[Show abstract][Hide abstract] ABSTRACT: The poor sensitivity of esophageal pH monitoring substantially limits the clinical value of the test. The aim of this study was to compare the diagnostic accuracy of esophageal pH monitoring and symptom association analysis performed at the conventional level with that obtained in the most distal esophagus.
Eighty-two patients with typical reflux symptoms and 49 asymptomatic subjects underwent dual 48-h pH monitoring with the electrodes positioned immediately above, and 6 cm above the squamo-columnar junction (SCJ). The degree of esophageal acid exposure and the temporal relationship between reflux events and symptoms were evaluated.
The sensitivity of pH recording and the diagnostic yield of Symptom Association Probability (SAP) were significantly higher for pH monitoring performed at the distal compared with the conventional level (82% versus 65%, p<0.001 and 74% versus 62%, p<0.001, respectively). The greatest improvement was observed in patients with non-erosive disease. In this group, the sensitivity increased from 46% at the standard level to 66% immediately above the SCJ, and with the combination of a positive SAP as a marker for a positive pH test, the diagnostic yield further increased to 94%.
The diagnostic accuracy of esophageal pH monitoring in the most distal esophagus is superior to that performed at the conventional level and it is further improved with the combination of symptom association analysis. PH monitoring with the pH electrode positioned immediately above the SCJ should be introduced in clinical practice and always combined with symptom association analysis.
No preview · Article · Sep 2015 · Scandinavian Journal of Gastroenterology
[Show abstract][Hide abstract] ABSTRACT: To characterize the immunophenotypic relationship between the squamous and the glandular compartments in the oeophagus of patients with columnar lined oesophagus.
Eight tissue blocks from three oesophageal resection specimens from patients who underwent oesophagectomy due to adenocarcinoma of the oesophagus were selected for immunohistochemical analysis. The markers of intestinal differentiation (CK20, CDX2 and MUC2) were all expressed in the anticipated pattern, solely in the glandular compartment of the resection specimens. CK4, CK17 and Lysozyme were expressed in both the glandular and the squamous compartments. In addition, CK 17 expression was found on both the squamous and glandular margins of the squamocolumnar transformation zones and in the SMG intraglandular and excretory ducts.
There is an immunophenotypic relationship between the squamous and the glandular compartments of the CLO with expression of lysozyme, CK4 and CK17 in both squamous and columnar cells. These overlapping immunophenotypes indicates similar differentiation paths and link the submucosal gland unit with the columnar metaplasia and the neosquamous islands in CLO. Our findings support the theory of a cellular origin of CLO and neosquamous islands from the SMG unit. This article is protected by copyright. All rights reserved.
This article is protected by copyright. All rights reserved.
[Show abstract][Hide abstract] ABSTRACT: AimTo evaluate the presence of multilayered epithelium (ME) and to compare the distribution, size and morphology of the oesophageal submucosal glands (SMG) beneath reflux exposed metaplastic columnar mucosa with those of normal squamous epithelium in patients with columnar lined oesophagus (CLO).Methods and resultsIn 8 oesophageal resection specimens, the SMG of the metaplastic segments were significantly larger than those in the squamous segments of patients with CLO (0.81 vs. 0.56 mm2, p=<0.001). There was an accumulation of SMG close to the neosquamocolumnar junction (NSCJ) as indicated by a higher median frequency of SMG (0.080 SMG/mm) compared with that of the squamous (0.013 SMG/mm) and metaplastic segments (0.031 SMG/mm), (p = 0,022). The frequency of ME was significantly higher in the metaplastic compared with the normal squamous segments (1/158 mm and 1/341 mm, respectively, p= 0.028) and ME was found almost exclusively (96%) in direct connection with the excretory ducts of SMG.Conclusions
Hyperplasia of SMG in the metaplastic segment, accumulation of SMG near the NSCJ, the presence of ME in connection with the excretory ducts of SMG and metaplasia are all reflux induced morphological changes, possibly induced by stimulation of progenitors in the excretory ducts of the SMG.This article is protected by copyright. All rights reserved.
[Show abstract][Hide abstract] ABSTRACT: A multipotential stem cell, possibly located in the submucosal gland ducts, has been suggested as the origin of metaplastic mucosa in the oesophagus. The topographic distribution of these glands and their excretory ducts (SMG) within the columnar lined oesophagus (CLO) is largely unknown. The aim of this study was to examine the distribution of SMG in relation to the type of overlying epithelium in patients with CLO.
Seven oesophageal resection specimens were examined histologically in toto. The median frequency of SMG was similar in the metaplastic segments (0.12 SMG/mm) and the normal squamous segments (0.10 SMG/mm). Within the metaplastic segments, the median frequency of SMG beneath the squamous islands was significantly higher than that observed under the columnar lined parts (0.22 versus 0.08 SMG/mm, P = 0.046), There was a strong accumulation of SMG at the squamo-columnar transition zones (0.53 SMG/mm), which was significantly greater than that found in the columnar and squamous parts (P = 0.001 and 0.002, respectively).
The relative accumulation of SMG beneath squamous islands and the squamo-columnar junctions within the metaplastic segment supports the hypothesis that both metaplastic columnar mucosa and neosquamous epithelium originate from a progenitor in the SMG.