 endoscopic biopsies of suspected columnar-lined esophagus, 80 confirmed IM, 50 identified cardiac or fundic epithelium, and 20 revealed only esophagitis. Typical GER symptoms were scored by patients preoperatively and postoperatively (0 to 4 scale). We compared symptom response (Wilcoxon rank sum test) and failure rates (t test) in patients with IM and GER controls without IM. Preoperative data were available for 74 IM patients and 496 controls. One-year follow-up was available in 45 IM patients and 301 controls. Intermediate follow-up (2 to 5 years) was available in 20 IM patients and 99 controls. RESULTS: Preoperatively and postoperatively, patients with IM reported heartburn, regurgitation, and dysphagia scores similar to controls. Procedure failure, requiring redo fundoplication, appeared more likely in IM patients than controls (6.3% versus 2.5%), but this difference did not reach statistical significance (P = 0.061). CONCLUSION: Fundoplication provides equivalent symptom relief for patients with and without IM. Am J Surg. 1999;178:18-21, (C) 1999 by Excerpta Medica, Inc.

关键词： barrett食管/并发症 barrett食管/病理学 barrett食管/外科学吞咽障碍随访研究胃底折叠术胃食管反流/病理学胃食管反流/外科学胃灼热生活质量疾病严重程度指数治疗结果人类

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Biomarker studies in reversed barrett's esophagus

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AMERICAN JOURNAL OF GASTROENTEROLOGY 1999年第10期94卷 2829-2833页

作者： Garewal, H Ramsey, L Sharma, P Kraus, K Sampliner, R Fass, R Vet Adm Med Ctr Hematol Oncol Sect Tucson AZ 85723 USA Vet Adm Med Ctr Gastroenterol Sect Tucson AZ 85723 USA Univ Arizona Hlth Sci Ctr Tucson AZ 85723 USA

OBJECTIVE: The purpose of this study was to use biomarkers to assess far cancer risk in barrett's esophagus patients with either squamous islands or complete reversal of their intestinal metaplasia to squamous epithelium. METHODS: The biomarkers included proliferation characteristic using Ki-67, p53 abnormalities using immunohistochemical methods with two antibodies, DO-1 and DO-7, and ornithine decarboxylase (ODC) activity. RESULTS: Eleven patients had complete reversal produced by a combination of acid suppression and thermal injury (multipolar electrocoagulation). Ki-67 staining was indistinguishable from that of normal squamous esophageal epithelium, i.e., basal layer staining only. All 11 cases were negative for p53. ODC activity was low and in the range for normal squamous epithelium. Fourteen patients had squamous islands (partial reversal) after prolonged proton pump inhibitor therapy. Multilayer Ki-67 staining occurred in nine cases (64%), and six (43%) had areas of positive p53 staining. CONCLUSIONS: Initial biomarker studies suggest that completely reversed squamous epithelium is biologically similar to normal squamous epithelium and of low cancer risk. In contrast, partial reversal, manifest as squamous islands, is accompanied by biomarker abnormalities. (C) 1999 by Am. Cell. of Gastroenterology.

关键词： barrett食管/并发症 barrett食管/代谢 barrett食管/病理学 barrett食管/治疗活组织检查电凝术上皮/病理学食管肿瘤/诊断食管肿瘤/病因学基因 p53 免疫组织化学 Ki-67抗原/分析突变奥美拉唑/治疗应用鸟氨酸脱羧酶/代谢质子泵/拮抗剂和抑制剂危险因素肿瘤标记生物学/分析老年人老年人 80以上人类中年人

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barrett's esophagus: the long and the short of it.

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Gastroenterology 2000年第4期119卷 1165-1166页

作者： Lewis, J.D.

GASTROENTEROLOGY 2000;119:1165-1166

关键词：腺癌/病因学腺癌/病理生理学 barrett食管/并发症 barrett食管/病理生理学食管肿瘤/病因学食管肿瘤/病理生理学危险因素人类

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