Dong Y, Qi B, Feng XY, Jiang CM. Meta-analysis of Barrett's esophagus in China.
World J Gastroenterol 2013;19(46):8770-8779
The disease pattern of Barrett's esophagus (BE) in China is poorly characterised
particularly in comparison with other developed countries. This meta-analysis of
3873 cases of BE collated from 69 clinical studies conducted in 25 provinces
between 2000 and 2011 investigated the epidemiology and characteristics of BE in
China compared to Western countries. The total endoscopic detection rate of BE
was 1.0% (95%CI: 0.1%-1.8%) with an average patient age of 49.07 ± 5.09 years,
lower than many Western countries.The authors postulate this may be attributed
to environmental risk factor variation, distinct genetics and different medical
practice including diagnostic criteria for BE and expertise in endoscopy. This
study identified a 1.781 male predominancefor BE in China, consistent with
Western reports. Short-segment BE accounted for 80.3% of cases with island type
and cardiac type the most common endoscopic (44.8%) and histological (40.0%)
manifestations respectively. Of the 1283 BE cases followed up for three to 36
months the incidence of esophageal cancer was 1.418 per 1000 person-years, lower
than the incidence reported in Western countries.
Lee HS, Jeon SW. Barrett esophagus in Asia: same disease with different pattern.
Barrett's esophagus (BE) is a common, pre-cancerous condition characterised by intestinal
metaplasia of squamous esophageal epithelium usually attributed to chronic
gastric acid exposure. This review article explores important differences in the
disease pattern of BE between Asian and the Western countries.
Overall the prevalence of BE is lower in Asia compared to the West with a greater proportion
of short-segment type. The authors identify great variability in the endoscopic
and pathologic diagnostic criteria for BE. Many of the studies in Asian
countries did not use a standardised four-quadrant biopsy protocol which may
have led to an underestimation of BE prevalence. The review highlights an
increasing incidence of esophageal adenocarcinoma in the West but unclear
disease trend in Asia with inter-country variability. Similarly in Asian and
Western countries BE is associated with the presence of hiatus hernia, advancing
age, male gender, alcohol consumption, smoking, abdominal obesity and longer
duration of gastro-esophageal reflux disease. The authors postulate that
Helicobacter pylori infection, more prevalent in Asia than
the West, may have a protective effect on BE.
There is a need for larger, prospective studies to further clarify the disease pattern of BE
in Asian countries. Clearly standardisation of the diagnostic process for BE is
important to validate the differences in disease trends between Asian and
Kiadaliri AA. Gender and social disparities in esophagus cancer incidence in Iran,
2003-2009: a time trend province-level study.Asian Pac J Cancer Prev
Esophageal cancer (EC) is a major cause of morbidity and mortality particuarly in Iran where
the incidence rate exceeds the global average. An understanding of the factors
influencing the province-specific incidence of EC in Iran is important to inform
disease-prevention strategies and address health inequalities. This ecological
study used cancer registry data to investigate the relationship between gender
and social class and the incidence of EC in Iran at province-level between 2003
and 2009. The age standardised incidence rates (ASIR) of EC were greatest in the
Northern provinces of Iran, specifically Razavi Khorasan in males and Kordestan
in females. Overall the EC incidence did not significantly differ according to
Interestingly, during the study period the ASIR increased by 4.6% per year in females
(p=0.08) and 6.5% per year in males (p=0.02). This may reflect increasing rates
of establised risk factors for EC including obsesity and gastro-esophageal
reflux disease alongside more vigilant recording of new cases. Social class was
inversely associated with the ASIR of EC regardless of gender which may be
attributed to class differences in risk factor distribution particularly
smoking, diet and obesity. An appreciation for the limitations of an
epidemiological study is important when interpreting results which should be
further evaluated in future studies.
Islami F et al.Determinants of gastroesophageal reflux disease, including hookah
smoking and opium use- A cross-sectional analysis of 50,000 individuals.
PLoS One 2014;9(2):e89256
Gastroesophageal reflux disease (GERD) is a highly prevalent cause of gastrointestinal
symptoms worldwide incurring great cost to the primary and secondary healthcare
sectors. An improved understanding of the factors which influence GERD symptoms
in low- to medium- income countries may inform public health initiatives. This
study analysed prospective data from the Golestan cohort study, primarily
established to investigate determinants of upper gastrointestinal cancers,
toexplore the risk factors influencing GERD symptoms (regurgitation and/or
heartburn) in 50,045 individuals aged 40-75 years in Golestan Province, Iran
enrolled between 01/2004 and 06/2008.Of note, 39.12% of individuals denied ever
experiencing GERD symptoms. A further 19.89% reported at least once weekly GERD
symptoms with 11.83% experiencing daily symptoms. Severe symptoms, defined as
disturbing daily work or sleep, were recorded by 11.33% of individuals.
Separately the occurrence of daily GERD symptoms and severe symptoms were inversely
associated with male gender (OR 0.36, 95% CI 0.33-0.39 both), level of formal
education (p=0.01 and p=0.001 respectively), wealth score (p<0.001 both) and
regular nass chewing (OR 0.86, 95% CI 0.75-0.98 and OR 0.87, 95% CI 0.76-0.99
respectively)and were positively associated with body mass index (p<0.001
both), intensity of physical activity (p=0.04 both), cigarette pack years
(p<0.001 both), alcohol consumption (OR 1.36, 95% CI 1.13-1.64 and OR 1.53,
95% CI 1.28-1.83 respectively) and opium use (OR 1.82, 95% CI 1.67-1.99 and OR
1.70, 95% CI 1.55-1.87 respectively).In addition hookah smoking had a borderline
significant correlation with mild and moderate severity GERD symptoms in
individuals who had never smoked cigarettes (OR 1.41, 95% CI 1.00-1.99 and OR
1.25, 95% CI 0.99-1.57 respectively).
Overall this large study contributes useful data to inform the prevention and management of
GERD symptoms particularly regarding the use of hookah, opium and nass which was
Barbera M et al. The human squamous oesophagus has widespread capacity for clonal expansion from cells at diverse stages of differentiation. Gut 2014;0:1–9. doi:10.1136/gutjnl-2013-306171
Current knowledge on human esophageal tissue homeostasis and injury repair is derived predominantly from murine models and hence may be inaccurate due to cellular and architectural differences. This study used 3D imaging in conjunction withstaining for cell lineage markers to investigate the cellular mechanisms involved in homeostasis of the normal human squamous esophagus in 10 participants undergoing esophagectomy for esophageal cancer. The self-renewal potential of cell subpopulations was also assessed using in vitro and in vivo assays.
A decreasing gradient of cell proliferation was observed from the inter-papillary basal layer to the tip of the papilla where there was no evidence of mitosis. The expression ofβ1-integrin, a putative stem cell marker, was consistent throughout the basal layer and therefore the entire basal layer can be considered undifferentiated. Quiescent β1-integrin/CD34-positive cells which failed to stain for CD45, S-100 or F4-80were identified at the tip of the papilla suggesting this is an extension of the basal layer. Contrary to previous data, this study found progenitor cells widely distributed in human esophageal tissue and included already differentiated epithelial cells. This insight into esophageal homeostasis may inform future studies exploring the pathological mechanisms underpinning homeostatic disruption in disease states such as Barrett's esophagus.
Papers were prepared by:
Drs Ishfaq Ahmad and Luke Materacki, Department of Medicine, Alexandra Hospital, Redditch, UK